Position Papers

Christine Hawk
Abnormal Psychology
Section 003 “Joseph”
Axis I: Panic Disorder with Agoraphobia Social Phobia General Anxiety Disorder
Axis II: No diagnosis
Axis III: Gastrointestinal problems Severe headaches Chest pressure & trouble breathing
Axis IV: Recent panic attack while shopping
Axis V: Current GAF: 61 Joseph presents as a neatly groomed, friendly and successful man in his thirties. He is very concerned with the appearance of what he considers normalcy. He is a successful insurance salesman who has been divorced but is currently engaged to an older woman. His former wife was the same age as Joseph with very outgoing and social tendencies. He was motivated to seek professional help because he suffered a panic attack while Christmas shopping with his fiancé. He was fine even though he had always been uneasy in large crowds, a symptom of agoraphobia. H suffered tremendous chest pressure and felt like he was going to smother. The physical symptoms were also joined with severe apprehension which shares comorbidity with General Anxiety Disorder and Social Disorder. Joseph is able to function at work and even excel although he admits that he suffered extreme worry about each meeting, wondering if the clients would like him or could he make the sale. None the less he was able despite his anxiety to meet and even exceed his sales quotas often. Some of the expectations that Joseph put on himself and causing his anxiety is related to the perfectionism that his father expected from Joseph and that Joseph felt he could not satisfy. His childhood seemed uneventful, except for his father’s high expectations. He was shy but had friends and even participated in drama club. His first signs of panic came in college especially during testing. This was also attributable to his feeling that he was not meeting the high standards of excellence that his father had ingrained in him. This high standard became unattainable for Joseph and he would even go blank during tests in college. This symptom is one of generalized anxiety disorder and also panic disorder and social disorder, thus the comorbidity. His physical symptoms escalated during his second year in college, manifesting themselves in gastroenterological ways such as constipation, cramping and diarrhea. He sought medical help but no evidence of physical impairments was found and he was diagnosed with irritable bowel syndrome and given medication. After leaving college due to his inability to meet his own and his parent’s standards of achievement, he and his first wife married. They both were achieving success in their separate fields but her advancement was dependent on Joseph’s ability to socialize with her co-workers and he was unable to do that due to increased physical symptoms and fear of gastroenterological events presenting while he was in a social situation. Although, this type of worry about being embarrassed in public is usually associated with social phobia and presents in panic attacks, Joseph seems to present with bits from all three conditions. He also admits to problems with sleeping such as difficulty staying asleep and unsatisfying sleep. Joseph met his new fiancé four years after his divorce and because she is somewhat older and

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