Case # 1
Diagnosis
In the case under analysis, the patient, Zev, is a 45-year-old man who is obsessed with performing specific rituals many times each day, explaining this need as a possibility to prevent terrible things. Focusing on repetitive behaviors to reduce anxiety and persistent thoughts, it is possible to identify obsessive-compulsive disorder (OCD) as a tentative diagnosis. To ensure that the patient is properly diagnosed, a healthcare provider should focus on additional information. For example, it is necessary to clarify if the patient tried to ignore or stop his behaviors and what results were observed. According to the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (DSM-5) (as cited in Stein et al., 2019), the insights of the condition could reveal the severity of the disease. If the patient recognizes his behaviors as not true, good insights are observed; and if he is sure that his beliefs are true, delusional beliefs are reported, proving worsened life-long effects.
Additional Information and Psychiatric Evaluation
Additional questions to confirm the diagnoses are “What does the patient feel about his behavior?”, “Does the patient want to get rid of his obsessions?”, and “Has he tried to avoid situations that cause worry?”. Such a method of psychological evaluation is required for OCD diagnosis. The mental status exam is based on the diagnostic DSM-5 criteria. The questions about the presence or absence of shortness of breath or jelly legs become a part of a physical examination to rule out other health problems. Additionally, the records of previous mental health disorders and family history help clarify if depression or schizophrenia can cause obsessions and what treatment methods have already been used. The psychiatric evaluation is recommended in this case to assess current symptoms, consider OCD severity, evaluate safety patterns, and investigate other co-occurring conditions.
Therapy
The main idea of the treatment for OCD patients is not to find a cure but gain control over the symptoms. The combination of medications and psychotherapy is frequently prescribed in the majority of cases. Stein et al. (2019) offer serotonin reuptake inhibitors for pharmaceutical treatment and cognitive-behavioral therapy. Dopamine could be effective only after the patient responds to serotonin augmentation (Stein et al., 2019). Cognitive therapy includes exposure to feared objects or situations and response prevention (the ways to resist repeating compulsive rituals). Although it could happen that Zev cannot neglect his urge to obsessions and compulsions, he would be able to control his behaviors and improve the quality of his family’s and his own life.
Case # 2
Diagnosis
Mallory is a 25-year-old patient presented to the clinic with mild depressive symptoms like dissatisfaction with her life, boredom, and a feeling of unfulfillment. During her communication with a therapist, additional factors as discomfort and shyness are revealed because Mallory wants to end an interview due to a fear of being boring with her “stupid complaints,” which tells about her intention to avoid situations that involve scrutiny. According to Natarajan et al. (2019), social phobias that are revealed from similar fears and concerns are the signs of social anxiety disorder. To make sure that the chosen diagnosis is correct, it is expected to identify the time period during which the patient has been experiencing similar symptoms. According to the National Institute of Mental Health (2016) and the DSM-5 criteria, the patient with social anxiety disorder should be challenged by the symptoms (fear, anxiety, and avoidance) for at least six months. Therefore, it is critical to specify when Mallory has begun noticed these emotional and behavioral changes.
Additional Information and Psychiatric Evaluation
In addition to the already developed interview with open-ended questions that helped disclose her fears and avoidance of communication, the following statements should be mentioned:
- During the last several days, the patient has felt moments of fear or fright in social situations;
- During the last several days, the patient has thought of being humiliated or rejected;
- During the last several days, the patient has tried to distract herself to avoid thinking about social situations;
- During the last several days, the patient has required help to cope with social obligations.
A physical exam is needed to identify if there are additional symptoms of social anxiety disorder. According to the National Institute of Mental Health (2016), sweating, trembling, rapid heart beating, and blushing are the major signs. The lack of eye contact, a nauseous feeling, and the tone of speaking may also be recognized. The assessment on the DSM-5 basis is required, as well as additional communication with a mental health specialist. The records about past and current medication should show if there are external triggers to depressive or anxiety symptoms. A physical examination may be done to prevent the development of other psychiatric comorbidities and their impact on the quality of life.
