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Discussion 3

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Discussion 3
Part 1: Ka-Sean
1. F41.1: Generalized Anxiety Disorder (GAD)
Description: Patients with Generalized Anxiety Disorder (GAD) always seem to worry
excessively and cannot control the excessive worry. The physical symptoms of this disorder are
restlessness and muscle tension for more than six months (APA, 2022).
Criterion A: There are several things that Ka-Sean worries about, be it her relationships
or academic success. For almost 80% of her adult waking hours, she worries every day (APA,
2022) and the worry lasts long.
Criterion B: She states she cannot manage worrying thoughts (APA, 2022).
Criterion C: It fatigues her, and she has sleep disturbances, restlessness, and tautness in
the muscles. Additionally, regarding how her focus only extends one step, APA (2022) states that
she can get distracted by tasks with more than one step.
Criterion D: She has clinically significant distress due to anxiety experienced and other
related symptoms, though they cause difficulty in her academic performance and work history
(APA, 2022).
Criterion E: There is no way to connect the symptoms with the physiological effects of
any substance or with another medical condition, such as hyperthyroidism (APA, 2022).
Criterion F: No other mental disorder symptoms precisely match the symptoms. The
worry pattern goes beyond panic attacks (panic disorder), social evaluation fears (social anxiety
disorder), and obsessive thoughts (OCD) (APA, 2022).
F41.0 – panic disorder
Criterion A: The unexpected panic attacks strike her repeatedly and induce shaking
hands as well as dizziness alongside rapid heartbeats and chest tightness, together with breathing
difficulties that result in complete body immobility. The emergency room became the first
destination after Ka-Sean experienced his first panic attack (APA, 2022).
Criterion B: After each panic attack, she tries to be hypervigilant and anxious, as her
anxiety is that she will have another one (APA, 2022).
Criterion C: Panic attacks are not a separate mental disorder because they do not take
place in social circumstances or due to obsessive thoughts (APA, 2022).
Criterion D: Panic attacks (APA, 2022) do not result from any other mental disorders,
including social anxiety disorder, specific phobia, and PTSD.
Criterion E: APA (2022) states that disturbance is not due to physiological effects of
substances or other medical conditions.
2. Differential Diagnosis:
 Panic Attack Specifier: APA (2022) demonstrates that KA-Sean does not qualify for the
panic attack specifier because her condition consists of multiple panic attacks among her
full-blown GAD diagnosis.
 Obsessive-Compulsive Disorder (OCD): APA (2022) states that she displays ruminative
thoughts instead of intrusive obsessions and does not perform any compulsive behavior.
3. Questions for Additional Clarification
1. At what age did she first experience panic attacks and excessive worrying?
2. Has Ka-Sean ever gone through a duration exceeding six months without exhibiting
anxiety symptoms?
3. Do her panic attacks have identifiable triggers?
4. Z and T Codes (DSM-5-TR)
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Z63.0 describes the relationship distress among spouses or intimate partners (APA,
2022).
Z60.5 – Target of persistent discrimination or persecution (APA, 2022).
Z91.49 marks the personal history of psychological trauma (APA, 2022).
5. Relevant Psychotropic Medications
Alprazolam (Xanax) is used by Ka-Sean as needed; it is a benzodiazepine. The
medication provides short-term benefits, but long-term strategies of treatment for GAD and
panic disorder encompass:
• SSRIs (sertraline, escitalopram): Because SSRIs have been demonstrated to reduce
worry and physical symptoms (Kress & Paylo, 2019), these drugs constitute primary treatment
options for GAD and panic disorder.
• SNRIs (venlafaxine): Also effective for GAD and panic symptoms (Kress & Paylo,
2019).
6. Ethical and Cultural Considerations
Ethical (ACA Code A.2.d):
As an African American lesbian, Ka-Sean is a marginalized group that requires cultural
competence and understanding by practitioners. Professionals in ethical counseling must obtain
informed consent from their clients and keep their information and identity confidential (Kress &
Paylo, 2019).
Cultural Considerations:
Her brother rejected Ka-Sean due to family tensions about her sexual orientation, which
resulted in growing anxiety and made her more vulnerable to rejection sensitivity. Who she is is
what informed her understanding of mental health, namely her racial background and her
religious beliefs (Kress & Paylo, 2019).
Why GAD?
Symptoms experienced during an episode of GAD would include the symptoms seen in
Ka-Sean.
· She worries about all domains, such as health status, personal relationships,
academic performance, and plans (APA, 2022).
· However, even when reassured by others, she is unable to control her anxiety
(APA, 2022).
· She has mental distress that includes fatigue, muscle tension, restlessness,
sleep difficulties, and stomach problems, which may eventually result in the onset of a stress
ulcer (APA, 2022).
· She is also affected by anxiety disorder in her professional life as well as her
educational and social life (APA, 2022).
Why Panic Disorder?
However, suddenly, panic attacks from Ka-Sean include severe physical symptoms like
chest tightness, heart palpitations, and difficulty breathing (APA, 2022). She still fears and says
that this will lead to her having emotional distress in the future when having panic attacks (APA,
2022).
Not Other Anxiety Disorders?
• Social Anxiety Disorder: She does not avoid social situations. Issues of general concern
also encompass her anxiety, which surpasses performance-related or social situation judgments
(APA, 2022).
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• Agoraphobia: For her, panic attacks occur without any reference to places or incidents
(APA, 2022).
