Abby is a 20-year-old female college student experiencing ongoing anxiety and worry without a specific cause for at least the last 3 months. She reports symptoms such as restlessness, muscle tension, and distress that interfere with her daily tasks. She visited the university’s counseling center, where Dr. Smith engaged her in discussion, informed her about confidentiality, and assigned her homework to log negative thoughts and their circumstances.
Paper For Above instruction
This paper provides an analytical exploration of Abby’s presented symptoms, theoretical frameworks relevant to her case, differential diagnoses based on her evolving symptomatology, and ethical considerations in her treatment. The aim is to deepen understanding of clinical diagnosis, theoretical models, and ethical responsibilities in mental health practice.
Initially, assessing Abby’s symptoms, she exhibits persistent anxiety and physical tension, characteristic of Generalized Anxiety Disorder (GAD) as outlined in the DSM-5. GAD is diagnosed when an individual experiences excessive anxiety and worry about various domains for at least six months, accompanied by symptoms such as restlessness, muscle tension, and difficulty controlling worry (American Psychiatric Association, 2013). Abby’s three-month symptom duration aligns with the criteria, although a comprehensive clinical interview would be necessary to confirm a diagnosis formally. The absence of a specific focus or traumatic event at this stage suggests GAD rather than a specific phobia or other anxiety disorders.
The homework assigned by Dr. Smith—logging negative thoughts—aligns with cognitive-behavioral therapy (CBT), particularly targeting cognitive restructuring. Cognitive models posit that maladaptive thoughts contribute to emotional distress (Beck, 1976). The daily logs help identify and challenge negative automatic thoughts, a core component of CBT, which aims to modify thought patterns to alleviate anxiety and improve functioning (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). This approach underscores the importance of cognitive processes in emotional regulation and behavioral adaptation.
If Dr. Smith recommended medications only, this would be consistent with a biomedical or biological model, which emphasizes neurochemical imbalances as sources of mental health symptoms. Pharmacotherapy—such as selective serotonin reuptake inhibitors (SSRIs)—is often prescribed to manage anxiety, aligning with the biological perspective that neurotransmitter dysregulation contributes to anxiety
disorders (Bandelow & Michaelis, 2015). Medication can be effective in reducing symptoms but is typically complemented by psychotherapy for long-term outcomes.
In contrast, recommending medications in addition to therapy aligns with an integrative biopsychosocial model, recognizing the complex interplay of biological, psychological, and social factors in mental health. This approach considers pharmacotherapy and psychotherapy as complementary tools addressing different aspects of the disorder (Engel, 1977). For Abby, combining medication with cognitive-behavioral techniques could provide a comprehensive treatment plan, addressing neural pathways and thought patterns simultaneously.
If Dr. Smith employed free association—allowing Abby to spontaneously share thoughts without censorship—it would reflect the psychodynamic model rooted in Freudian theory. Free association aims to uncover unconscious conflicts and repressed emotions that influence current behaviors (Freud, 1913). This method relies on the therapist’s interpretation to elucidate underlying issues contributing to the symptoms of anxiety, emphasizing early life experiences and unconscious processes.
Additionally, if Dr. Smith utilized unconditional positive regard, it would exemplify Carl Rogers’ humanistic approach. This therapeutic stance involves providing nonjudgmental, empathetic acceptance of the client, fostering a safe environment for self-exploration. Rogers believed such acceptance encourages clients to discover their authentic selves and promotes psychological growth (Rogers, 1957). In Abby’s context, unconditional positive regard could facilitate her trust and openness, essential for effective therapy.
If Abby reported experiencing distress following a traumatic event, such as a car accident with symptoms like nightmares, avoidance of driving, and distorted self-beliefs about her driving ability, and these symptoms persisted beyond a month, the appropriate DSM-5 diagnosis might be Post-Traumatic Stress Disorder (PTSD). PTSD is characterized by intrusive memories, avoidance behaviors, negative alterations in cognition and mood, and hyperarousal following trauma (American Psychiatric Association, 2013). The duration of symptoms exceeding a month is consistent with the full criteria for PTSD.
Alternatively, if Abby experienced persistent sadness, anhedonia, changes in sleep and appetite, fatigue, and difficulty concentrating over the past two weeks, without episodes of mania or hypomania, the clinical picture suggests Major Depressive Disorder (MDD). The DSM-5 stipulates that these symptoms significantly impair functioning and persist for at least two weeks for diagnosis (American Psychiatric
Association, 2013).)
In a scenario where Abby displays elevated energy, irritability, increased talkativeness, decreased need for sleep, and distractibility over a week, with a history of similar episodes and prior depression, the diagnosis could be Bipolar I Disorder in the current manic episode. This disorder involves at least one manic episode, characterized by an abnormally elevated or irritable mood and increased activity or energy lasting at least one week (American Psychiatric Association, 2013).
When Abby exhibits lifelong suspiciousness, mistrust of others, and a need to stay vigilant, especially since childhood, the DSM-5 diagnosis might be Paranoid Personality Disorder. This personality disorder involves pervasive distrust and suspicion of others, which begins in early adulthood and is consistent with her history (American Psychiatric Association, 2013).
If Abby reports a pattern of needing increasing amounts of alcohol to achieve the same effect, losing her job, and experiencing delirium tremens, the diagnosis would be Alcohol Use Disorder, severe. The delirium tremens indicates severe withdrawal symptoms, which pose life-threatening risks. DSM-5 recognizes alcohol dependence as involving compulsive use with withdrawal symptoms (American Psychiatric Association, 2013).
For her roommate’s observations of Abby talking to herself, hearing voices, and exhibiting deteriorating hygiene—signs of psychosis—the diagnosis might be Schizophrenia Spectrum Disorder. Such symptoms include hallucinations, delusions, disorganized speech, and social withdrawal, typically lasting for more than six months (American Psychiatric Association, 2013). The increase in severity over the last month supports this diagnosis.
If a five-year-old child exhibits recurrent separation anxiety, nightmares, physical symptoms, and refusal to leave home, the probable diagnosis per DSM-5 is Separation Anxiety Disorder. This disorder involves excessive fear of separation from attachment figures, interfering with daily activities (American Psychiatric Association, 2013).
For a 67-year-old showing notable decline in memory and attention without prior neurocognitive disorder diagnosis, the likely DSM-5 diagnosis is Major Neurocognitive Disorder, formerly known as dementia. Significant cognitive decline in these areas, affecting independence, fits the criteria for this neurocognitive disorder (American Psychiatric Association, 2013).
Finally, in the context of ethical practice, Dr. Smith’s discussion of confidentiality limits and informed consent are fundamental to safeguarding the patient’s rights and autonomy. They protect the patient's _______________, by ensuring informed participation in treatment and safeguarding privacy rights (Beauchamp & Childress, 2013).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
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Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.
Freud, S. (1913). On beginning the treatment (J. Strachey, Trans.). In The standard edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 141–153). Hogarth Press.
Hofmann, S. G., Asnaani, A., Vonk, J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.