Therapy
Regarding the offered diagnosis, Mallory needs two types of treatment: cognitive-behavioral therapy and medications. Effective management of therapies includes paroxetine controlled release tables, relaxation, and cognitive restructuring (Natarajan et al., 2019). Although it is possible to invite the patient to support group meetings, individual cooperation plays a crucial role because it helps control anxiety and depression symptoms through breathing and visualization techniques. With time, exposure to feared social situations is necessary to observe how the patient is able to control the environment, minimize stress, and achieve goals.
Case # 3
Diagnosis
A 28-year-old married female, Jessica, reports a feeling of worthlessness, shame, fatigue, difficulties in concentrating at work, irritability, and insomnia. In her life, the woman finds it necessary to achieve perfection and obtain top honors. The intention to follow high standards is a critical factor at work and at home. However, her high-stress job and medical education have their outcomes, and, according to her coworkers, Jessica has become easily irritable and withdrawn. In addition, suicidal thoughts start bothering the patient due to the impossibility of getting rid of frustration. All these are the signs of major depressive disorder, and Jessica meets more than five DSM-5 criteria, including anhedonia, low mood, fatigue, insomnia, suicidal ideation, and retardation (Ng et al., 2016). To confirm this diagnosis, the only requirement that has to be clarified is the duration of the symptoms. If they have been present during the last two weeks and influence the quality of work and life, depression is diagnosed.
Additional Information and Psychiatric Evaluation
To identify the severity of depression, psychologists involve patients in taking questionnaires. The main questions are “Has the patient felt hopeless in the last several weeks?” and “Has the patient been bothered by no interest in doing things in the last several weeks?”. According to Ng et al. (2016), during the evaluation, neurological examination and mental state assessment should be guided by clinical suspicion. Regarding the presence of suicidal thoughts, the patient has to be immediately hospitalized for psychiatric evaluation (Ng et al., 2016). To distinguish depression from other mental health conditions like schizophrenia or bipolar disorder, the records from a family history are necessary.
Therapy
A collaborative care model for the patient with depression includes pharmacotherapy and psychotherapy to control the present symptoms and reduce the risk of relapse. The first-line medication treatment involves selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors like venlafaxine (improvement of her general mood) and atypical antidepressants (removal of suicidal thoughts) (Kraus et al., 2019). However, many American women prefer cognitive behavioral therapy over medications. It focuses on personal mood and thoughts and identifies targets and appropriate behaviors. By discussing the positive and negative aspects of human life and evaluating routine events, the patient learns to control her reactions and practice self-control and improvement. As soon as a balance in thoughts is achieved, Jessica could be introduced to adverse situations and show how she deals with feelings, makes decisions, and reduces stress constructively.
Case # 4
Diagnosis
The uniqueness of this case is that the patient has no evident psychological problems and mental or personality disorders except his fear of bridges. Walter is a 50-year-old man who experienced a car accident on a bridge when he almost went over the guard rail. Since that period, he considered bridges as collapsing or in states of disrepair. However, he has to go to work, it is hard to avoid all bridges in the city, and Walter should investigate his possible traveling routes, with a minimum of bridges on his way. On the one hand, he could be diagnosed with post-traumatic stress disorder that is triggered by a car accident. However, the lack of negative flashbacks, nightmares, or anxiety symptoms makes the psychologist look for other explanations. In Walter, a marked fear about a specific object (a bridge) provokes behavioral changes. According to the DSM-5 criteria, the patient has specific situational phobia of driving across bridges (as cited in Wardenaar et al., 2017). The irrationality of his behavior is explained by no actual danger from the subject that causes such a negative attitude in the patient. The history of this fear and its duration has to be clarified.
