Scenario: Abby, A 20-Year-Old Female College Student

Scenario Abby Is A 20 Year Old Female College Student For At Least T

Abby is a 20-year-old female college student experiencing ongoing anxiety and worry for at least the past 3 months without a specific cause. She feels restless, notices muscle tension, and her symptoms are affecting her behavior and daily tasks. She initially believed her feelings were normal but has not become more comfortable over time. She visited the university’s counseling center, discussed her concerns with Dr. Smith, who listened attentively, obtained informed consent, and assigned a homework task to log negative thoughts and their circumstances. She plans to bring this log to her next appointment.

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Abby's presentation aligns closely with Generalized Anxiety Disorder (GAD) as characterized in the DSM-5. GAD involves excessive, uncontrollable worry about various aspects of life, accompanied by symptoms such as restlessness, muscle tension, and difficulty concentrating or completing tasks (American Psychiatric Association, 2013). Her persistent worrying without a specific stimulus, ongoing muscle tension, and the impact on her everyday functioning resonate with diagnostic criteria for GAD. The chronicity of her symptoms over three months further supports this diagnosis (McElroy et al., 2016).

The homework assignment that Dr. Smith provided—keeping a log of negative thoughts and the circumstances—corresponds to cognitive-behavioral theory, specifically cognitive restructuring. This model emphasizes identifying and challenging maladaptive thoughts and beliefs to modify emotional responses and behaviors (Beck, 2011). By documenting her negative thought patterns, Abby is actively engaging in the cognitive restructuring process, likely aiming to recognize and dispute distorted thinking that fuels her anxiety.

If Dr. Smith recommended medications only, this would primarily align with the biomedical model of mental illness, which emphasizes the biological and physiological processes underlying mental disorders. Pharmacotherapy targets neurochemical imbalances presumed to contribute to anxiety symptoms, with selective serotonin reuptake inhibitors (SSRIs) often prescribed for GAD (Bandelow et al., 2017). This approach focuses on altering brain chemistry to alleviate symptoms but does not directly address cognitive or behavioral factors.

In the case where Dr. Smith advocates for medications in addition to therapy, this reflects an integrative biopsychosocial model. This model recognizes the interaction of biological, psychological, and social factors in mental health treatment (Engel, 1977). Combining pharmacotherapy with psychotherapy provides a comprehensive approach that targets physiological imbalances and cognitive-behavioral patterns, which is often effective for complex anxiety disorders (Hoffman et al., 2012).

If Dr. Smith engaged in free association exercises with Abby, this would correspond to psychodynamic or psychoanalytic theory. Free association involves exploring unconscious thoughts and feelings by encouraging the patient to verbalize whatever comes to mind without censorship (Freud, 1913). This technique aims to reveal hidden conflicts and unresolved issues underlying psychological symptoms, typical of psychoanalytic approaches.

Using unconditional positive regard during treatment aligns with humanistic therapy, predominantly Carl Rogers’ client-centered approach. This approach emphasizes creating a supportive, nonjudgmental environment where clients feel accepted and understood (Rogers, 1951). Such an environment fosters self-awareness and emotional growth, which can help alleviate anxiety and develop healthier coping strategies.

If Abby instead reports a history of experiencing a traumatic event such as a car accident with symptomatology including fear of driving, nightmares, and self-blame, with symptoms lasting longer than a month, the DSM-5 diagnosis would likely be Post-Traumatic Stress Disorder (PTSD). PTSD is characterized by intrusive memories, avoidance, negative alterations in mood and cognition, and hyperarousal following a traumatic event (American Psychiatric Association, 2013).

For symptoms of persistent low mood, anhedonia, difficulty sleeping, concentration problems, and fatigue over at least two weeks, the relevant DSM-5 diagnosis would be Major Depressive Disorder. The absence of manic or hypomanic episodes supports this, as bipolar disorder would require mood elevation episodes (American Psychiatric Association, 2013).

If Abby reports episodes of irritability, increased energy, decreased need for sleep, distractibility, and prior similar episodes, these symptoms suggest Bipolar Disorder, specifically a manic or hypomanic episode. The history of past depressive episodes also supports a bipolar diagnosis, requiring mood elevation with clinical significance (American Psychiatric Association, 2013).

Persistent suspiciousness and distrust toward others, along with a longstanding pattern of perceiving others as untrustworthy, would align with Paranoid Personality Disorder. This disorder involves pervasive distrust and suspicion, often resulting in social withdrawal and difficulty forming relationships (American Psychiatric Association, 2013).

Abby’s progression into problematic alcohol use with withdrawal symptoms such as delirium tremens indicates Alcohol Use Disorder with severe physiological dependence. The risk of life-threatening withdrawal symptoms and the recognition of her problematic drinking behavior are consistent with this diagnosis, requiring medical intervention (Mayo Clinic Staff, 2018).

If Abby’s roommate reports auditory hallucinations, distorted beliefs such as thinking she is Joan of Arc, decreased hygiene, and delusional thinking persisting over more than six months, this suggests Schizophrenia, a psychotic disorder characterized by hallucinations, delusions, and disorganized behavior (American Psychiatric Association, 2013).

In a hypothetical case where a five-year-old exhibits nightmares, physical complaints, separation fears, and refuses to leave home, the diagnosis most consistent with DSM-5 criteria would be Separation Anxiety Disorder. It is common in children and features excessive fear of separation from attachment figures (American Psychiatric Association, 2013).

For an older adult experiencing significant decline in cognitive functioning, with memory and attention impairments that interfere with independence but no other neurocognitive disorder diagnosis, the appropriate DSM-5 diagnosis would be Major Neurocognitive Disorder (major neurocognitive disorder). If cognitive decline is less severe, it might be classified as Mild Neurocognitive Disorder (American Psychiatric Association, 2013).

Dr. Smith’s discussions regarding confidentiality and obtaining informed consent serve to protect the patient’s autonomy, bodily integrity, and psychological safety. These ethical components are essential to ensure informed participation and safeguard the client’s rights during mental health treatment (American Psychological Association, 2017).

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Beck, A. T. (2011). Cognitive Therapy and the Emotional Disorders. New York: Guilford Press.
• Bandelow, B., et al. (2017). Pharmacotherapy of anxiety disorders. Pharmacopsychiatry, 50(4-5), 149-164.
• Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.
• Freud, S. (1913). The interpretation of dreams. Basic Books.
• Hoffman, S. G., et al. (2012). A meta-analysis of randomized controlled trials for the treatment of anxiety disorders. Journal of Anxiety Disorders, 26(7), 773-785.
• Mayo Clinic Staff. (2018). Alcohol use disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder
• McElroy, S. L., et al. (2016). Anxiety Disorders. In M. H. Keller et al. (Eds.), Principles and Practice of Psychiatric Treatment (pp. 737-763).
• Rogers, C. R. (1951). Client-Centered Therapy. Houghton Mifflin.