Bob Case Analysis of Anxiety

¶ … Bob

Case Analysis of Anxiety Disorder, OCD and Agoraphobia in Bob Wiley

Developing a treatment course for the multiphobic individual carries a number of inherent challenges. Particularly, the treating therapist must work to prioritize the issues of most pressing importance for the patient. This requires a comprehensive assessment of the presenting cognitive dissonances in the individual and some examination of the root causes of the subject's state of general phobic disorder. In the assessment below, the patient under consideration presents with a number of phobic disorders that imply some underlying trauma. The assessment will provide an appropriate course for diagnosis and intervention.

Short Synopsis:

At the center of the case assessment is a historical vignette which helps to contextualize the patient's set of interceding disorders. After a long and sustained period living as a recluse with no apparent source of employment and companionship only with his pet goldfish, Bob Wiley determined to seek treatment from the emergent therapist Dr. Leo Marvin. Over the course of a single session, the therapist provided sparse counsel through a methodology which he had coined, called Baby Steps. Due to the success of the text which shared that name, Marvin had been preparing to take his family on vacation. Mr. Wiley, instantly compelled by Marvin's philosophy of incremental steps toward mental health, develops severe and insecure attachment to his new therapist and consequently invades the private life of the therapist. This denotes a clear crisis situation and, in spite of the social and emotional progress which the subject appears to make, the inappropriate nature of his behavior and relationship with the therapist denote that there is a need for treatment intervention at this juncture.

Subject:

The crisis in question concerns Bob Wiley, a 41-year-old Caucasian male who is unmarried, unemployed and appears to have no significant personal social network of family for support.

Presenting Problem:

Mr. Wiley presents in his first meeting with Dr. Marvin as possessing a wide range of phobias with many overlapping dimensions. From the outset, it is clear that Mr. Wiley possesses some manner of general depression coupled with a persistent anxiety disorder. The subject's relative lack of professional or personal motivation, limited interest in his social appearance and a failure to interact on a functional and healthy level with other individuals all suggest depression. More specifically though, Mr. Wiley exhibits a number of characteristics that point to particular conditions on the depression spectrum

Many of the symptoms Mr. Wiley displays are classic indicators of an Obsessive Compulsive Disorder (OCD). According to the DSM-IV (2010), behaviors such as Wiley's adherence to repetitive patterns, his preventative germ phobias and his avoidance of otherwise non-threatening and ordinary situations all denote a proclivity toward compulsion. The DSM-IV defines compulsion, in part, as a condition in which "the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive." (DSM-IV, p. 1)

Among these excessive behaviors is the emergence of several phobic responses. These imply that the patient has begun to exhibit increasingly irrational and anxiety-driving patterns in his lifestyle and behavior. Mr. Wiley's agoraphobia is a matter of particular concern as this defensive response to his anxiety disorder has prevented the subject from engaging a normal, health, active, productive life. According to A.D.A.M. (2010), "panic disorder with agoraphobia is an anxiety disorder in which there are repeated attacks of intense fear and anxiety, and a fear of being in places where escape might be difficult, or where help might not be available. Agoraphobia usually involves fear of crowds, bridges, or of being outside alone." (A.D.A.M., p. 1) The fear of the outside world has inclined the subject in this case to increasingly shut himself off from others and from opportunities to experience life. The result, A.D.A.M. (2010) reports, is a deepening sense of isolation and a further descent into the irrational response mechanisms that have come to control Mr. Wiley's life.

Demographic Implications:

One major demographic concern for Mr. Wiley might be fear of the stigma connected to seeking therapy as an adult male. For one who fears constantly the loss of control in his own life, giving one's self over to the support of therapy may be challenged by certain cultural constructs.

Crisis Intervention:

That said, because Mr. Wiley has actively sought out the assistance of Dr. Leo Marvin, it is reasonable to assess that he is prepared to obtain the help needed to make improvements. Thus, it is first necessary to provide the subject with a number of coping mechanisms relating to the onset of panic. Here, cognitive behavioral therapy is recommended in the text by A.D.A.M. And implies the need to alter reflexive panic responses to triggers such as crowds, unfamiliar social situations or situations that disrupt routinized behavior. A.D.A.M. also indicates that pairing this with anti-depressant pharmacy treatment is also common.