Additional Information and Psychiatric Evaluation
In the majority of cases, a diagnosis of specific phobia requires a thorough clinical interview and the analysis of diagnostic guidelines (DSM-5, for example). In this case, the patient reports anxiety in regard to the phobic situation of driving across a bridge and a fear of danger that may be posed by bridges. The reports from medical, psychiatric, and social history should be used. Many health organizations agree that if the avoidance of bridges interferes with occupational functioning and results in the inabilities of doing normal routines or social activities, the patient’s well-being is at risk, and there is a need for psychiatric evaluation and intervention (Witthauer et al., 2016). The questions about emotional changes, cooperation with people, and family support as a part of a clinical interview help understand if other psychological issues contribute to this type of phobia.
Therapy
Usually, people with specific phobias do not ask for treatment and try to cope with challenges on their own. However, Walter admits the need for professional help for his behavioral orientation. Therefore, psychotherapy in the form of exposure therapy or cognitive behavioral therapies is usually effective in managing specific phobias (Wardenaar et al., 2017). Therapeutic effectiveness depends on how well the patient is able to respond to the situation and deal with his fear. The exposure method aims at developing immunity to bridges, including looking at pictures, observing them distantly, reading about them online, and approaching them. With time, it should be easier for Walter to cross bridges fearlessly.
Case # 5
Diagnosis
Based on the symptoms mentioned in Martin’s case, this 21-year-old patient is suffering from a mental disorder, namely schizophrenia. Delusional disorder is out of the diagnostic list because of the presence of delusions along with other psychosis symptoms, including disorganized speech and hallucinations. First, he behaves atypically, which is observed in his whispering in an agitated voice, even if he is alone. Besides, irrational thinking is proved by his beliefs that the aliens want to kill him and use his brain for another being, and his family is in conspiracy with aliens each time they want to send them to a psychiatrist for evaluation. Finally, negative symptoms (poor communication and socialization) are reported because Martin has already stopped attending his classes and left behind his coursework. It is also necessary to specify the paranoid type of schizophrenia due to the existing dysfunctional outcomes and impairments in real-world interpersonal relationships (Pinkham et al., 2016). To verify this diagnosis, it is expected to ask about the duration of such strange behavior because psychotic disorder may be diagnosed if the episodes last from one day to one month.
Additional Information and Psychiatric Evaluation
This case and diagnosis are based on the information that Martin’s friends and family share. The assessment of schizophrenic patients should be done individually with the patient. Therefore, such questions are important to make certain conclusions:
- Has the patient even heard voices in his head? (auditory hallucinations)
- Has the patient seen people or creatures who wanted to harm him? (visual hallucinations)
- When did the patient find out about potential threats from the world? (disturbance duration)
- Has the patient ever tried to stop aliens or enemies in his life? (tactile hallucinations)
- Does the patient feel that someone is watching behind him? (persecutory delusions)
To continue diagnosing, a physical exam may be done to find out if the patient has traumas or other health concerns about his current state. Additional tests for drug or alcohol abuse are necessary even if the patient denies drinking or other poor habits. LeBaron et al. (2019) state that computed tomography or magnetic resonance imaging may reveal structural brain abnormalities in schizophrenic patients. After the analysis of family records (Martin’s aunt was a patient of psychiatric hospitals) and a full psychiatric evaluation (more than five DMS-5 criteria are met), a final diagnosis can be given.
Therapy
To improve the patient’s well-being, a long-life treatment must be developed. The combination of pharmacological and psychosocial therapies is obligatory to manage the current behaviors and predict the emergence of new symptoms and comorbidities. The effectiveness of typical antipsychotics (chlorpromazine, haloperidol, and thioridazine) and atypical antipsychotics (aripiprazole, clozapine, and quetiapine) is tested during the first two weeks of a treatment plan (Haddad & Correll, 2018). Individual cognitive therapy helps the patient identify his fears and problems and discuss everything directly with an expert. In contrast, group cognitive therapy connects the patient with other people who experience similar emotions and are challenged by obscure situations.
