Question: To a psychologist or Psychiatrist. Need some help with these two vignettes also. It's very important I'm correct about these as they are the precursor to a whole lot of other work. DSM-5 trying to diagnose them for a class. These are different ones than before. The first one I thinkSocial Anxiety Disorder. is would there be a co-occuring disorder with it?
The second one I think is PTSD for a child under six. Is there a co-occurring disorder with this one? Are my answers correct?
I will need to write a rationale for these also. When I'm done, can I send it to you for verification they are done well?
Thanks.
Here are the vignettes. Named 1 and 2
1. XXXXXXX was a nice looking man in his mid-30’s. He could trace his shyness to boyhood and his social anxiety to his teenage years. He had married a girl he knew well from high school and had almost no other dating history. He and his wife, XXXXXXX had three children, two girls and a boy.At our first meeting, XXXXXXX was very shy and averted his eyes from me, but he did shake hands, respond, and smile a genuine smile. A few minutes into our session and XXXXXXX was noticeably more relaxed. "I’ve suffered with this anxiety for as long as I can remember", he said. "Even in school, I was backward and didn’t know what to say. After I got married, my wife started taking over all of the daily, family responsibilities and I was more than glad to let her."
If there was an appointment to be made, XXXXXXX made it. If there was a parent-teacher conference to go to, XXXXXXX went to it. If XXXXXXX had something coming up, XXXXXXX would make all the social arrangements. Even when the family ordered takeout food, it was XXXXXXX who made the call. XXXXXXX was simply too afraid and shy. Indeed, because of his wife, XXXXXXX was able to avoid almost all social responsibility – except at his job. It was his job and its responsibilities that brought XXXXXXX into treatment.
Years earlier, XXXXXXX had worked at a small, locally-owned record and tape store, where he knew the owner and felt a part of the family. The business was slow and manageable and he never found himself on display in front of lines of people. Several years previously, however, the owner had sold his business to a national record chain, and XXXXXXX found himself a lower mid-range manager in a national corporation, a position he did not enjoy. "When I have to call people up to tell them that their order is in," he said, "I know my voice is going to be weak and break, and I will be unable to get my words out. I’ll stumble around and choke up....then I’ll blurt out the rest of my message so fast I’m afraid they won’t understand me. Sometimes I have to repeat myself and that is excruciatingly embarrassing........" XXXXXXX felt great humiliation and embarrassment about this afterwards: he couldn’t even make a telephone call to a stranger without getting extremely anxious and giving himself away. That was pretty bad!
For years, he has beaten himself up over these issues. What was wrong with him? Why was he so timid and scared? No one else seemed to be like he was. He simply must be crazy! After a day full of this pressure, anxiety and negative thinking, XXXXXXX would leave work feeling fatigued, tired, and defeated. XXXXXXX reports that he recalls feeling this fatigue and hopelessness as far back as high school. He reports that for as long as he can remember he has felt “down.” In fact, he cannot remember the last time he did not feel “down and hopeless.” He reports that he thinks these issues have affected his ability to concentrate and held him back first in school and now on his job.
Meanwhile, his wife, being naturally sociable and vocal, continually enabled XXXXXXX not to have to deal with any social situations. In restaurants, his wife always ordered. At home, she answered the telephone and made all the calls out. He would tell her things that needed to be done and she would do them. XXXXXXX and XXXXXXX enjoyed a good relationship and their family life was the one bright spot in Jim's life.
2.On the morning of September 11, 2001, a terrorist attack on the World Trade Center as well as the Pentagon devastated the XXXXXXX public. XXXXXXX had just turned five years old one month before the tragedy. His parents had a big birthday party for him which included a magic show, clowns, balloons, cake and ice cream. On the fateful morning, XXXXXXX and his family awoke and prepared for another typical day: Paul’s father was as assistant chief at the New York Fire Department; his mother worked at the south tower of the World Trade Center; his brother, XXXXXXX attended a parochial school; and XXXXXXX set off for kindergarten in a nearby public school. After the towers collapsed (where both Paul’s parents were killed), the impact of the crash devastated Paul’s school to the point where no one could safely exit the building. Two firefighters pulled XXXXXXX out from under a metal file cabinet. Doctors said that the filing cabinet likely saved Paul’s life as it shielded him from falling debris.
For a while, XXXXXXX seemed more confused than affected by the situation. He never asked any questions about the day of the tragedy. XXXXXXX often spent weeks without saying more than a few words at a time. He walked slowly as if the “weight of the world was on his shoulders.” XXXXXXX endeavored to put a smile on Paul’s face, but his efforts met with little success. His grandparents tried to get XXXXXXX to participate in activities that used to amuse him. He refused to eat cake and ice cream or any of the dinners that were once “standards” cooked by his mother.
Within the past couple of months XXXXXXX has been eating much less than he used to and has been losing weight quickly. He has become increasingly detached and appears tearful and sad more days than not. He is having difficulty getting to sleep and periodically awakens in the middle of the night screaming and shivering. Paul's grandparents reported to his doctors that he is also "spacing out" whenever someone would mention his parents. His teachers have reported a lack of concentration in regards to his schoolwork. XXXXXXX has also developed a tendency to display sudden outbursts of anger when others try to approach him in a caring fashion. XXXXXXX is often found playing with his Lego blocks but when he finishes a construction he frequently smashes it down with the palm of his hand, pretending it is an incoming airplane