Mark’s diagnosis was determined utilizing the decision-tree method from the latest DSM (American Psychiatric Association, 2000). This method encourages clinicians to follow pathways of differential diagnoses to rule out a number of conditions until the most descriptive diagnosis remains. There is no reason to believe that Mark’s symptoms are due to a medical condition. The client does not report any substance use or the presence of panic attacks. Unlike agoraphobia, Mark does not seem concerned about being unable to escape from places.
Although little information is available about Mark’s attachment history, there is no evidence that his current symptoms are related to being attached from an attachment figure. Mark’s anxiety is also not tied to any particular object, situation, obsession, or compulsion. Mark’s anxiety is due to the stressor of his friend’s health condition that resulted in premature death. These symptoms have occurred for 5 months, which is less than the 6 month requirement for other diagnoses. While his anxiety is heightened when he thinks about physical exertion, Mark did not report flash-backs or a fear for his life related to his anxiety.
At this time, the most appropriate diagnosis for Mark is Adjustment Disorder with Anxiety. His multi-axial diagnosis is below: I. Adjustment Disorder with Anxiety II. No diagnosis III. None reported IV. Marital discord V. GAF = 55 Objectives for Treatment Increase Mark’s repertoire of coping strategies Decrease Mark’s anxiety Improve Mark’s functioning within interpersonal relationships, including his marital relationship with his wife Assessment Evaluate Mark’s current coping strategies for stress. Beck’s Anxiety Inventory
State/Trait Anxiety Scale Clinician Characteristic Experienced working with anxiety complicated by adjustment, comfortable discussing sexual dysfunction, willing to consider the involvement of Mark’s wife in therapy. Location of Treatment Private practice office Intervention Cognitive-Behavioral Therapy: Mark needs to identify his dysfunctional thoughts and replace them with adaptive thinking. Improving communication with his wife would be an especially beneficial coping strategy for Mark to learn, practice, and effectively implement in his life.
Repetitive usage of assessments could assist Mark to identify his areas of improvement while developing an awareness of his continued need for growth. The most important focus for Mark’s treatment will be the prevention of the adjustment disorder deteriorating into a more severe clinical diagnosis (Schatzberg, 1990).
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM IV- TR. (4th ed. ). Washington, DC: Author. Schatzberg, A. F. (1990). Anxiety and Adjustment Disorder: A treatment approach. Journal of Clinical Psychiatry, 20-24.