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Anyone want to help me diagnose these people/case studies?

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#1
This is part of my next assignment. There are 3 particular areas of focus here as far as diagnoses go: trauma- and stressor-related disorders, obsessive-compulsive disorders (i.e. OCD, OCPD, trichotillomania, hoarding, body dysmorphic disorder, etc.), and anxiety disorders, which means that the diagnosis (or diagnoses) for each should fall under one of those categories.

Case #1 - Fred

- middle of 3 brothers, all of whom were close
- Parents are successful realtors
- Fred was a straight-A student, top athlete, and eventually became a practicing anesthesiologist
- He came out to his family one day about his homosexuality. Father was hesitant, but accepting. Older brother was okay with it. Mother wasn't accepting and told him to never speak of it again. Younger brother became increasingly resentful toward Fred due to him upsetting his mother.
- Fred is also experiencing distress over whether to have a marriage ceremony with his partner, considering how his mother and brother feel.
- Has daily panic attacks, especially when getting ready for work or at the end of workday
- Panic attacks began when he was robbed at gunpoint in the subway.
- Avoids subway now even though it's inconvenient to do so.
- No previous mental illness in family except for his mother's father's alcoholism

Case #2 - Phil

- 20 y.o. and stressed due to not working
- quit first job at restaurant because it was "too messy"
- showered for hours to get smell of food off of him, but still felt dirty afterward
- 2nd job was at clothing store and he was initially well-regarded by his boss
- worked hard at organizing, folding, and arranging clothing items by size
- eventually made assistant manager
- boss became frustrated because Phil was still focusing on organizing clothing instead of his managerial duties despite numerous warnings
- Phil was not able to effectively deal with customer complaints
- got married, but wife left because she said he was too "controlling"
- Phil would get angry when she did not put things away properly
- Ex-wife would get angry when he tried to clean kitchen while she was in the middle of cooking

Case #3 - Stacey

- lives alone, was married at 20 for four years, and no children
- was shy when little and often played alone
- has brother who is 10 years older
- she used to live in countryside with a lot of pets and animals and was always good at caring for them
- had a single close friend in 1st grade whom she spent time with, but friend moved out of state
- Stacey is small and wears glasses, and was therefore often bullied at school
- became more reclusive after divorce
- husband said she was "a doormat with no personality"
- Stacey worked as a cashier for 7 years and is accurate and efficient at her job
- spends her free time alone with her pets
- enrolled in college, but was paralyzed with fear when asked to do presentations
- she dropped out because she was afraid to get made fun of
- she's content with her living situation because "animals and pets don't criticize"

What do you guys think? I think that Fred possibly has PTSD, panic disorder, and/or generalized anxiety disorder. Phil clearly has OCD, possibly OCPD, or both. And Stacey has social anxiety disorder. I'm assuming there are probably multiple diagnoses for each person.
 

Nick

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#3
Before reading your answers, I came to the same conclusion. I'll think on it a bit and see if anything deeper pops out and let you know.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#4
I'm thinking no GAD for Fred on second thought. There doesn't seem to be any evidence of it, at least, based on the info given. But Panic Disorder vs. PTSD (or both) i'm not certain about yet.

OCPD probably also isn't the case for Phil because it goes under personality disorders, which isn't one of the categories that was given, and there also isn't enough evidence in the info. But OCD is a definite.

And SAD is the only thing I can think of for Stacey.

So maybe each person actually has only one diagnosis.
 

Paisley

* * *
SF Artist
SF Supporter
#5
I'm assuming there are probably multiple diagnoses for each person.
In the way that I interpreted this part of the question: " the diagnosis (or diagnoses) for each should fall under one of those categories"... each person could either have a multiple diagnosis or a single diagnosis. I think your initial feeling is spot on, but take my opinion with a grain of salt.
 

Ash600

Of dust and shadows
SF Creative
SF Supporter
#6
My take on it, for what it's worth is :

1. Fred has GAD along with possible PTSD

2. Phil - displayin signs of OCD

3.Stacey - seems to be suffering from social anxiety.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#7
My take on it, for what it's worth is :

1. Fred has GAD along with possible PTSD

2. Phil - displayin signs of OCD

3.Stacey - seems to be suffering from social anxiety.
Why do you think GAD for Fred?

