Krystal Parra Dec 3, 2010 Abnormal Psych 313 Case Analysis #1 Annette DSM-IV Diagnosis: Axis I: Anxiety Disorder

1. Social Phobia 2. Panic Disorder --Alternate diagnosis pending information: Somatoform Disorder 1. Body Dysmorphic Disorder Axis II: No known diagnosis at this time. Axis III: No known diagnosis at this time. Axis IV: Problems with support group. -Although Annettes parents have been actively concerned about her avoidant behavior, they may have potentially acerbated the issue by forcing Annette into social situations she is not ready for. Annettes primary support group needs to be more empathetic towards her situation instead of causing more anxiety for her. Axis V: Current GAF scale is 41 to 50. Annettes symptoms have become severe enough to keep her from socializing with her own family and participating in any social situation. Diagnosis: The diagnosis of social phobia under Anxiety disorders under Axis I was reached because Annette has been experiencing: persistent fears of social or performance situations with unfamiliar people where her main concern is possible humiliation of herself, anxiety produced by social situations, recognition that her fear is unreasonable,

significant distress and avoidance for at least six months (Comer, 2010). The diagnosis of panic attacks under Anxiety disorders under Axis I was reached because Annette has experienced multiple episodes of unexpected panic attacks marked by an accelerated heart rate, shortness of breath, dizziness, trembling, sweating, and chest discomfort (Comer, 2010). Alternative Diagnosis: Under DSM-IV-TR Axis I Somatoform Disorders, body dysmorphic disorder is considered as an alternative diagnosis, however further information is needed to fully diagnose. Throughout Annettes case study description, she kept mentioning how unfamiliar people and social situations made her feel extremely anxious because of the way they may perceive her personality and physical attributes. She is afraid that, although she good-looking, that she will not be seen as such by others if she goes out and socializes. She is significantly distressed with her body image and impaired enough to avoid any social situations. Annette strongly believes that others will take special notice of her appearance in a negative way. Additional information needed to diagnose Annette with this disorder would include the length of time she has been significantly preoccupied with her body image and if she has done something to try and hide her ugliness. Her upbringing would be important to assess

because there may be some underlying pressures that may have influenced Annettes feelings of inadequacy. Information on past relationships would also serve as an important basis for the formation of her disorder. It would also be important to know of any eating disorders Annette my have or has experienced in her past to rule out any other disorder concerning her body image. However her case study does indicate Annette is suffering from an eating disorder, but her current state may be the result of an unresolved disorder in her past. Assessment Tools: To assess Annettes condition, the utilization of semi-structures interviews would be very important to have a clear idea of any presence of DSM-IV-TR anxiety and somatoform disorder symptoms. Annette and her parents description of the situation are not merely enough to make a diagnostic decision. The use of specific structured checklists and interview schedules, such as a mental health exam, would also be used as an assessment tool. An interview would give the initial overall idea of what Annette and her family is experiencing. Other than interviews, several clinical tests would be useful as well. I would use the projective test of sentence-completion to try and initiate a discussion on why she has projected such thoughts. The MMPI-2 may also be practical in identifying social anxiety symptoms on the social introversion (Si) scale (Colmer, 2010). The Beck BAI scale

would be very helpful in measuring the severity of anxiety Annette is experiencing. Id also use response inventories to help measure the severity of anxiety in social situations as well as body image anxieties since these tests are designed for specific disorders. Intervention For the treatment of Annettes social phobia, I would first implement various psychotherapies before attempting to put her on any antidepressant medication, since the rate of relapse is less when patients are treated with therapy and not medications alone. Exposure therapy would be one of the therapies I choose to use with Annette because unlike her parents, the therapy does not force her to experience dreaded social interactions but encourages them within a safe environment. This therapy is very gradual, but helpful for this phobia. Rational-emotive therapy is also another avenue to explore with Annette due to its success at relieving social fear (Colmer, 2010). These psychotherapeutic treatments, however, often do not eliminate social phobia entirely, they just reduce the social fear associated with it. Thus, social skills training will also be used jointly with these therapies to help Annette gain better social skills. If there is resistance to these therapies, antidepressant medications will complement the therapies. To treat the panic attacks, cognitive interoceptive exposure therapy will be used to help Annette stop misinterpreting her bodys

sensations. Relaxations techniques will be exercised to help Annette cope with her panic attacks more effectively. Also since this therapy is found to be just as successful as drug therapy, medication will only be prescribed if Annette is resistant to these therapies (Colmer, 2010). Cognitive and drug therapies are more appropriate for these disorders, however, there are always biological therapies that can help such as biofeedback during stressful situations. The only familial concern for this case is Annettes parents involvement with her disorder and trying to force her into social situations without prior therapy to teach her relaxation techniques. They also need to undergo some training to effectively help Annette, not perpetuate her disorder.