Case Study 1 Donald Is A 54-Year-Old Paper Mill Employee

Case Study 1donald Is A 54 Year Old Paper Mill Employee He Has Adult

Donald is a 54-year-old paper mill employee experiencing persistent and excessive worry across multiple domains of his life, including his health, finances, family, and job responsibilities. His worry has become pervasive, impairing his daily functioning, leading to physical symptoms such as muscle tension, chronic fatigue, sleep disturbances, and episodic physical sensations mimicking cardiac distress. Donald's avoidance behaviors, such as declining promotions and refraining from exploring new employment opportunities, stem from fears of failure and increased stress. His worry has also contributed to depression, feelings of hopelessness, and envy toward others who seem to enjoy relaxation and leisure, which he perceives as unavailable to him.

The case presents key issues related to anxiety, possible comorbid depression, physical health concerns, and psychosocial stressors. Clinically, Donald's symptoms suggest a primary anxiety disorder, potentially Generalized Anxiety Disorder (GAD), with considerations of panic disorder due to episodic physical symptoms and possible comorbid depression evidenced by his feelings of hopelessness and loss of pleasure. His physical complaints, including chest sensations and sleep issues, warrant assessment of somatic components associated with anxiety and depression and to rule out medical causes.

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Introduction

Donald’s case exemplifies the complex presentation of chronic anxiety compounded by depressive symptoms, impacting multiple spheres of his life. Understanding his psychological state, determining an accurate diagnosis, and formulating an effective treatment plan require careful consideration of symptoms, comorbidities, and biopsychosocial factors.

Key issues in Donald's case revolve around persistent worry, physical symptoms, avoidance behaviors, and emotional distress. These issues can be prioritized based on their impact on his functioning and the potential for change through intervention. The most pressing concern is his generalized worry, which underpins his physical symptoms, sleep disturbances, and depressive feelings. Without addressing this core anxiety, other issues such as depression and physical health concerns may persist or worsen.

Secondly, his physical health concerns, including chest sensations and fatigue, must be evaluated to rule out medical conditions, while also acknowledging their psychological origins. His avoidance of promotions and career development highlights the influence of his anxiety on occupational functioning. Finally, his feelings of hopelessness and envy denote depressive symptomatology that could impede motivation and engagement in therapy.

The prioritization aligns with the anticipation that reducing anxiety should lead to overall improvement in depressive symptoms and physical health concerns. Targeting anxiety first will address the primary psychological distress and decrease the somatic symptoms, ultimately promoting better quality of life and functioning.

Diagnostic impressions depend on a thorough assessment aligned with DSM-5 criteria. The core feature of Donald's presentation is excessive and uncontrollable worry occurring most days for at least six months, with difficulty controlling the worry, as described in GAD (DSM-5, 2013). His worry encompasses multiple domains—health, finances, family, and job—which is characteristic of GAD. Additionally, his physical symptoms, including muscle tension, sleep disturbance, fatigue, and episodic acute sensations resembling panic attacks, suggest possible comorbid panic disorder or somatic manifestations of anxiety. The episodes with symptoms resembling a heart attack, though medically ruled out, point toward somatic anxiety symptoms often associated with panic disorder (DSM-5, 2013).

Furthermore, Donald’s depressive features—persistent hopelessness, anhedonia, and prolonged low mood—align with a diagnosis of Major Depressive Disorder (MDD) if symptoms meet the duration and severity criteria. The presence of depression alongside GAD is common, with considerable symptom overlap complicating the clinical picture (Kessler et al., 2003).

Other differential diagnoses considered include obsessive-compulsive disorder (OCD), given the intrusive images related to grandchildren; however, these images seem more consistent with anxious ruminations than compulsive rituals. Social anxiety disorder was less likely, as Donald's worries are broad and not confined to social situations, and the avoidance pertains more to career and personal health. Medical conditions such as cardiovascular disease had been ruled out after emergency room visits, which supports the psychological origin of his physical symptoms.

References

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