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Rationale (what did you see that supports the diagnosis?)
Client is a 29-year old female who is obsessively concerned about her safety. She meets diagnostic criterion A due to the presence of recurring thoughts. The client believes she is being constantly watched by people. The thoughts are distressing for Debra; therefore, she attempts to suppress them by performing compulsions. The womans compulsions take the form of regularly checking locks and light switches.
The behaviors are not realistically connected to the anxiety that the client tries to alleviate. Debra meets criterion B because her compulsions take more than one hour per day (APA, 2013). Furthermore, the presence of obsessions and compulsions leads to a substantial distress in her social and occupational functioning (APA, 2013). For example, the compulsive rituals interfere with her work and limit her social interactions. The woman meets criterion C because she does not have any underlying medical conditions and substance abuse issues (APA, 2013). The clients symptoms cannot be attributed to another mental disorder (Criterion D). Debra does not recognize that the delusional beliefs are not true.
Developmental Disorder(s): No diagnosis
Rationale (what did you see that supports the diagnosis?)
The client has a BA degree and is gainfully employed, which is evidenced by her lack of financial concerns. Debra was able to name both the current and past presidents. She was alert during the interview.
Personality Disorder(s): No diagnosis
Rationale (what did you see that supports the diagnosis?)
The clients symptoms fall under four diagnostic criteria for obsessive-compulsive disorder. Debra shows no signs of other personality disorders.
Medical Disorder(s): No diagnosis
Rationale (what did you see that supports the diagnosis?)
Debra regularly exercises and does not have an eating disorder. She adheres to her diet and eats well. The client states that she does not have medical issues and does not take medications. Therefore, it is not possible to diagnose any underlying medical disorders.
Client Strengths
- Debra is alert, young woman who has successfully pursued a bachelors degree.
- The clients mother is extremely supportive and shows considerable concern over her wellbeing.
- The woman reports engaging in a regular exercise, which is a considerable strength since purposeful physical activities are associated with a lower risk of developing chronic illnesses. Furthermore, regular exercise is a source of stress relief. Another mental benefit of physical activities is anxiety alleviation.
- Debra is willing to build a social life.
- The woman had a normal childhood.
- The client is an active member of a church, which can provide her with additional support.
- Debra maintains a healthy diet, thereby avoiding weight disorders.
- The client is gainfully employed, which reduces her exposure to unexpected financial challenges.
- Debra does not report experiencing suicidal thoughts.
- The woman is not concerned about her physical appearance.
Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations which helped you with your diagnostic decision making
General anxiety disorder has been considered as a differential diagnosis. However, the diagnosis was discarded because the patient does not meet key criteria such as fatigue, muscle tension, and sleep disturbance (APA, 2013). Avoidant personality disorder is also not applicable to the case because the client reported seeking social interactions. In addition, Debra regularly visits a church and does not regard herself as being personally unappealing.
Obsessive-compulsive disorder can be misdiagnosed as anxiety; therefore, she was assessed with regard to the accuracy of her convictions (Grant, 2014). The absent insight in the presence of delusional beliefs helped to distinguish obsessive-compulsive disorder from other anxiety disorders. The woman might have experienced physical abuse from her former boyfriend, which is a stressful event that can contribute to the development of the disorder (APA, 2013).
References
APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Grant, J. (2014). Obsessive-compulsive disorder. The New England Journal of Medicine, 371(1), 646-653.
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