• Specific Phobia: She is anxious and has no relevant object or situation that triggers the
anxiety (APA, 2022).
• Obsessive-obsessive-compulsive disorder (OCD): There is no correlation between any
obsessive thought or compulsive action and her rumination activities (APA, 2022).
tack Specifier: The frequency and severity of panic attacks must result in functional
impairment to make a separate diagnosis of panic disorder, even if they occur in an anxiety
disorder such as GAD (APA, 2022).
Obsessive-Compulsive Disorder: Compulsions vs. Obsessions
An obsessive, according to Kress and Paylo (2019), has intrusive thoughts or images that
make them feel very uncomfortable with anxiety. These thoughts contradict people's self-
concept; therefore, they suffer from these thoughts. However, they know it is illogical, and they
cannot stop them. Compulsions are repetitive behaviors or mental rituals done to reduce distress
related to the obsessions or prevent feared outcomes. These behaviors are not logically linked to
the results and may be excessive (Kress & Paylo, 2019).
What stood out: What might look like a mental exercise might appear in compulsive
actions. Compulsive behaviors involve any mental task, such as counting and silent word
repetition, while recalling past events to get reassurance. It prevents counselors from missing
them during clinical assessments by directly questioning them about subtle compulsions (Kress
& Paylo, 2019).
Time/Duration Factors in OCD Diagnosis
OCD symptoms must:
· The process is more than one hour (Kress & Paylo, 2019).
· The condition involves substantial social and work environment and other life
areas distress and disability (Kress & Paylo, 2019).
· There is no explanation for her symptoms that would be more appropriate than
some other mental disorder (Kress & Paylo, 2019), and she cannot be attributed to the effect of
drugs or other physical health problems.
Part 2: Case Analysis — Joseph
1. F40.10 – Social anxiety disorder (Social Phobia)
According to APA standards (2022), people with social anxiety disorder are very fearful
of or anxious about situations where they encounter others, such as interacting with them,
speaking to them, and observing others. Additionally, the diagnostic criteria of Joseph mentioned
below are all the complete diagnosis of a person with that condition:
Criterion A: Joseph has social phobia, for he is concerned about being made fun of by
people because of his age (growing old) and gradual deterioration of his vision and hearing
(APA, 2022).
Criterion B: He has a recurrent theme of being viewed as having disabilities or less
capable (APA, 2022).
Criterion C: These scenarios tend to elicit anxiety nearly all the time (APA, 2022).
On Criterion D, he either does or changes to contend with the activity of large
assemblies and social get-togethers and with extreme disturbance (APA, 2022).
Criteria E: His level of fear is much greater than the actual threat he faces (APA, 2022).
Criterion F: Some months after his retirement (APA, 2022), the symptoms have
persisted for a couple of months.
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Criterion G: It prevents him from enjoying his retirement and prevents him from doing
hobbies with his wife (APA, 2022).
Criterion H: The symptoms (organs involved) cannot be due to using a substance like
drugs or a medical condition (APA, 2022).
Criterion I: Other mental disorders (panic disorder, dysmorphic disorder, or autism
spectrum disorder—APA 2022) cannot explain his condition better.
2. Differential Diagnosis
Generalized Anxiety Disorder (GAD)—In other words, Joseph’s anxiety is restricted to
social situations and not to other actions or subject matters (APA, 2022).
Panic Disorder—Since he does not experience recurrent, unexpected panic attacks (APA,
2022), he runs out of panic disorder.
Agoraphobia—Joseph has not been diagnosed with agoraphobia because his anxiety is
linked to fear of being judged, not fear of getting in certain situations (APA, 2022).
3. Additional Questions
1. At what age did Joseph begin to demonstrate signs of social anxiety?
2. Have you ever had panic attacks in crowds or physical manifestations while
socializing?
3. How much does his anxiety interfere with his day-to-day life?
4. Has he withdrawn from social and family activities he used to enjoy?
4. Relevant Z/T Codes
Z63.0 – Relationship issues with wives, husbands, or significant others use problems
(APA, 2022).
Z60.4: Disconnection and ostracism (APA, 2022).
Z55.9— Academic or educational problem (adjustment to retirement from the academic
role) (APA, 2022).
5. Relevant Psychotropic Medications
Research on drugs such as sertraline and paroxetine show that they are therapies that are
used often to treat Social Anxiety Disorder because they have proven successful in the relief of
symptoms of anxiety, as elaborated upon by Kress & Paylo (2019). Beta-blockers are used in the
treatment of performance-related anxiety. Patients also experience relief in symptoms when used
as an adjunct to psychotherapy (Kress & Paylo, 2019).
6. Ethical Considerations—ACA Code A.2.d: Counselors of their clients shall respect
cultural values and identity. Joseph’s chokecherry status as a Cherokee defines his views
regarding mental health, emotional expression, and culturally relevant techniques
(American Counseling Association [ACA]; 2014; Kress & Paylo, 2019).
Cultural Consideration: In other words, Indigenous people who experience mental
health issues regularly face stigma around mental health or a non-conforming view of mental
health terms. Joseph’s cultural strengths, such as family ties and religious beliefs, are used in
treatment design, and trust and therapeutic alliance are built (Kress & Paylo, 2019).
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental
disorders (5th ed., text rev.)
Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive
approach to case conceptualization and treatment (2nd ed.). Pearson.