DSM-5 diagnostic criteria and treatment approaches for anxiety and related disorders

DSM-5 Case Study Answers

Case Studies

Allyson

Using DSM-5 criteria, it appears Allyson may be suffering from social anxiety disorder, known as social phobia under DSM-IV (dsm5.org, 2016a). There are 7 symptoms listed under 300.23, the first is a fear of social or permanence situations, where there may be the scrutiny of others, and there is a fear of embarrassment (DSM5.org, 2016). Under DSM-IV, there was no timeframe, under DSM-5 this must be for at least 6 months, which we may assume is the case with the ongoing medication. There may also be reason to consider substance abuse, with increasing use of the drugs.

Karen

Karen should be considered under the substance use disorder. Two - three symptoms out of 11 listed, in DSM-5 there is no differentiation made between abuse and dependence (dsm5.org, 2016b). If Karen was drinking all the time, it is likely she was craving, or had a strong desire to use alcohol, it is also likely that the drinking levels may be the result of a second symptom of tolerance; both diagnostic criteria (Bergland, 2015). However, Karen has stopped drinking, and does not fit any of the other 9 criteria. Therefore, this is a borderline case.

3. Mary

Mary has developed mysophobia, which is a fear of germs. However, the DSM-5 condition is classified under obsessive compulsive and related disorders, which is no longer under the anxiety disorders. As Mary is undertaking a constant ritual of washing her hands, which is a compulsive act, this is also seen with the constant urge for house cleaning and her expressions of the need for cleaning that indicate a high level of anxiety. However, care should be taken to ensure that underlying cause is not a depressive disorder, which can occur concurrently and account for the symptoms (dsm5.org, 2016c).

Part 2: Treatment Scenarios

1. Anxiety disorder

There are several types of anxiety disorder (SAD), one is separation anxiety. Separation anxiety is normal children between 3-4 years, and needs to occur for at least 4 weeks, or in adults more than 6 months (Schneider et al., 2011). Early intervention are beneficial; those suffering as children are likely to suffer as adults (Schneider et al., 2011).. A sound approach is cognitive behavioural therapy (CBT), which should include the use of role play and storytelling (Schneider et al., 2011).. For children the use of family therapy and creative therapies may also be useful (Schneider et al., 2011).

3. Differentiating Anxiety and OCD from Substance Induced Disorders

Differentiating between anxiety and OCD symptom that are caused by the use of other substances, and symptoms that indicate a primary condition can be problematic. The first consideration should be the full medical history that has been taken, and the presence of other substances on that history; both prescription and non-prescription substances. Where an individual is unable to answer, there are tests which may be used to assess if there is exposure, remembering that there is a potential for unrealised exposure; these may include blood and hair tests. However, tests should only be undertaken with relevant permissions and authority to avoid ethical breaches. If symptoms are present without any potential substance causes the anxiety or OCD may be the primary condition. If substances are present the patient should be further examined to determine the causes.