Psychosocial Development and Social Anxiety

Biopsychosocial Case Formulation (BCF) Perspective

The BCF perspective considers the 4 P’s of biological, psychological, and social factors: predisposing factors, precipitating factors, perpetuating factors, and protective factors. Predisposing factors indicate vulnerabilities that could represent risk variables in the patient’s presenting issue, such as temperament, attachment style, family history of psychological disorder or prenatal exposure to substance abuse, immigration history, or access to health care. Precipitating factors are typically stressors that precipitate symptoms of the presenting issue, such as medical illness, family or social conflicts, identity crises, cognitive distortions or psychosocial development transitions. Perpetuating factors include conditions within the patient’s life systems that affect the patient’s issue, such as chronic illness, emotional dysregulation, unresolved conflicts, socioeconomic instability, work-related stress, or education hurdles. Protective factors can refer to an individual’s good health, support systems, religious faith, skills, hobbies, likes, abilities, or other factors such as access to outpatient healthcare services that provide positive support and that serve as counteractive agents to the other three P’s (Barker, 1995).

Advantages of the BCF Perspective

The advantages of the BCF perspective are that it provides a holistic view of the patient that facilitates an accurate formulation of how the person came to be presenting with the symptoms he/she shows. It is not the same as a diagnosis, which tells what the patient’s illness is. Rather, the BCF perspective provides an explanation of how the patient may have acquired the illness. It is not a perspective that is narrow, rigid, or fixed in stone. Instead, it is a perspective that is constantly changing and evolving as more information and insight is gained (Krauss Whitbourne, 2019). Another advantage is that it by combining biological, social and psychological risk factors within its view, it enables the person to understand himself more completely and to see how elements from these three areas may be impacting his mental or behavioral health. Finally, a third advantage is that it provides support for complementary interventions that might otherwise go unused, such as animal-assisted therapy, music therapy, or dance therapy, all of which can be shown to help in the areas where the individual may be at risk (Muela et al., 2017).

Biological Risk Factors

Biological risk factors associated with Mike include his Mexican heritage, which places him at risk of feeling marginalized, and his sexual orientation, which could be described as biological predisposition toward atypical sexual behavior. As Mays et al. (2018) point out bisexuality “is a minority within the sexual minority population” (p. 551). Due to his sexual orientation and his Mexican heritage, Mike may have insecurity issues that contribute to his discomfort around others. He has also has a shy temperament.

Social Risk Factors

He has discomfort around authority figures and has no social support system since moving to college. Before college he had only a small group of friends for social support and that is now missing with nothing to fill its place. He feels new people he meets are judging him and focusing only on his flaws, which makes him want to avoid people (Felsman et al., 2019). He is also hyper sensitive of his own quirks, including a tendency to study when he loses concentration. There is no one or nothing in terms of a group forcing him to come out of hiding in his dorm; his attendance at school is not mandatory in the sense that he is obliged to attend, for if he chooses to skip and fail it is on his own account. He has no social connection other than his roommate, whose calls he avoids. Being around new people stresses because he fears what they might think of him, which may contribute to his social anxiety (Jefferies & Ungar, 2020).

Psychological Risk Factors

The transition from high school to college has occurred at a time when Mike is still in the Identity vs. Role Confusion stage of psychosocial development, according to Erikson’s model of psychosocial development (Liu et al., 2017). He is separated from friends and family who know him and whom he knows well. He experiences long periods of isolation in which he plays video games in his dorm room. These long periods of isolation likely reinforce his anti-social feelings (Loades et al., 2020). The persistence of isolation prevents him from developing self-esteem through positive contacts with others who might offer him stable, supportive relationships. There appears to be a lack of empathetic resources in his life, with no indication of having an affinity for a religious group or organization. His cognitive distortions keep him focused only on what he perceives to be his own personal defects and the “stupid” things he says when around others. His chronic negative thoughts and isolative reinforcing environment perpetuate his anxiety and stress. It needs to be better understood what his views of the world are and whether he is internalizing any views without realizing it. There also appears to be a lack of protective factors in his life, such as good coping skills, positive self-image, and no ability to change thought patterns.