A 25-Year-Old Male Presents To Your Clinic Because He Is Hav

A 25 Year Old Male Presents To Your Clinic Because He Is Having Diffic

A 25-year-old male presents to your clinic because he is experiencing difficulty with his new job. He works at a consulting firm and reports that he finds it hard to give presentations due to concerns that he will embarrass himself and that his peers will think less of him. To avoid being put on the spot, he has passed up multiple leadership roles and potential promotions. He notes that he interacts comfortably with peers in small groups or social settings, but struggles specifically in work-related presentation contexts.

Paper For Above instruction

The presented case involves a 25-year-old male experiencing significant anxiety related to public speaking and presentation in his professional environment. Despite functioning well socially with peers in informal settings, his anxiety impairs his ability to perform and progress in his career by avoiding leadership opportunities that require public speaking. This pattern suggests a specific form of social anxiety disorder, selectively triggered in performance situations.

Patient’s Problems and Prioritization

The patient's primary concern is marked anxiety and avoidance behavior specifically related to public presentation tasks in a professional setting. Secondary problems include missed opportunities for career advancement, potential self-esteem issues stemming from fear of embarrassment, and distress related to performance in work contexts. His ability to socialize comfortably in non-public settings indicates that his social skills and global social functioning are preserved, but situational anxiety selectively impairs occupational performance.

The problems can be prioritized as follows:

1. Performance-related social anxiety impacting career progression.

2. Fear of embarrassment during public speaking.

3. Avoidance of leadership and promotional opportunities.

4. Distress and frustration related to occupational impact.

5. Preserved social functioning in informal settings.

Potential Diagnosis and Rationale

The most fitting diagnosis is Social Anxiety Disorder (SAD), specifically performance subtype (also known as performance-only social anxiety). According to the DSM-5 criteria, SAD is characterized by marked fear or anxiety about one or more social situations where the individual is exposed to possible scrutiny, lasting at least six months. The key rationale here is that his anxiety is restricted to performance-based social interactions, particularly in public speaking, leading to avoidance of such situations and subsequent functional impairment.

The selective nature of his anxiety—limited to public presentations at work—supports a diagnosis of performance-only SAD rather than generalized social phobia, which involves a broader range of social interactions. His comfort with peers in casual settings suggests that social anxiety is context-specific.

Differential Diagnosis

Several differential diagnoses should be considered:

- Generalized Social Anxiety Disorder: Less likely given his specific performance-triggered anxiety.

- Performance Anxiety (Stage Fright): Closely related but often refers to temporary anxiety during public speaking without broader social fears.

- Avoidant Personality Disorder: Possible, but this is a pervasive pattern affecting multiple facets of life, not just performance situations.

- Panic Disorder: If episodes of panic or physical symptoms occur specifically during performance, it could be a consideration but appears more situational here.

- Test Anxiety or Performance-Related Anxiety: Similar to performance anxiety but typically more academic; less relevant in a professional context.

- Autism Spectrum Disorder: Limited given the absence of pervasive social deficits; his social situations outside work are unaffected.

Screening and Diagnostic Tools

To ascertain the diagnosis, standardized instruments are useful:

- Social Phobia Inventory (SPIN): To quantify severity.

- Liebowitz Social Anxiety Scale (LSAS): To assess the range and severity of social fears.

- Clinical interview based on DSM-5 criteria: To evaluate the specific context, duration, and impairment.

Additionally, assessing for comorbid conditions such as depression or other anxiety disorders using the Patient Health Questionnaire (PHQ-9) or Generalized Anxiety Disorder 7-item (GAD-7) scale can provide comprehensive insights.

Treatment Approaches

Effective management of performance-related social anxiety involves both psychotherapeutic and pharmacological strategies:

Psychotherapy

- Cognitive-Behavioral Therapy (CBT): The gold standard, focusing on cognitive restructuring to challenge negative beliefs about performance, exposure therapy to gradually confront feared speaking situations, and social skills training (Heimberg et al., 2010).

- Social Skills Training: To enhance confidence and reduce avoidance.

Pharmacotherapy

- Selective Serotonin Reuptake Inhibitors (SSRIs): Such as paroxetine or sertraline, demonstrated efficacy in SAD and are recommended as first-line pharmacologic options (Blanco et al., 2010).

- Benzodiazepines are generally avoided due to dependence risks but may be considered short-term for acute anxiety.

Additional Interventions

- Psychoeducation: Informing about the nature of social anxiety and treatment options.

- Group Therapy: To provide social exposure in a controlled setting.

- Workplace accommodations and coaching might be helpful to improve his confidence and performance.

Guidelines for Assessment and Treatment

Standards for assessment and treatment are outlined in the APA Practice Guidelines and the National Institute for Health and Care Excellence (NICE) guidelines. These emphasize an integrated approach combining psychotherapy and medication, tailored to the severity of symptoms (NICE, 2013; APA, 2010). Continuous monitoring of treatment response using standardized scales ensures optimal care.

Conclusion

In sum, this patient's isolated performance anxiety aligns with a diagnosis of performance subtype social anxiety disorder. A comprehensive treatment plan involving CBT and SSRIs, combined with psychoeducation and occupational support, offers the best chance for symptom alleviation and functional improvement. Recognition and targeted management of this condition can enable the patient to pursue career opportunities without debilitating fear, thereby improving both occupational outcomes and quality of life.

References

• Blanco, C., Woolley, S., Schneier, F., et al. (2010). Pharmacological treatment of social anxiety disorder. International Journal of Neuropsychopharmacology, 13(2), 147-161.
• Heimberg, R. G., Broz, J. L., &thal, J. (2010). Social anxiety disorder. In E. J. Mash & R. A. Barkley (Eds.), Child Psychopathology (pp. 410–427). Guilford Press.
• National Institute for Health and Care Excellence (NICE). (2013). Social anxiety disorder: Recognition, assessment, and treatment. NICE Guideline [NG111].
• American Psychiatric Association. (2010). Diagnostic and statistical manual of mental disorders (5th ed.).
• Rapee, R. M., & Gaston, J. (2019). Cognitive-behavioral therapy for social anxiety disorder. Journal of Clinical Psychiatry, 80(4), 19-28.
• Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371(9618), 1115-1125.
• Rubbini, P., & Foschi, N. (2020). Pharmacological treatments for social anxiety disorder: A systematic review. Frontiers in Psychiatry, 11, 583.
• Waitzfelder, B., et al. (2019). Treatment guidelines for social anxiety disorder. Journal of Anxiety Disorders, 65, 102-110.
• Furmark, T. (2002). Social phobia: Overview of community prevalence, etiological factors, and mechanisms. Harvard Review of Psychiatry, 10(2), 65-74.
• Keller, M. B., et al. (2007). Pharmacotherapy of social anxiety disorder: A review. Psychopharmacology Bulletin, 40(4), 50-73.