Case Study Report

What diagnosis has been given to this client?

Panic Disorder with Agoraphobia

Background Information

Please outline the major symptoms of this disorder.

According to the DSM, the major symptoms of Panic Disorder with Agoraphobia are, recurrent panic attacks and enduring anxiety about experiencing another panic attack. The individual is also anxious about going places where escape might be difficult or embarrassing, or where they will be unable to receive assistance in case of emergency. The symptoms cannot be better explained by another medical or psychological effect.

Briefly describe the client’s background (age, race, occupation etc).

The client is named Annie, and she is a 24 year-old Caucasian woman. According to the case history she had an abusive relationship with her parents, and started experiencing mental health problems during puberty. Annie is currently unemployed, and is receiving disability payments from the federal government. Please describe any factors in the client’s background that might predispose him or her to this disorder.

During the interview, Annie states that her childhood was normal. However, during the interview she occasionally alludes to some abusive experiences, but is reluctant to talk about them any further. The client also makes reference to the night terrors she experienced at the young age of four, eight and twelve. These “intense” nightmares terrified her growing up, and she attributes some of her anxiety to them. She believes that after the night terrors she experienced anxiety over a constant feeling of dis-reality and dissociation, due to flashbacks of the night terrors occurring in her everyday life.

Observations

Please describe any symptoms that you have observed which support the diagnosis. You can include direct quotes or any other behaviors you may have observed. The DSM states that people with Panic Disorder are anxious about experiencing another panic attack. Annie makes it very clear in her interview, that she is afraid of having panic attack in public. She says she is not so much afraid of feeling overcome with anxiety, as she is embarrassed about how her body reacts when undergoing a panic attack. Annie states that most of her panic attacks occur as a result of her imagining how embarrassing it will be if she has a panic attack in public—she loses control of her bladder, she will run out of the situation, and most often hide in the bathroom. Annie states that the Agoraphobia is a result of her overthinking how people view her. Throughout the interview, Annie often demonstrates how she thinks others view her—“why did she just run out” or “she is crazy”. During the interview, it becomes clear that Annie is mainly afraid of judgment by other people. In her interview, Annie mentions that feelings of being trapped also cause her anxiety. She recurs a time when she was invited to a party. Annie explains that while she may want to go to a party, she has to surround herself with people who understand her condition, and will understand if on the way to the party, has to turn around because she may not feel like she will be able to handle talking and socializing with people. Annie further explains, by describing a situation in which, hypothetically, if a person Annie was taking to a party is not okay with turning around, or leaving a party early, then Annie would feel trapped which would then most likely lead to a panic attack.

Please describe any symptoms or observations that are inconsistent with the diagnosis.

It seemed as though everything Annie described about her Panic Disorder with Agoraphobia, was consistent with the DSM criteria for the disorder.

Describe any information you observed about the development of this disorder.

In the beginning of her interview, Annie talks about her many struggles with night terrors as a child. While she says these events contributed to her anxiety, it wasn’t until she was fifteen when things “broke down” for her. She states that at the age of fifteen, she began to analyze things within her family, and realize all the abuse that was happening—and that was about the time she began going to a psychiatrist. After 8 years of experiencing panic attacks, Annie says that she is now able to “ride” through the attacks. She explains a time, when she underwent a panic attack while working at her job at a record store. Annie claimed that it was as if she was starting at herself, through her own eyes, from very far away. She says that while she was experiencing a panic attack, she could see herself in reality continuing to check customers out, and saying “have a good day” as they left. In the interview Annie says that she is also aware that her disorder is partly caused by incorrect “firings” between the neurons in her head. Overall, the interview concludes that Annie’s Panic Disorder with Agoraphobia is caused by both biological and psychological factors. Diagnosis

Did you observe any evidence of any Axis 3 issues (general medical conditions) that might contribute to this disorder? In her interview, Annie states that she suffered from night terrors, which is a general medical condition that I believe directly contributed to the Panic Disorder with Agoraphobia.

Did you observe any evidence of any Axis 4 issues (psychosocial and environmental problems) that might contribute to this disorder?

Annie briefly mentions some abuse as a child which, I consider an environmental problem that may have contributed to her disorder. To make things worse, I don’t think that people reacting negatively to her disclaimer “I have a panic disorder” really helps her cope in her daily life. I believe that people reacting negatively to her disorder, only increases her levels of anxiety.

Based on your observations, what is the client’s overall functioning (Axis 5)? Please use a 1-100 scale where higher numbers indicate higher functioning.

I would give her a ranking of 50, because, she has problems dealing with people, holding a job, any kind of romantic relationship, and even going to a grocery store, or a party. However, she is able to hold together some friendships, and is able to function without medication.

Therapeutic Intervention

In your opinion, what are the appropriate short-term goals for this intervention?

In my opinion, I think the best short-term goal for Annie, would be to get her out of the house without having a panic attack about where she may be going. This short-term goal should allow Annie to drive to the grocery store (even while accompanied by a friend) and not panic about what anxiety attack may or may not happen while she is out. Another short term goal is to help Annie develop a sense of confidence that she is able to ride through all of her anxieties, so that they won’t develop into panic attacks.

In your opinion, what are the appropriate long-term goals for this intervention?

The long term goals for this disorder should be to eliminate panic attacks in Annie’s everyday life, and in her everyday activities.

Which therapeutic strategy seems most appropriate in this case? Why?

There are two psychotherapeutic techniques mentioned in the treatment for Panic Disorder with Agoraphobia. The first is called relaxation training. This form of therapy will force the client to relax each muscle in their body, with hopes that the client is then better able to relax when confronting a stressful event. The second, and most appropriate therapeutic strategy in this particular case, is panic control treatment. A therapeutic strategy designed to help the client assert control over their thoughts and bodily functions. This strategy also has three steps: first, the therapist uses cognitive restructuring to reduce the clients catastrophic thinking; second, the therapist helps the client develop a better understanding of their own bodily sensations; and third, the therapist helps the client breather more slowly and deeply, to help the client avoid hyperventilation. Research shows that this (PCT) technique can be as effective as medications in controlling panic attacks.
Which therapeutic modality seems most appropriate in this case? Why?

According to the treatments for this particular case, many clinicians recommend a treatment paradigm, which involves a combination of medications and psychotherapy. The medications recommended are the benzodiazepines: Xanax, Librium, and Valium; however, antidepressant drugs may also be helpful.
I believe that the combination of these medications with the therapeutic strategy, panic control treatment, will emit a positive outcome.