Key information from the case study
Often, an anxiety disorder precedes an eating disorder, which might be Anita’s case. At this point, her eating-related behaviors are moderately problematic (distorted body-image, emotional eating, a sense of lack of control during eating). Nonetheless, if not appropriately addressed, there is high likelihood that these early signs will develop into a full-blown eating disorder (bulimia nervosa / anorexia nervosa).
Possibly co-occurring: Body Dysmorphic Disorder and (mild) Substance Use Disorder (DSM-5, APA, 2013).
Primary Diagnosis
Generalized Anxiety Disorder
There is a strong possibility that Anita suffers from GAD.
Individuals with GAD experience perpetual, chronic and most frequently unfounded worry. In some cases it disrupts work, studies, social activities. Physical symptoms include gastrointestinal discomfort, muscular tension, fatigue, restlessness, edginess, difficulty getting sleep, irritability.
Because many of the GAD symptoms overlap with depressive disorders, a proper diagnosis is often complicated. 45% of anxiety disorders are improperly identified and misdiagnosed as somatic issues. Interestingly, the main symptom is pain or even difficulty getting sleep, and not anxiety (Gilespie, 2015).
In order to make an appropriate diagnosis of Generalized Anxiety Disorder all of the following symptoms must be observed:
Excessive worry and anxiety, present for at least 6 months, more days than not, regarding a variety of events
Difficulty controlling the sense of worry
The worry or anxiety are connected to at least 3 of the six symptoms bellow:
Restlessness, edginess
Easily tired
Problems concentrating
Irritability
Sleep disturbance
Muscular tension
The anxiety produces clinical distress or impairment of normal functioning
The disturbance is not caused by the effects of a medical condition or of a substance
The dysfunction is not more properly explained by another medical disorder (APA, 2013 cited in Gilespie, 2015).
At first sight, Anita meets all the criteria for GAD- however, multiple considerations must be refined before reaching a proper conclusion (eliminate the possibilities that her anxiety-related complications are not caused by another medical disorder or her substance abuse problems).
Secondly, let us take a look at Substance Use Disorder, as defined by DSM-5.
In DSM-5 (APA, 2013), Substance Use Disorder is defined by a problematic use of an addictive substance that impair daily life functioning and produces significant distress. For an individual to be diagnosed with a disorder because of a substance, they must be show 2 of the 11 symptoms within 12-months:
An increased consumption of alcohol/other substance compared to a previous time
Worrying about ceasing or failing to control one’s consumption behavior
Spending a large amount of time using substances
The use of these substances has as an effect a failure to fulfill role obligations (work, school, home)
Craving
Continuing using them in spite of health problems caused by them
Continuing using them despite them having a negative impact on their relations with others
Use in a dangerous context (while driving, for instance)
Normal activities are affected by consumption
Building up tolerance
Withdrawal symptoms
Simulations
There is no strong reason to consider that a Depressive Disorder is the root of Anita’s complications. Social Anxiety Disorder might co-occur with Anita’s Generalized Anxiety Disorder (our primary diagnosis) but most likely does not constitute her primary diagnosis (which we consider to be GAD, in this case). Other co-morbidities include, but are not limited to, Body Dysmorphic Disorder and Substance Abuse Disorder (a more specific diagnosis according to DSM-5 can be made based on the particular substances Anita abuses- Stimulant Use Disorder, Alcohol Use Disorder etc).
Since GAD’s co-morbidities include substance abuse disorders, other anxieties, bipolar disorder or major depression, it is important to analyze the connection between her anxiety symptoms and her substance abuse problem (cause or effect?).
II. Developmental and Cultural Considerations
In order to properly address her GAD and find efficient treatment avenues, we must explore any developmental issues that might have contributed to her developing an anxiety disorder (impact of peer relations, family environment and so on).
As for cultural considerations, DSM-5 demonstrates a greater cultural sensibility compared to earlier editions by updating its criteria to mirror transcultural variations in symptom presentation and offering a more detailed view of cultural concepts regarding distress (APA, 2013). Finally, DSM-5’s cultural formulation interview would help us accurately assess any potential cultural factors that might influence Anita’s treatment possibilities and her perception of her own symptoms.
III. Key Avenues for Treatment
According to NHS, the initial treatment for GAD is constituted by a self-help course suggested by the practitioner for a period of one or two months in order to help the patient cope with their anxiety.
Secondly, in the situation that the initial treatment does not seem to give positive results, the patient will be presented with the option of following more intense psychological treatment or medication, as following: CBT (cognitive behavioral therapy, probably the most efficient treatment for GAD, whose benefits can outlast those of medication), Mindfulness and applied relaxation (as effective as CBT). As for medication, the main ones that are used to treat GAD are SSRIs, SNRIs or Pregabalin (an anticonvulsant, in case SSRIs and SNRIs are unsuitable), benzodiazepines.
IV. Personal Reaction
A seemingly simplistic case like Anita’s has the potential to reveal the complicated process of making an accurate diagnosis and of grappling with the intricacies presented by comorbid disorders. Overall, a great exercise in psychological analysis. The presence of a wider number of details regarding Anita’s background would have made for a more confidant diagnosis.
Bibliography
American Psychiatric Association. (2013). Cultural Concepts in DSM-5. online: American Psychiatric Association http://www. dsm5. org/Pages/Default. aspx.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.
Gilespie, B. Generalized Anxiety Disorder. Retrived from http://www.theravive.com/
on 22/04/15.