I actually have a new theory for Fred. He doesn't fit all the symptoms of PTSD, such as flashbacks, nightmares, hypervigilance, etc. There have to be 9 criteria matched for PTSD. He only matches 2-3. So instead, I realized maybe Adjustment Disorder. He's stressed about his family, about the marriage ceremony, has panic attacks ever since he got mugged, and avoids the subway now because he views the world as dangerous. It seems more fitting.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#8
The panic attacks had only started 4 months ago, also, which qualifies for an adjustment disorder diagnosis. If it was 6 months or over, and he still kept having symptoms, but didn't meet the criteria for PTSD, he would then be rediagnosed with trauma- and stress-related disorder NOS (not otherwise specified). Plus, the DSM doesn't regard being a victim of a crime so much as a PTSD-related traumatic event it seems.

And panic disorder is also out because he doesn't meet criteria for that either.
 

Freya

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Forum Owner
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#9
The panic attacks had only started 4 months ago, also, which qualifies for an adjustment disorder diagnosis. If it was 6 months or over, and he still kept having symptoms, but didn't meet the criteria for PTSD, he would then be rediagnosed with trauma- and stress-related disorder NOS (not otherwise specified). Plus, the DSM doesn't regard being a victim of a crime so much as a PTSD-related traumatic event it seems.

And panic disorder is also out because he doesn't meet criteria for that either.
Do you think that Stacey is only socially anxious? She dropped out of college not because of generally anxious but because she was specifically afraid of being made fun of, her husband said she was a doormat which I am reading as not expressing her opinion (possibly to avoid confrontation?) and at the end she prefers animals because they don't criticise (aren't mean to her?) do you think she has some trauma from the bullying at school that is an aggravator or even cause of the social anxiety? Does the cause of it matter? I just thought it seemed as if she was suffering the after effects of trauma with regard to the bullying when I read the college / husband / pets not criticising parts.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#10
Do you think that Stacey is only socially anxious? She dropped out of college not because of generally anxious but because she was specifically afraid of being made fun of, her husband said she was a doormat which I am reading as not expressing her opinion (possibly to avoid confrontation?) and at the end she prefers animals because they don't criticise (aren't mean to her?) do you think she has some trauma from the bullying at school that is an aggravator or even cause of the social anxiety? Does the cause of it matter? I just thought it seemed as if she was suffering the after affects of trauma with regard to the bullying when I read the college / husband / pets not criticising parts.
Well, it says that she was usually playing by herself as a child and she was shy even back then. That was before the bullying. You're right though that it's possible she might have experienced some sort of trauma from the bullying at school. However, I have to go on strictly the information that's been provided. There are no trauma-related symptoms given for her. Just that she's basically a loner and she's okay with it. Her husband saying she was a "doormat" could either mean that she's someone people easily take advantage of or he literally meant that she has the personality of a doormat. As in, she's a boring person (most likely because she doesn't do much except spend time with her pets at home).

And the fact that she's been able to keep a steady job as a cashier...well, technically, being a cashier does require some talking to customers, but only the general "Hi, how are you?" type stuff. I've been a cashier also, and it didn't trigger my social anxiety too badly. So I'm thinking that she's good at her job because it doesn't require a whole lot of social interaction. The only other thing I was suspicious of her having is Avoidant Personality Disorder, which is often comorbid with SAD. She's a loner and avoids social interaction, but still longs for close relationships with certain people, such as her friend in 1st grade or her husband. But like I said before, I don't think personality disorders count for this, so I think SAD is probably the best option. And being afraid of getting made fun of is definitely symptomatic of SAD.
 

UKDude

Well-Known Member
#11
I was thinking 1 has PTSD and maybe some kind of avoidant PD like GAD, but maybe just PTSD (gets nervous when leaving for work, or leaving work - both involve going to subway).

2) OCPD / OCD

3) cPTSD. The doormat comment made me think she's maybe high on the agreeableness scale, being taken advantage of but afraid to stand up for herself - related to bullying, lack of learning to interact with other people when young (and with a large age dif between her and brother)?
 

