September 30 2013
In many of our lives today we experience stress and anxiety. However, when behaviors, thoughts and emotions cause a person to be unable to function, meet personal needs, or are a danger to themselves or others it would therefore be a psychological disorder. Treatment for these disorders is imperative to the health and safety of the individual and all that are involved with the individual. It can also affect the individual’s ability to work and to love. I will discuss two case studies each with their own individual disorder. I will give the symptoms they are experiencing, a diagnosis and a treatment plan for each disorder.
Client I A 31-year-old chemist gave a history of frequent palpitations and faintness over the previous 15 years. There had been periods of remission of up to 5 years, but in the past year the symptoms had increased and in the last few days the patient had stopped working because of the fear attacks. His chief complaints were that at any time and without warning, he might suddenly feel he was about to faint and fall down, or tremble and experience palpitations, and if standing would cringe and clutch at the nearest wall or chair do to fear. If he was driving a car at the time he would pull up at the curbside and wait for the feelings to pass off before he resumed his journey. He was becoming afraid of walking alone in the street or of driving his car for fear that the episodes would be triggered by it and was fearing to travel by public transport. Although he felt safer when accompanied by others, this did not completely cure his symptoms. The attacks would come on at any time of day or night. This patients symptoms are that of a panic disorder called agoraphobia. Agoraphobia is anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help may not be available (American Psychiatric Association, 2000). For agoraphobia to be diagnosed, it must meet these criteria according to the DSM-III-R: Anxiety about being in places or situations that it may be difficult or embarrassing to get out of, or in which you may not be able to get help if you develop panic-like symptoms. Avoiding places or situations where you fear you may have a panic attack, or having great distress and anxiety in those situations. This client is a code I agoraphobic according to the DSM-III-R checklist under 2. A the subject has fear in common agoraphobic situations: 1 being outside the home alone current is 9: 2 Being in a crowd or standing in line current is 9: 3 Being on a bridge current is 9: 4 Traveling in a bus car or train current is 9.
The DSM-III-R acknowledges the connection between Panic and Agoraphobia by providing two separate diagnostic categories for Panic Disorder one being Panic Disorder with Agoraphobia and the second Panic Disorder without Agoraphobia. Panic with Agoraphobia is a lot more common than panic without agoraphobia. The DSM-III-R refines a phobia as a persistent, irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the dreaded object, activity or situation (Association A. P., 2000).
The second client Claire, age 26 was unable to explain the experience. She initially believed it may have had something to do with where she was that caused the anxiety attack, so she stopped going there and began to shop elsewhere. When she had a similar attack in another location, she stopped going there too. Within five months she had stopped going to so many places that it was only at home she felt truly safe. She left her job as a nurse and spent the next two-and-a-half years indoors. She went to here general practitioner and was told to seek treatment for possible agoraphobia. When administering the DSMV-III-R checklist for