Abnormal Psychology, Case Study Example

1. The major symptoms Cheryl presents include a shocking sensation leading upwards to her back. This was accompanied by weakness and shaking limbs. There was the feeling of impending death and irregular heartbeats. Cheryl was very fearful and anxious. Besides, she expressed heat in her body and surroundings along with being disoriented in time and place. There was also a fear of going crazy; dizziness and feeling on unreality.
2. These symptoms fit or not fit into the major categories of anxiety disorders discussed in class as it pertains to excessive and worry anxiety, which is characterized by muscle tension. Muscle tension appears to be the only similarity in this category since Cheryl does not worry excessively neither, is experiencing sleeplessness; difficulty in concentrating and the mind going blank. Also, she was not easily fatigued and there is no immense difficulty in controlling worry.¹

Panic disorder showed many similarities to symptoms expressed by Cheryl. They include palpitations; pounding or accelerated heart rate; trembling or shaking and sweating are almost identical to symptoms Cheryl displayed.  However, choking feelings accompanied by sensations of shortness of breath; nausea and abdominal distress; chest pain and discomfort; numbness and tingling of extremities; fear of dying and losing control were no significantly demonstrated in this attack.²

In relation to specific phobia many of the symptoms did not fit. For example, the fear has to be associated with an object or experience. In the case study Cheryl’s symptoms were not linked to any fear in her environment even though it was reported that as the anxiety progress attacks occurred when she was in a crowded subway or bus. Also if she was exercising on a stationary bike and expecting a confrontation with someone. Besides, specific phobia symptoms are considered from a deeper level. It is believed that other mental disorders may be associated with phobia symptoms. Significantly especially in children this type of phobia  anxiety is expressed by crying, tantrums and freezing.³ However, in this case study demonstrating anxiety the client displayed very little manifestations that phobia was expressed by the client in this case study.

Agoraphobia is characterized by fear and anxiety emerging from five specific situations. They include when using public transportation; being in open spaces; standing in line or being in a crowd or merely being alone at home.  Significant symptoms, relate to fear of falling and incontinence. Generally the fear expressed is out of proportion to the fear itself. Avoidance of the  fear situation is perpetual. There may be associating medical conditions such as inflammatory bowel disease and Parkinsons.⁴ Clearly these symptoms do not fit in any way with Cheryl’s anxiety manifestations even though Agoraphobia symptoms are associated with anxiety.

Social Anxiety disorder is characterized by fear of appearing in social settings. At the onset of Cheryl’s there was not fear of social settings such as going to work. However, as the anxiety progressed and she could not cope with managing her emotions subtle fears began to overwhelm her as she began spending more time at work feeling incapable of performing at a high standard. As such, much of the initial symptoms demonstrated at the onset do not fit into the Social Anxiety disorder category. Precisely, symptoms are expressed among children as crying, clinging, failing to talk in public becoming speechless. For adults it is anxiety produced by interacting with others during a conversation or gathering/functions.⁵

Compulsive obsessive disorder presents as hoarding habits and tendencies. It is a type of anxiety whereby individuals engage in repetitive behaviors such as frequent hand washing; ordering another person; checking on persons or even praying. Prior to expressing the behavior pattern individuals try to suppress these recurring thoughts, but they become overwhelming after a time. Importantly these thoughts could begin as obsessions and move towards compulsive demonstrations. Cheryl’s symptoms do not fit into any of these for similarity purposes.

Post traumatic disorder symptoms do not fit entirely either. Symptoms are displayed after exposure to a terrifying situation such as, accidental death of a loved one; or witness a murder scene or consistently viewing frightening movie. Persons display anxiety in the form of irritable behavior fear and reflecting mentally on the scenes and nervousness. Cheryl’s anxiety occurred  three months after her paternal grandfather died, but it was not reported that she saw him experiencing a violent death therefore her symptoms do not fit post traumatic disorder either

3. The most likely diagnoses for Cheryl’s anxiety symptoms must be applied to the DSM axis for accurate evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has five axes. DMS 1: personality disturbances inclusive of neurosis and sexually disoriented symptoms such as homosexuality. It is difficult to align Cheryl’s symptoms according to DSM 1 classifications since the anxiety was not based on sexual activity incapability. However, neurosis is a form of anxiety, which was classified as obsessive compulsive disorder, hysteria and anxiety neurosis. However, the terminology neurosis has been eliminated from DMS 1 classifications to reflect anxiety disorders, which can be considers the most suitable category for Cheryl’s diagnosis.

DMS 11 reflects sexual orientation disorders; mental deficiency; organic brain syndrome and alcoholism. In the symptoms and history offered in this case study Cheryl was not an alcoholic. As such, this category is not applicable for consideration as a diagnosis. DSM 111 includes brain injuries and other medical conditions, which were not reflected in Cheryl’s history neither demonstrated in the symptoms observed. DSM 1V caters for diagnoses relating to psychosocial and environmental contributory factors of the disorder DSM axis V is totally unrelated to Cheryl disorder manifestation since she is an adult and this axis is a Global Assessment of Functioning or Children’s Global Assessment Scale for children and teens under the age of 18.⁶

4. A psychoanalyst would explain Cheryl’s anxiety from Freud‘s (1856-1937) theoretical perspective whereby the death of her paternal uncle may have initiated an anxiety focus related to coping with a loss. The case study did not elaboration on the relationship between Cheryl and her paternal grandfather. However, theoretically it is assumed that Cheryl might have had repressed sexual desires accompanying the outward appearences. No mention was made of a husband or boyfriend either sex partner.

Cognitive behavior theories are also utilized in psychoanalytic evaluations. For example, a perception change is the focus of this application. Cheryl’s perception during these repeated anxiety episodes ultimately related to her job performance. She began spending extra tine at work as long as 14 hours per day feeling that she is inefficient. Therefore, combining her lack of sexual expression, fear of losing her job due to inefficiency and mother’s anxiety problem a self- image distortion has occurred from a psychoanalytic perspective.

5. A behaviour therapist would explain Cheryl’s anxiety by applying the theoretical assumption based on psychodynamics. These assumptions emerge from paradigms posited by Kring, Johnson, Davison & Neale (2013) explaining that anxiety does not occur from one specific source, but a combination of factors are responsible for the symptoms expressed. For example, Cheryl’s anxiety disorders could be linked to the behavior genetics paradigm in clarifying the psychodynamic theory, whereby genes and environment play an important role. This is with reference to the multiple factors creating anxiety.⁷

Precisely, a psychoanalyst would use Cheryl’s mother anxiety history in evaluating reasons for the symptoms she is expressing. This paradigm links the psychodynamic assumption that anxiety may be due to anticipated fear of being unable to achieve goals as was expressed by Cheryl in her job situation. Genetics here is described as genotype that cannot be observed outwardly, but a total of observable behaviors as exhibited in Cheryl’s anxiety presentation is classified a phenotype. It was further explained that phenotype changes over time and is actually interaction among genotype and phenotype producing fear, shame and insecurity.⁸

6. Many other factors ought to be considered in understanding Cheryl’s anxiety disorder that was not clarified in the case study. For example, in evaluating social anxiety the case study mention only her work situation and emergence of the symptoms when in crowded environments. What about when she is interacting with staff? Does interacting with people have any relationships with the outcome? Again her medical conditions must be considered and monitored. Mental illnesses do have a relationship to  anxiety expression. Therefore, these are other evaluations, which ought to be considered beneficial to Cheryl.