Week 5 Anxiety Disorders, Obsessive-Compulsive And Related D ✓ Solved

Week 5 Anxiety Disorders Obsessive Compulsive And Related Disorders

Analyze a case from the anxiety and OCD spectrums. You also consider cultural idioms and the cultural formulation interview (CFI) of the DSM-5. The CFI is designed to help a social worker adapt diagnosis and treatment both to cultural variations and to the individual experience of a person within that culture. Given that anxiety may manifest in diverse ways due to cultural influences, you practice using the CFI to guide treatment conceptualization for anxiety. Learning Objectives Students will: · Analyze a case study focused on an anxiety disorder utilizing steps of differential diagnosis · Recommend an intervention for treating anxiety disorder · Role-play a client interaction to complete a Cultural Formulation Interview · Analyze cultural variables in mental health treatment planning

Sample Paper For Above instruction

Introduction

This paper presents a comprehensive analysis of Nahla, a 29-year-old African American woman exhibiting symptoms consistent with an anxiety disorder, specifically obsessive-compulsive disorder (OCD). Through the application of DSM-5 criteria, differential diagnosis, cultural formulation, and evidence-based interventions, the goal is to formulate an accurate diagnosis and propose effective treatment strategies mindful of the client’s cultural background and individual experiences.

Diagnostic Assessment

The primary diagnosis for Nahla, based on her clinical presentation, is Obsessive-Compulsive Disorder (OCD). According to the DSM-5, OCD is characterized by the presence of obsessions and/or compulsions that are time-consuming or cause significant distress or impairment (American Psychiatric Association, 2013a). In Nahla’s case, her longstanding preoccupation with germs, her compulsive house cleaning (scrubbing the house), and her anxiety symptoms align closely with OCD criteria. She reports recurrent, persistent, and intrusive obsessions related to germs and disease, which trigger physical symptoms like dizziness, sweating, nausea, and shortness of breath—typical responses during obsessive episodes.

Regarding severity, Nahla’s symptoms appear to interfere significantly with her daily functioning, including her work focus and social interactions, meeting the criteria for at least moderate severity (Morrison, 2014). Her compulsive cleaning routines, which delay her daily schedule and provoke arguments with her partner, further underscore the impact on her functioning. The ICD-10-CM code for OCD is F42 (NOS), with specifiers for severity and features as applicable.

Additional relevant codes include Z63.0 (Problems related to primary support group), reflecting her family and relational stressors, and Z63.4 (Discord with others), considering her arguments with Dion.

Matching Symptoms to Diagnostic Criteria

Nahla’s obsession with germs and contamination is persistent and recurrent, fitting the DSM-5 criteria of obsessions—intrusive thoughts causing distress (DSM-5, 2013a). Her compulsive acts, chiefly compulsive cleaning, serve as a response to reduce her anxiety, aligning with the compulsions criteria (DSM-5). Her physical symptoms during obsessions, such as dizziness and nausea, suggest heightened autonomic arousal consistent with anxiety responses. The compulsive behaviors have become time-consuming, interfere with her routine, and are driven by an uncontrollable need to mitigate feared consequences of contamination, fulfilling the diagnostic criteria for OCD.

Differential Diagnoses Considered

Other potential diagnoses considered included Generalized Anxiety Disorder (GAD), Body Dysmorphic Disorder (BDD), and specific phobias. GAD was considered due to her pervasive worry; however, her core symptoms center specifically around contamination fears and compulsive cleaning rather than generalized excessive worry about multiple domains, which is characteristic of GAD (American Psychiatric Association, 2013a). BDD was less likely as her preoccupations are germ-related, not appearance-focused. Specific phobias were eliminated because her fears are more persistent and involve compulsive rituals rather than situational fears.

Assessment Tools

An evidence-based assessment scale suitable for ongoing validation of the diagnosis is the Obsessive-Compulsive Inventory-Revised (OCI-R) (Foa et al., 2002). The OCI-R is a validated self-report instrument that measures the severity of OCD symptoms across different dimensions such as washing, checking, and ordering. This instrument can monitor treatment progress and symptom fluctuations over time, providing valuable data for clinical decision-making.

Treatment Recommendations

Based on current evidence, cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is considered the gold standard for OCD treatment (Foa et al., 2005). ERP involves gradually exposing Nahla to her feared contamination stimuli while preventing her from engaging in compulsive cleaning, thereby reducing her anxiety organically. This intervention addresses maladaptive thought patterns and behavioral responses, promoting habituation and cognitive restructuring.

Pharmacologically, selective serotonin reuptake inhibitors (SSRIs), such as sertraline or fluoxetine, are recommended (Styer et al., 2009). These medications increase serotonin levels, which are often dysregulated in OCD. Combining CBT and medication enhances treatment efficacy, especially for clients with severe symptoms (Rasmussen & Eisen, 2017).

Cultural Considerations in Treatment Planning

It is vital to incorporate the cultural context of Nahla’s experiences. The Cultural Formulation Interview (CFI) helps tailor treatment, acknowledging her military upbringing, cultural values, and personal beliefs about cleanliness, health, and anxiety. For instance, her background suggests a high value on discipline and order, which can influence her receptiveness to ERP. Understanding her cultural perspective ensures that her treatment plan respects her identity and promotes engagement and adherence (Diáz et al., 2017). Moreover, addressing potential stigma associated with mental health within her community encourages acceptance and reduces barriers to care.

Conclusion

In sum, Nahla’s presentation aligns with a diagnosis of OCD, characterized by contamination obsessions and compulsive cleaning behaviors. A thorough differential diagnosis process confirms this, supplemented by validated assessment tools. A combination of ERP and pharmacotherapy, integrated with cultural sensitivity informed by the CFI, offers the best approach to treat her symptoms effectively. Such a paradigm ensures a client-centered, culturally competent intervention that can improve her quality of life and functioning.

References

• American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
• Diáz, E., Añez, L. M., Silva, M., Paris, M., & Davidson, L. (2017). Using the cultural formulation interview to build culturally sensitive services. Psychiatric Services, 68(2), 112–114. https://doi.org/10.1176/appi.ps
• Foa, E. B., Huppert, J. D., Leiberg, S., et al. (2002). The Obsessive-Compulsive Inventory-Revised (OCI-R): Development and validation. Psychological Assessment, 14(4), 393–400.
• Foa, E. B., Yadin, E., & Lichner, T. K. (2005). Exposure and Response Prevention for Obsessive-Compulsive Disorder. Oxford University Press.
• Morrison, J. (2014). Diagnosis made easier (2nd ed.). Guilford Press.
• Rasmussen, S. A., & Eisen, J. L. (2017). The epidemiology and genetics of obsessive-compulsive disorder. Journal of Clinical Psychiatry, 78(3), 413–419.
• Styer, D. M., Allen, A. K., & McLean, J. A. (2009). Pharmacotherapy for OCD: Current practices and future directions. Current Psychiatry Reports, 11(4), 345–352.
• American Psychiatric Association. (2013d). Cultural formulation. In DSM-5. Arlington, VA: Author.