Diagnosis of Anxiety Disorders and Obsessive-Compulsive and Related Disorders
Assignment: Diagnosis of Anxiety Disorders and Obsessive-Compulsive and Related Disorders
After completing two practice diagnoses, take a moment to reflect on your progress and understanding of how to diagnose. Mastering the process of diagnosis takes time and experience, just as with any skill.
Here are a few reminders:
Have you started using tabs in the book for common sections you frequent? If not, consider doing so.
Remember to include all the words that go with the diagnostic code.
When you use a symptom to support a diagnosis, the same symptom cannot be used to support another diagnosis.
Some specifiers can be used for many different diagnoses, such as with:
Anxious distress
Panic attacks
Note: Remember that symptoms can occur in many disorders. As a result, all disorders in the DSM-5-TR covered up until this point may factor into your diagnosis (for example, as a possible additional disorder you diagnose).
To Prepare
Review the case study for this week.
Start by familiarizing yourself with the disorders from the DSM-5-TR found in the Learning Resources this Week.
Look within the noted sections for symptoms, behaviors, or other features the client presents within the case study.
If some of the symptoms in the case study cause you to suspect an additional disorder, then research any of the previous disorders covered so far in the course.
This mirrors real social work practice where you follow the symptoms.
Review the correct format for how to write the diagnosis noted below. Be sure to use this format.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
By Day 7
Submit your diagnosis for the client in the case. Follow the guidelines below.
The diagnosis should appear on one line in the following order.
Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.
Code + Name + Specifier (appears on its own first line)
Z code (appears on its own line next with its name written next to the code)
Then, in 1–2 pages, respond to the following:
Explain how you support the diagnosis by specifically identifying the criteria from the case study.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
Identify the differential diagnosis you considered.
Explain why you excluded this diagnosis/diagnoses.
Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
Explain why you chose the Z codes you have for this client.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
Week 5 – CASE OF YASMIN – 3 F codes and 1 Z code
Intake Date: May 1, xxxx
IDENTIFYING/DEMOGRAPHIC DATA:
Yasmin is a 39-year-old Middle Eastern female of Turkish ancestry who has been married for 21 years. She lives with her husband and her 15-year-old son. Her daughter is a sophomore in college and lives on campus. Yasmin owns an ice cream parlor.
CHIEF COMPLAINT/PRESENTING PROBLEM:
Yasmin presents for treatment complaining of an increased sense of hopelessness and a persistent feeling of being a failure. She relates that she has no motivation and nothing seems to bring her pleasure. Yasmin reports feeling very sad and has difficulties getting out of bed in the morning, having irregular sleep patterns, frequently awakening throughout the night and staring at the clock, unable to fall back to sleep. Yasmin reports intense periods of anxiety affecting her sleep and occurring upon awakening and she especially worries about her children, her business, and things going on in her neighborhood, and wondering if everything will work out in her family members’ lives. She states that her anxiety becomes so severe that it makes her teeth chatter uncontrollably. Yasmin reports that she experiences periods of tearfulness and crying during the day especially when things are particularly stressful at her business. She is always tired and fatigued and has difficulty making even simple business decisions.
HISTORY OF PRESENT ILLNESS:
Yasmin states that she has always worried about being successful and that recent marital problems have increased these feelings. She states that feelings of impending disaster plague her in the morning and that these anxious feelings have been going on for 11 months. Client states that she feels as if her “anxiety regulator” has broken.
Yasmin was very involved with her parents and other family members. She worries that something might happen to her elderly parents. Yasmin states that as her parents age it concerns her that she may not have them around forever. Once this thinking started Yasmin reports intense periods of frequent and severe “attacks” which include chest pains, shortness of breath and dizziness. When this happens, she just wants to throw up. Sometimes she has bizarre dreams, suffers from night sweats and chills, and wakes up with a feeling that she is going crazy. Since June, Yasmin has lost 35 lbs. and has difficulty concentrating on running her business. Although her attacks would come on suddenly, they did not last very long, but it seemed like hours.
Yasmin states that she cannot shake feelings of anxiety, especially when she is unable to reach her husband. She has spent the last several months worrying about the attacks happening when she cannot reach her parents. Yasmin states she also began worrying about dying. She reports a previous period of depression that began 5 years ago. She identified feelings of hopelessness and sleep disturbances as well as persistent thoughts of suicide. Client states she began psychotherapy and was put on Prozac for about one year. She was able to deal with the depression and felt generally happy for two years.
Client reports years of worrying about her life, her children and all of her family members. Even though it makes her irritable, she doesn’t even try to stop it anymore. The situation with her parents only increased things for her to worry about. She expresses concern about her business although there is no indication that there is any trouble.
CURRENT FAMILY ISSUES AND DYNAMICS:
Yasmin was married 19 years ago. Yasmin was given her business by her father at age 24 and is successful in the business. She comes from a family of business owners. Client has two children. Clients reports she separated from her husband two times because of his unmotivated behavior.
MENTAL STATUS EXAM:
Yasmin presents friendly and cooperative and is dressed neatly in appropriate attire. Yasmin’s mood is depressed. She is oriented to time, place, and person. She demonstrates general knowledge consistent with education. Yasmin demonstrates proper judgment, insight, and normal memory, both recent and remote. Additionally, Yasmin presents with normal perceptions and normal stream of thought. Yasmin’s speech is spontaneous. She initially presents with an appropriate affect although she demonstrates a moderate lability to her mood. Her expression of mood ranged from intense laughter to periods of uncontrollable sobbing. Mood was congruent with expression. Yasmin appeared anxious when discussing monetary matters. She denies active suicidal/homicidal ideation but states that her family would be better off if she were dead so that they could collect on the insurance.
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