Case # 6
Diagnosis
The patient of this case is presented with such symptoms as constant worry about losing her job and developing a number of worse-case related problems like becoming homeless. Kristen is a 38-year-old divorced woman with two children, and, despite the fact that she has been working for the same company for over six years, her worry causes tiredness, restlessness, and tenseness. Generalized anxiety disorder (GAD) is characterized by anxiety related to worrying and fears about everyday events like work (Ströhle et al., 2018). The signs of GAD must be evident during the last six months. To be differentiated from other similar mental health problems, the patient presents enough information for GAD diagnosis at the moment: worries about several issues (not one like in phobia) for an extended period (not occasionally like in depression).
Additional Information and Psychiatric Evaluation
To make sure the chosen diagnosis is correct, a clinician should pose several questions and develop a physical and psychiatric evaluation. The question “Is the patient a worrier by nature?” will help understand the temperament of the patient (it happens that some people consider their anxious behaviors as a norm). The question “Does the patient have problems with sleep or concentration?” contributes to a better understanding of the patient’s emotional concerns. Blood and urine tests are necessary to analyze if other physical changes, like hypothyroidism, influence Kristen’s state. A psychiatric evaluation includes the discussion of personal and family history and tests to check the patient’s reasoning and memory. Finally, it is expected to use the DSM-5 criteria and experience three of the following symptoms – restlessness, fatigue, poor concentration, irritability, muscle tension, or sleep disturbance.
Therapy
Psychotherapy and medications are the two types of treatment for GAD patients. Psychological counseling and talking help people reduce anxiety symptoms and understand how to control and manage worriers. Atypical antipsychotic drugs and antidepressants like quetiapine (50 mg) or agomelatine (25 mg) during at least ten weeks are highly effective against GAD (Ströhle et al., 2018). Common recommendations also cover the need for regular physical activities, relaxation, healthy eating habits, and sleep improvement as a part of lifestyle changes. Some patients prefer to deal with their symptoms alone, and some people like to socialize and involve their family members. As soon as Kristen’s priorities are defined, it is possible to consider her choice and create an environment that is favorable for her.
Case # 7
Diagnosis
The situation of Harrison, a high-school student, is complex due to the presence of the symptoms of several mental health diseases. The boy has an ulcer that has been developed because of unhealthy family dynamics. He could eat extensively for several days and then starts dieting to obtain his wrestling weight, which tells about the possibility of binge-eating disorder (BED). This diagnosis is chosen as the patient eats large amounts of food in a discrete period of time due to a lack of control over eating (Ghaderi et al., 2018). Many studies prove that patients with BED often present with other comorbid psychiatric diagnoses (Ghaderi et al., 2018). Substance use disorder may also affect Harrison’s behavior and irrational thoughts. The patient buys some pills at a health food store to manage his health. At the same time, substance abuse can be a symptom of borderline personality disorder in addition to other problems like intense interpersonal relationships, disturbance, and inappropriate anger.
Additional Information and Psychiatric Evaluation
In this case, much additional information is necessary to confirm the diagnosis and clarify the true reasons for the patient’s condition. Blood and urine tests are necessary to check the condition of liver functioning, the number of electrolytes, and the level of digestive enzymes. A physical examination shows if there are any conditions that provoke the current symptoms of substance abuse and BED. A psychiatric evaluation with a detailed interview and medical history exam is obligatory to analyze the mental state of the patient. “Does the patient experience a fear of abandonment?” “Are there any cases of emotional swings?” and “Are there any recent changes in self-image?” are the questions to be posed to Harrison.
