Lesson 4 - Assessment and the DSM-V

Description

After a year of being overly “nervous”, a 12 year-old girl was brought to a health care practitioner for consultation. The practitioner learned that a year earlier her parents had separated from what seemed to be a rather“stable” marriage. After the separation, the patient began to bite her nails, experience heightened anxiety, and become fearful and apprehensive. She even developed a fear of the dark. She did not have panic attacks but did worry about the safety of her parents. Although her fears were based in reality, they were greatly exaggerated.

She also worried about her appearance and often felt awkward and shy. Although she had a couple of close peer relationships, she had difficulty making friends overall. The patient was very tense during the interview – she had sweaty palms and avoided eye contact. When asked if she was sad, she denied it although she admitted she felt somehow responsible for her parents’ separation. Her academic performance was satisfactory, and physical tests showed that she was otherwise healthy.

Diagnosis

The main feature of the patient’s illness is anxiety. Her symptoms do not warrant a phobic disorder, obsessive-compulsive disorder, separation anxiety disorder, or panic disorder diagnosis but rather that of generalized anxiety or overanxious disorder. She worries unrealistically about her parents’ safety, has an inability to relax, is self-consciousness, and is overly concerned about school performance. Her symptoms have persisted for more than six months, thus resulting in the over-anxiety diagnosis.

On Axis IV note that the parents’ separation is a moderate psychosocial stressor that relates, most likely, to the development of the Axis I disorder. On the fifth axis, her rating is 65 because she does have close friends and is succeeding at school. The overall diagnosis using the DSM-III-R is as follows:

Axis I: Overanxious Disorder

Axis II: No Diagnosis or Condition

Axis III: None

Axis IV: Psychological stressors:
            separation of parents
            Severity: 3 - Moderate

Axis V: Global functioning ranks at 65
            (moderate difficulty)