Evidence-based answers to questions on anxiety disorders

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1. The DSMIV category of Anxiety Disorders is very different than the DSM5. Describe how the DSM5 is different than the DSMIV. Be sure to include disorders of anxiety, OCD, and trauma in your answer.
2. Think and write about your own counter transference with a client and describe how that was generated. If you did not have a counter transference reaction, make one up and then describe how that might have been generated.
3. Case Study: Jennifer
Jennifer, a 6 -year-old girl currently in Kindergarten, was referred to you by her family NP because of a long-standing pattern of shyness and behavioral inhibition that had become dramatically worse on her entering school. She expressed fear that her mother would be harmed or become ill and had several times come home early from school. She had tremendous difficulty separating from her mother at the start of school and would become upset on leaving the car. She had never been willing to take the bus with other children on her street. When left at school, Jennifer would quickly begin to complain of a headache. She often left the classroom to go to the nurse’s office because she felt nauseous and was afraid she would vomit in the classroom. Her academic abilities were at age level. Her teacher was concerned that her degree of difficulty with separation and numerous physical complaints were taking a toll on her peer relationships and would eventually impact her academic progress.
Her mother noted that Jennifer had a history of anxiety-related difficulties, only falling asleep when one of her parents was in bed with her. She often woke during the night and would come into her parents bed complaining of nightmares. Although he would play with children in the neighborhood, she wanted her mother around. Her parents had difficulty leaving her with a babysitter. Her mother had a history of anxiety-related difficulties as a child and described herself as like Jennifer with many worries about the future.
What is your diagnosis of Jennifer and why?
How would you conceptualize this case and why?
What comprehensive treatments would you provide and why?
4. Case Study: Tommy
Tommy, a 1 -year-old boy currently in 7th, was referred by his PCP to you. Tommy has a long history of being a worrier but the degree of worrying has recently increased exponentially. Tommy’s parents report that he is a bright and academically successful boy who has always been a worrier since toddler-hood. He worried about bad things that might happen. He was very meticulous, wanting his projects and school work to be perfect. He constantly sought feedback on his performance and would repeatedly check his work. With the onset of adolescence, Tommy had become extremely worried about his appearance and cleanliness. He wanted to have a girlfriend but was worried that his body odor (not notable to anyone else) would turn them off to him. Now, as he recently entered 7th grade, he is experiences a more challenging academic load. He has to deal with many teachers as opposed to just one. Now, even small mistakes in his work result in his redoing his assignment. He has become more meticulous about his clothing and more withdrawn and preoccupied. He seems to be taking longer and longer to get things done.
Over two evaluation sessions, the psych NP discovered that Tommy had a number of obsessions and compulsions and is preoccupied with cleanliness because he feels dirty most of the time. He is become very stressed in his new school. Although always a perfectionist, he now realizes that it had begun to interfere with his school work. He is aware of engaging in a number of rituals, including counting the number of drafts of each paper, which often was more than 10, showering a minimum of 3 times/day and staying in the shower more than 30 minutes each time. He is worried that if he does not engage in these acts, his life would fall apart. He also shares with the psych NP that he has been picking his face, sometimes staying in front of a magnifying mirror for an hour at a time. He has very small, almost unnoticeable skin lesions on his face. He states that after he does it, he cleans his face well and applies Neosporin ointment to avoid infection. He has tried to stop but can’t seem to do so. As a result, he does not like to socialize as much and he refuses to go to places where there are bright lights.
A family history revealed a maternal grandfather with depression and a paternal uncle with Tourette’s syndrome. His father is very intense but does not have any diagnosable disorder.
What is your diagnosis of Tommy and why?
How would you conceptualize this case and why?
What initial treatment would you provide and why?
If the initial treatment failed, what might you further do?
If you have prescribed a medication and the client only experiences partial relief, how might you augment?

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