Therapy
If an ulcer does not require medical treatment, it is enough to provide the patient with psychotherapy. Sometimes, antidepressants like citalopram, fluoxetine, or sertraline may be prescribed to reduce the symptoms or other mental health disorders (Ghaderi et al., 2018). Still, the development of healthy eating habits is obligatory, including the avoidance of dieting and following a regular meal-taking plan. Cognitive behavioral therapy in the form of dialectical behavior therapy and interpersonal psychotherapy are recommended to manage binge-eating episodes and anger and improve the sense of control in unhealthy family relationships (Ghaderi et al., 2018). Behavioral therapy should show that weight control is possible without taking pills and starving from time to time. Healthy eating is explained as one of the major priorities in Harrison’s lifestyle. Finally, family therapy can be proposed as a solution to Harrison to discuss his concerns about his parental relationships and their impact on his life.
Case # 8
Diagnosis
A 19-year-old male patient, Jake, has such problems as aggression, anxiety, irrational behavior (wearing sunglasses, keeping the curtain drawn, or talking when he is alone), and delusions (he thinks that his neighbors watch him). According to the National Alliance on Mental Illness (n.d.), these are the symptoms of early psychosis or brief psychotic disorder. The patient experiences changes in his thoughts and perceptions, and he cannot understand if what is going on and if all these events are true. The same episodes have lasted over the past two weeks, which meets the DSM-5 criteria of brief psychotic disorders (from one day to one month). Besides, negative toxicology results, no past mental health history, and the presence of mentally ill family members (his uncle) serve as a solid background for the chosen diagnosis.
Additional Information and Psychiatric Evaluation
There are no specific tests to make the chosen diagnosis, but several recommendations for healthcare providers exist. To confirm the diagnosis, a physical examination should be developed to rule out brain or other tumors, infections, or epilepsy (The National Alliance on Mental Illness, n.d.). Blood and urine tests show the levels of electrolytes and glucose and prove the functional quality of the liver and thyroid. A psychiatric evaluation is based on the DSM-5 criteria – the presence of one or more symptoms from the list (delusions, hallucinations, disorganized speech, and catatonic behavior). Although no toxicological abnormalities have been discovered, the questions like “Has the patient used some drugs?” or “What is the evidence of his neighbors’ strange behavior?” should be posed.
Therapy
As soon as the early signs of psychosis are revealed, it is better to start treatment and improve long-term life quality. The National Alliance on Mental Illness (n.d.) suggests following coordinated specialty care that includes the development of a personal treatment plan, with specific goals and the involvement of family members. The purpose is not only to help the patient but to show his family how to support and accept the situation. Psychotherapy (cognitive behavioral therapy) and medications (antipsychotics) are necessary to control anxiety and remove the reasons for worries that are present in his delusions. Self-group meetings may be helpful after the major symptoms are under control due to the offered medications. The creation of a supportive environment with people who have similar problems can be a useful second-line service for psychotic patients.
Case # 9
Diagnosis
A distinctive feature of this case is the participation of a family attorney in defining the mental health symptoms of the patient. Sarah, a 35-year-old woman, addresses an attorney for help to get divorced because she feels in love with a politician, although they have never met. The woman is concerned about the possibility of attracting this politician’s attention as soon as she becomes single. This irrational behavior is explained by the presence of erotomanic delusions, with no evident impairments within her social or personal life. As a result, Sarah should be diagnosed with delusional disorder. However, delusions may not be the outcome but the symptoms of another, more serious mental health disorder. Regarding the presence of other symptoms like racing thoughts, insomnia, and increased psychomotor activity (which is not inherent to delusional disorder), bipolar I disorder with manic episodes should be considered.
Additional Information and Psychiatric Evaluation
To diagnose mania in bipolar disorder, the patient needs to take a physical exam (with blood and urine tests) to analyze if other medical problems influence her behavior. In addition, a psychiatric evaluation is obligatory to analyze the patient’s thoughts and feelings and their impact of her behavior. The DSM-5 criteria include a decreased need for sleep, distractibility, talkativeness, racing thoughts, and excessive moment; the patient meets more than three items (Gold & Sylvia, 2016). To prove her elevated mood, the questions about the experience of extreme happiness are necessary. Questions about sleep conditions and needs should prove insomnia-related problems. Family members could participate in the assessment because their information helps reveal additional symptoms that the woman does not consider as problematic ones.