Ash600

Of dust and shadows
SF Creative
SF Supporter
#12
Why do you think GAD for Fred?

I actually have a new theory for Fred. He doesn't fit all the symptoms of PTSD, such as flashbacks, nightmares, hypervigilance, etc. There have to be 9 criteria matched for PTSD. He only matches 2-3. So instead, I realized maybe Adjustment Disorder. He's stressed about his family, about the marriage ceremony, has panic attacks ever since he got mugged, and avoids the subway now because he views the world as dangerous. It seems more fitting.

Admittedly it was just an initial gut feeling. Yeah I know, applying the relevant criteria and seeing if the threshold is passed for a definite diagnosis would've been better. I could enlarge on this, but perhaps it'll be best to save it for another thread or convo elsewhere as I don't wish to detract from the original purpose of this thread.
 

Gonz

sick and tired of being sick and tired
#13
Don't get too smart for your own good; when you hear hoofbeats don't let the possibility that it might be zebra distract you from the likelihood that it's just a horse.

Post Traumatic Stress Disorder

Obsessive Compulsive Disorder

Social Anxiety Disorder

I forget the names, but you know who each applies to.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#14
Don't get too smart for your own good; when you hear hoofbeats don't let the possibility that it might be zebra distract you from the likelihood that it's just a horse.

Post Traumatic Stress Disorder

Obsessive Compulsive Disorder

Social Anxiety Disorder

I forget the names, but you know who each applies to.
Look at the criteria for PTSD, though.

In the most recent publication of the DSM, the DSM-V, PTSD symptoms are grouped into five different clusters. One or more symptoms are required from each of these clusters in order for a patient to receive a full diagnosis. Those clusters include:
  1. Stressor – (one required) The person was exposed to injury or severe illness that was life-threatening, which includes actual or threatened injury or violence. This may include at least one of the following:
    • Direct exposure to the trauma
    • Witnessing a trauma
    • Exposure to trauma by being a first responder, such as police, firefighter, medic, or crisis counselor
    • Learning that someone close to you experienced the trauma
      1. Intrusion Symptoms (one required) – The person who was exposed to a trauma then re-experiences the trauma in one or more ways, including:
        • Flashbacks
        • Nightmares
        • Distressing and intense memories
        • Distress or physical reactions after being exposed to reminders, known as β€œtriggers”
      1. Unpleasant Changes to Mood or Thoughts (two required) –
        • Blaming self or others for the trauma
        • Decreased interest in things that were once enjoyable
        • Negative feelings about self and the world
        • Inability to remember the trauma clearly
        • Difficulty feeling positive
        • Feelings of isolation
        • Negative affect, and difficulty feeling positive
      1. Avoidance (one required) – This occurs when a person tries to avoid all reminders of the trauma, including:
        • Avoiding external reminders of what happened
        • Avoiding trauma-related thoughts or emotions, sometimes through the use of drugs or alcohol
      1. Changes in Reactivity (two required) – This occurs when a person becomes more easily startled and reacts to frightful experiences more fully, including symptoms of:
        • Aggression or irritability
        • Hypervigilance and hyper-awareness
        • Difficulty concentrating
        • Difficulty sleeping
        • Heightened startle response
        • Engaging in destructive or risky behavior
        • Difficulty sleeping or staying asleep
    • All of these symptoms must have persisted at least one month, and they must be causing distress or functional impairment of some kind. These symptoms must not be related to any substance use, illness, or medications.

I highlighted in red his symptoms. He doesn't match all the criteria.
 

Gonz

sick and tired of being sick and tired
#15
Look at the criteria for PTSD, though.

