Social workers take particular care when diagnosing anxiety due to its similarity to other conditions. In this Discussion, you carefully assess a client with anxiety disorder using the steps of differential diagnosis. You also recommend an intervention for treating the disorder.
To prepare: Read “The Case of Emily P.” Review the decision trees for anxiety and OCD in the Morrison (2014) text and the podcasts on anxiety. Then access the Walden Library and research interventions for anxiety.
Post a 300- to 500-word response in which you address the following:
- Explain your own diagnostic decision tree with a brief rationale for any elimination of close differentials for the case of Emily.
- Provide the full DSM-5 diagnosis for Emily. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention).
- Describe an evidence-based assessment scale that would assist in ongoing validation of your diagnosis.
- Recommend a specific intervention and explain why this intervention may be effective in treating Emily. Support your recommendation with references to scholarly resources.
The Case of Emily P.
Emily is a 62-year-old, single, heterosexual, African American female who seeks treatment for anxiety. She says she often hears a female voice directing her to punish herself by tweezing the hair from her head or by scrubbing her home clean. She reported that tweezing her hair eases her anxiety. Emily reports that germs have been a milder but regular concern of hers since adolescence, when she learned in health classes about the risks of serious diseases “like HIV.” Emily presented with meticulous grooming, although the knees of her pants were noted as worn. She has arthritis in her spine and knees and uses a walker to help her manage mobility safely.
Emily receives Social Security income and is not employed. She lives alone in a subsidized apartment in the same building as her 72-year-old, unmarried sister.
Emily and her sister shared an apartment for over 30 years, beginning when each of their marriages dissolved. Emily reported that when her sister began a romantic relationship 5 years ago, Emily began to feel very anxious and started to cry often. Emily moved into an apartment down the hall in the building and began to tweeze the hair from her head, hiding her hair loss by wearing wigs. This behavior occured at different times and resulted in scabbing. Emily said she feels better after but does not always notice how much she is pulling. Her sister learned of Emily’s tweezing after her wig slipped off one evening to reveal bald spots. Her sister encouraged Emily to seek treatment rather than “hiding her ways.” Emily is reliant upon her sister for transportation and for a sense of social and emotional connection. She agreed to this session even though she is pessimistic about anything working.
During our initial visit (at a local mental health center), Emily shared that when she was 2 years old her mother died from tuberculosis, and the following year her father, an army officer, died from colon cancer. After his death, Emily lived with her paternal aunt, from whom she felt no love. Her older brother and sister were placed in an orphanage, and Emily was permitted to see them on Sundays. When it became apparent that the children were entitled to death benefits, Emily’s aunt agreed to take custody of all three siblings. The household then consisted of Emily’s paternal aunt, her husband (who Emily described as an alcoholic), their three children, and Emily and her two older siblings.
Emily was briefly married in her early 20s (4 years) but was disappointed and hurt by her husband’s infidelity. She moved in with her sister at that time. Emily reported it as an “anxious” time but denied tweezing then. Emily also enrolled in a cosmetology school and liked her work. She had to stop working “for health reasons” when she was 58 years old.
When asked what her behaviors are with her hair, Emily reluctantly admitted that if she cannot get to her hair she will pick at a scab or skin. Generally, she avoided social situations so that her behavior is not exposed. She denied other behavior rituals but became noticeably anxious at this question. When asked about “goals” if treatment was to be effective for her, Emily stated that she wanted to “cope better” and to “stop
listening to the punishment voice.” Emily was collaborative during this assessment and engaged after a reluctant start.
Adapted from: Plummer, S.-B., Makris, S., & Brocksen, S. (2013). Social work case studies: Concentration year. Baltimore, MD: Laureate Publishing.