Anxiety, Trauma, and Obsessive-Compulsive Disorders

Anxiety, Trauma, and Obsessive-Compulsive Disorders

Anxiety, Trauma, and Obsessive-Compulsive Disorders all cause people to behave abnormally in certain situations. The goal of this paper is to examine case studies provided by Capella University and compare them to the American Psychological Association’s DSM-5. This paper will also examine Fred’s treatment options and analyze a peer-reviewed article about his condition.

Fred’s Case is Diagnosed

Fred has experienced emotional upheaval throughout his life. Years ago, before coming out to his family as a homosexual, he was distressed. He also went through some emotional turmoil in the last year because he and his partner want to marry, but Fred isn’t sure what his family would think about it. He has recently been having daily panic attacks before work and shortly after leaving work. He was robbed at gunpoint on the subway four months before his panic attacks. He no longer takes the subway to and from work because he considers it unsafe (Capella University).

Because Fred has daily panic attacks, he may be diagnosed with Panic Disorder at first glance. However, when we look at the Panic Disorder diagnosis factors, we see that, while his symptoms clearly align with most of the diagnosing factors, such as a drastic change in behavior to avoid unfamiliar situations (i.e., not taking the subway), it is clearly stated that, in order to be diagnosed with Panic Disorder, the patient’s panic attacks must not be triggered by another mental disorder (APA, 2014).

Although Fred had previously experienced emotional stressors, the panic attacks began after he was robbed at gunpoint. It is also critical to keep track of when his panic attacks occur. They only occur before work and before he leaves. This demonstrates that he is concerned about something related to his commute to and from work. He actively avoids the subway because he considers it too dangerous, despite the fact that riding his bike is significantly more inconvenient. Although these symptoms are shared by Phobia and Posttraumatic Stress Disorder, the correct diagnosis is Phobia of being assaulted on the subway. The Disorder would not be classified as PTSD because, despite the similarities in symptoms, Fred has shown no dissociative reactions such as flashbacks, has not complained of dreams about the incident and appears to be otherwise distressed.

Phil’s Situation

Phil’s case exemplifies Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder in the absence of insight (APA, 2014). Phil quit his restaurant job because it was too messy, and he had to spend hours showering afterward. This is an example of over-washing, which is a time-consuming process. He was also fired from his next job for failing to perform his managerial duties due to his constant folding and rearranging of clothes, a task he was supposed to delegate to an employee below him. This is an example of repetitive behavior that impairs his ability to perform effectively at work. He has been unable to keep a job due to his obsession with things being neat and clean, and he has had no insight into his OCD tendencies thus far. OCPD can also be diagnosed because it was present in his relationship with his ex-wife. She claimed he was too controlling and a perfectionist, becoming enraged when she didn’t put things in their proper places. Phil has no understanding of his OCPD because he claims he doesn’t understand what she means and doesn’t see the abnormality in his behavior (Capella University).

Case of Stacey

Stacy never had many friends growing up because her best friend moved out of state in fourth grade, making her a target for bullying. It was also stated in her case that her husband chastised her for having no personality. She only interacts with people now when she is working the cash register and going to and from work on a regular basis. She also claims that she prefers to spend her time with her pets rather than interact with people (Capella University). Her avoidance of interaction with others due to her fear of criticism, as well as her unwillingness to be involved with others unless she is certain she is liked, are symptoms of Avoidant Personality Disorder (APA, 2014). Stacey also exhibits symptoms of Social Anxiety (APA, 2014), as she fears being mocked in social situations, avoids social interaction, and her fear and anxiety are exaggerated. Stacey also discusses her apprehension about public speaking (Capella University). Her paralyzing fear of even thinking about public speaking, her avoidance of the activity by dropping all of her classes, and her exaggerated anxiety are all symptoms of public speaking Phobia. She exhibits no symptoms of Obsessive-Compulsive Disorder.

Treatment Options for Phil

Medication, exposure therapy, and cognitive behavioral therapy are some of the treatment options for OCD (Kerr, 2011). The results of a 52-week study with sixty-two adults that focused on cognitive treatment versus behavioral treatment revealed that behavioral treatment has the greatest slope change in OCD symptom severity overall (Olatunji et al., 2013, p. 423). This means that the behavioral treatment group’s OCD symptoms improved faster than the cognitive behavioral group’s. Based on the findings of this study, I would advise Phil to consider behavioral treatment. Exposure and ritual prevention therapy (ERP) (Olatunji, Rosenfield, Tart, Cottraux, Powers, & Smits 2013 419) is the type of behavior treatment I would consider, with intense sessions for the first four weeks and waning in time and consistency for the remaining weeks to ensure progress. Exposure to situations in which Phil’s rituals would be triggered would constitute the ERP. For Phil, this would be things out of order, getting a dirty substance on his hands, or a pile of unfolded clothes. His therapy goals would be to teach him to be less anxious about such things, to wash clothes for the appropriate amount of time, and to leave them alone. These rituals may include family members and/or his ex-wife.

Brenda Key et al. completed a study whose goal was to assess the impact of mindfulness-based cognitive therapy as an additional augmentation treatment after cognitive-behavioral treatment (Key et al., 2017, p.1109). The authors of this study hypothesize that with this additional treatment, patients’ anxiety, depression, and obsessive beliefs will be less severe. Furthermore, the authors argue that the patients’ mindfulness skills will improve, which will be associated with the reported decreases in their symptoms. They also believe that patients will be pleased with the intervention (Key et al., 2017, p. 1111).

