Summary
A 25-year-old male comes to my clinic because he has been experiencing difficulties in his new job. Since he works in a consulting firm, it is challenging for him to give a presentation because he will embarrass himself, and his peers will judge him negatively or demean him. In order to avoid embarrassment, he has been rejecting multiple leadership roles and promotions as well. He says he doesn’t like interacting with small groups or friends in the workplace.
List of the patient’s problem
- Social phobia
- Anxiety
- Glossophobia
The main reason for selecting the above disorders is because the patient is experiencing them at different levels. For example, the patient fears interacting with small groups and friends in the workplace. Secondly, he fears presentation, which makes him have a stage-flight phobia, also known as glossophobia. Lastly, he suffers from anxiety since he passes up multiple leadership roles and promotions because he fears being assigned roles that involve interaction.
Diagnosis to be considered
The appropriate diagnosis process is by conducting a physical examination of the patient to identify the symptoms, which will enable the doctor to identify the appropriate disorder the patient is suffering from (Mayo Clinic, 2020). Also, the doctor might perform a blood test to determine whether the patient has other conditions, such as hypothyroidism, which might cause anxiety symptoms.
Rationale for diagnosis
In this case, one of the major symptoms of his disorder is isolating himself from others or fearing to interact with his collogues at the workplace of friends. According to the DSM IV, people diagnosed with social phobia are likely to isolate themselves or stay alone. They rarely share their information with other people, such as friends. As a result, the person is likely to suffer from other disorders, such as stress and depression.
Differential diagnosis to consider
The appropriate differential diagnosis to consider in this case is anxiety because the other two disorders result from anxiety. For example, the patient could not experience social phobia without experiencing the fear of interacting with other people. Secondly, stage-flight phobia or glossophobia is also a type of anxiety. Therefore, addressing anxiety disorder will elicit other disorders.
Screening tools
The Hamilton Anxiety Rating Scale (HAM-A) is a popular screening tool for measuring anxiety. It evaluates a number of anxiety-related symptoms even though they came before modern conceptions of anxiety. The HAM-A includes subscales for both physical and mental anxiety. The psychological subscale, which includes questions about the more individualized cognitive and affective aspects of anxious experiences, such as anxious mood, tension, and anxieties, is particularly helpful in determining how severe anxiety is (Belzer, 2019). In contrast, the somatic subscale emphasizes anxiety symptoms that are a little less common, such as autonomic arousal and cardiovascular and respiratory symptoms.
Treatment
The first treatment strategy to address this disorder is subjecting the patient to psycho-education. This will enable the patient to understand the disorder in detail and know the consequences that emanate from it, thus maximizing the chances of developing a solution. Secondly, psychotherapy will address the patient’s disorder because it enables the patient to understand how their thoughts and behavior contribute to the disorder. The last treatment strategy is using medications, such as antidepressants. This medication increases the activity of neurotransmitters in the brain which helps in reducing anxiety.
Standard guidelines
The major guideline I would use to assess the patient is conducting a mental and physical examination to determine the disorder and come up with the best treatment strategy.
Reference
Belzer, K. D. (2019). Tools for assessing generalized anxiety disorder. Psychiatric Times, 23(3), 26-26.
Mayo Clinic, (2020), Social anxiety disorder (social phobia), https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
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