In the most recent publication of the DSM, the DSM-V, PTSD symptoms are grouped into five different clusters. One or more symptoms are required from each of these clusters in order for a patient to receive a full diagnosis. Those clusters include:
  1. Stressor – (one required) The person was exposed to injury or severe illness that was life-threatening, which includes actual or threatened injury or violence. This may include at least one of the following:
    • Direct exposure to the trauma
    • Witnessing a trauma
    • Exposure to trauma by being a first responder, such as police, firefighter, medic, or crisis counselor
    • Learning that someone close to you experienced the trauma
      1. Intrusion Symptoms (one required) – The person who was exposed to a trauma then re-experiences the trauma in one or more ways, including:
        • Flashbacks
        • Nightmares
        • Distressing and intense memories
        • Distress or physical reactions after being exposed to reminders, known as β€œtriggers”
      1. Unpleasant Changes to Mood or Thoughts (two required) –
        • Blaming self or others for the trauma
        • Decreased interest in things that were once enjoyable
        • Negative feelings about self and the world
        • Inability to remember the trauma clearly
        • Difficulty feeling positive
        • Feelings of isolation
        • Negative affect, and difficulty feeling positive
      1. Avoidance (one required) – This occurs when a person tries to avoid all reminders of the trauma, including:
        • Avoiding external reminders of what happened
        • Avoiding trauma-related thoughts or emotions, sometimes through the use of drugs or alcohol
      1. Changes in Reactivity (two required) – This occurs when a person becomes more easily startled and reacts to frightful experiences more fully, including symptoms of:
        • Aggression or irritability
        • Hypervigilance and hyper-awareness
        • Difficulty concentrating
        • Difficulty sleeping
        • Heightened startle response
        • Engaging in destructive or risky behavior
        • Difficulty sleeping or staying asleep
    • All of these symptoms must have persisted at least one month, and they must be causing distress or functional impairment of some kind. These symptoms must not be related to any substance use, illness, or medications.

I highlighted in red his symptoms. He doesn't match all the criteria.
Well, he's definitely avoidant, you specifically said he avoids the subway even though that's inconvenient for him. And the fact that he now responds to stress with daily panic attacks certainly sounds like a change in reactivity.
 

Auri

🎸🎼Rock Star🎼🎸
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#16
Is the point to make a diagnosis, or just to speculate about what could be happening if given more information?
I don't know enough about anxiety and panic disorders, but I agree that there is not enough information to say Fred has "diagnosed" PTSD. I don't know how long ago he has experienced the trauma, but it could be ASD if it was not so long ago... or simply some post-traumatic stress without it being a mental disorder.

Edit : Oh well, given the criteria you posted, he may well be diagnosable with PTSD. At first glance it seemed to me like there were only like 3-4 symptoms but it looks like you don't have to have a plethora of them for the diagnosis. :)
 
Last edited:

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#17
Well, he's definitely avoidant, you specifically said he avoids the subway even though that's inconvenient for him. And the fact that he now responds to stress with daily panic attacks certainly sounds like a change in reactivity.
Well, he's definitely avoidant, you specifically said he avoids the subway even though that's inconvenient for him. And the fact that he now responds to stress with daily panic attacks certainly sounds like a change in reactivity.
Okay, so maybe the panic could fall under "heightened startle response."
But even so, there have to be 2 changes in reactivity. And avoiding the subway falls under the physical reaction when exposed to reminders criterion.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#18
Is the point to make a diagnosis, or just to speculate about what could be happening if given more information?
I don't know enough about anxiety and panic disorders, but I agree that there is not enough information to say Fred has "diagnosed" PTSD. I don't know how long ago he has experienced the trauma, but it could be ASD if it was not so long ago... or simply some post-traumatic stress without it being a mental disorder.

Edit : Oh well, given the criteria you posted, he may well be diagnosable with PTSD. At first glance it seemed to me like there were only like 3-4 symptoms but it looks like you don't have to have a plethora of them for the diagnosis. :)
The point is to use only the info given, not to speculate.
 

Aurelia

πŸ”ΆπŸ”Έβœ΄ πŸ‘‘ βœ΄πŸ”ΈπŸ”Ά
#19
Actually, forget what I said before @Gonz I do see what you're saying now that I've looked at it again. The subway thing kind of falls under both categories. So the only things missing then are the second reactivity symptom and the second changes to mood or thoughts symptom.
 

MichaelKay

Well-Known Member
#20
The description of Stacey made me think of Avoidant Personality DIsorder.

"People with AvPD often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They often avoid becoming involved with others unless they are certain they will be liked. " (stolen from Wiki).
 

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