The study’s method included thirty participants. Interventions and questionnaires were given to the participants. All of their hypotheses were supported in the end, with the exception of the fact that increased mindfulness correlates with a decrease in the participants’ symptoms, for which there was no strong correlation reported. Based on the findings of this study, I would also recommend mindfulness-based cognitive therapy following behavior therapy if Phil is still experiencing severe symptoms.

If Phil’s symptoms do not improve after his behavioral treatment, I recommend prescribed medication as an additional form of treatment. Anafranil is a tricyclic antidepressant that has been shown to be effective (Greenberg, 2018). Prozac and others are examples of potentially effective selective serotonin reuptake inhibitors (Greenberg, 2018). Phil may want to try different medications if he experiences side effects from the medication that his psychiatrist or physician recommends. Each medication may take six to ten weeks or longer to produce noticeable results (Greenberg, 2018).

Journal Analysis of Obsessive-Compulsive Disorder

Saleem Tamkeen et al. conducted a study to determine whether obsessive-compulsive Disorder reduces the quality of life. The study also investigates whether obsessive-compulsive Disorder combined with comorbid psychiatric disorders such as bipolar Disorder, depression, schizophrenia, or anxiety reduces the quality of life (Saleem, Gul & Khalily 2012, p. 2).

To determine this, eighty participants aged twenty-five to forty years old were recruited, with approximately forty-six percent having one or more of the previously mentioned co-morbidity psychiatric disorders (Saleem et al., 2012, p. 3). The Yale-Brown Obsessive Compulsive Scale was administered to each participant. The severity of symptoms associated with obsessions and compulsions is measured using this scale (Saleem et al., 2012, p. 4). They were also given the World Health Organization Quality Of Life Bref, which is a “scale used to measure the quality of life profile, providing four domain scores… The four domain scores represent a person’s perception of quality of life in the Physical, Psychological, Social Relationships, and Environment domains.” Saleem et al. (2012), p.

After analyzing the data from the scales, the authors discovered that having OCD, in addition to comorbid psychiatric disorders, causes a lower quality of life than having OCD without comorbid psychiatric disorders. Comorbid psychiatric disorders with OCD were also found to “negatively influence social functioning, physical functioning, employment, and general quality of life.” Saleem and colleagues, p.

This relates to Phil’s diagnosis in that his quality of life has decreased since he was diagnosed with OCD. He resigned from one job, was fired from another, and his wife divorced him. He is now having difficulty finding work. Phil’s quality of life may continue to deteriorate if he does not receive proper treatment.

Information Utilization

This paper will inform my professional behavior by providing me with background information on symptoms and keys to diagnosing anxiety, trauma, and obsessive-compulsive disorders. It also informs me on how to help patients suffering from obsessive-compulsive Disorder by providing treatment options.

Conclusion

In conclusion, the abnormal behaviors associated with the previously mentioned disorders may reduce one’s quality of life. There are, however, always treatment options as well as coping methods to learn and practice.

References

American Psychological Association. (2014). Anxiety Disorders. Retrieved from https://dsm- psychiatry online org.library.capella.edu/doi/full/10.1176/appi.books.9780890425596.dsm05

American Psychological Association. (2014). Obsessive-Compulsive and Related Disorders. Retrieved from https://dsm-psychiatryonline- org.library.capella.edu/doi/full/10.1176/appi.books.9780890425596.dsm06

American Psychological Association. (2014). Personality Disorders. Retrieved from https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm18

American Psychological Association. (2014). Trauma- and Stressor-Related Disorders. Retrieved from https://dsm-psychiatryonline- org.library.capella.edu/doi/full/10.1176/appi.books.9780890425596.dsm07

Capella University. (n.d.). CASE STUDY VIGNETTES. Retrieved from https://courserooma.capella.edu/bbcswebdav/institution/PSYC-FP/PSYC FP3110/181000/Course_Files/cf_case_study_vignettes.html

Greenberg, W. M. (2018). Obsessive-Compulsive Disorder Medication. Retrieved from https://emedicine.medscape.com/article/1934139-medication

Kerr, M. (2011). Check-up: Obsessive-compulsive Disorder. Irish Times Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com %2Fdocview%2F884645369%3Faccount

Key, B. L., Rowa, K., Bieling, P., McCabe, R., & Pawluk, E. J. (2017). Mindfulness‐based cognitive therapy as an augmentation treatment for obsessive–compulsive Disorder. Clinical Psychology & Psychotherapy, 24(5), 1109–1120. https://doi- org.library.capella.edu/10.1002/cpp.2076

Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. J. (2013). Behavioral versus cognitive treatment of obsessive-compulsive Disorder: An examination of outcome and mediators of change. Journal of Consulting and Clinical Psychology, 81(3), 415–428. https://doi-org.library.capella.edu/10.1037/a0031865

Saleem, T., Gul, S., & Muhammad, T. K. (2012). QUALITY OF LIFE OF INDIVIDUALS HAVING OCD WITH AND WITHOUT CO MORBID PSYCHIATRIC DISORDERS. Pakistan Journal of Psychology, 43(1) Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com %2Fdocview%2F1112372468%3Facco

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Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma-related disorders.

Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.

Review the video, Case Study: Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.