Therapy
The combination of medications and cognitive behavioral therapy is required to control the symptoms of bipolar I disorder. On the one hand, cognitive psychotherapy aims at discovering the roots of negative or irrational beliefs and replacing them with real conditions and beliefs. This approach is effective for managing insomnia and lowering bipolar episodes and mania relapses (Gold & Sylvia, 2016). A psychologist usually prescribes antipsychotics and antidepressants to control symptoms and stabilize mood. Sleeping pills (benzodiazepines) turn out to be an old and verified method to slow down the functions of the body and provide the patient with a possibility not to think about current problems and concerns but take some rest.
Case # 10
Diagnosis
Regarding the main factor that Robert, a 22-year-old patient, has served a military tour overseas and been involved in combat, with his troop being injured, post-traumatic stress disorder (PTSD) has to be diagnosed. This condition is characterized by re-experiencing symptoms, including negative alternations and uncontrolled memories (Miao et al., 2018). This definition of the condition explains frequent nightmares, jumps when Robert hears loud noises, and irregular, short thoughts about the already experienced hostile environment. At the moment of the first assessment, no additional information is necessary to confirm the chosen diagnosis. However, attention should be paid to the duration of the overall symptoms and their impact on the patient’s quality of life and functioning.
Additional Information and Psychiatric Evaluation
A psychologist should make a decision to perform a physical examination and reveal if there are any medical problems that could provoke similar symptoms. A psychological evaluation aims at focusing on the signs of PTSD as per the DSM-5 criteria (repeated exposure to traumatic events, dissociative reactions, psychological distress, and physiological reactions). About 16% of military service members (more prevalent in males than females) are diagnosed with PTSD (Miao et al., 2018). The exposure to a negative, traumatic event was thoroughly explained by the patient; therefore, no psychiatric evaluation is necessary to prove the diagnosis. However, it is necessary to make sure that similar symptoms occur more than one month since the exposure. Finally, the assessment of the patient should include the possibility of comorbid conditions like depression, substance abuse, or memory problems. Questions about an overall mood, behavioral changes, and ways of dealing with the episodes are developed.
Therapy
In the majority of cases, PTSD patients need psychotherapy to learn how to address the symptoms, enhance positive thinking, and cope with behavioral problems. Miao et al. (2018) recommend the combination of cognitive behavioral therapy, cognitive processing therapy, and cognitive restructuring therapy, so the patient distinguishes what is real and what is not. Family involvement and group meetings are possible to encourage Robert’s socialization and cooperation. Pharmacological treatments include antidepressants (fluoxetine or sertraline), antipsychotics, and benzodiazepine to improve mood, restore energy, and avoid negative thoughts. This method should be applied if the patient does not respond to cognitive interventions and professional counseling within at least two weeks.
Reference
Ghaderi, A., Odeberg, J., Gustafsson, S., Råstam, M., Brolund, A., Pettersson, A., & Parling, T. (2018). Psychological, pharmacological, and combined treatments for binge eating disorder: A systematic review and meta-analysis. PeerJ, 6. Web.
Gold, A. K., & Sylvia, L. G. (2016). The role of sleep in bipolar disorder. Nature and Science of Sleep, 8, 207-214. Web.
Haddad, P. M., & Correll, C. U. (2018). The acute efficacy of antipsychotics in schizophrenia: A review of recent meta-analyses. Therapeutic Advances in Psychopharmacology, 8(11), 303-318. Web.
Kraus, C., Kadriu, B., Lanzenberger, R., Zarate, C. A., & Kasper, S. (2019). Prognosis and improved outcomes in major depression: A review. Translational Psychiatry, 9. Web.
LeBaron, D. B., Mahjoub, Y., & Abba-Aji, A. (2019). Incidental intracranial pathology: a retrospective case review of structural neuroimaging results amongst young adult psychiatric patients. Neuropsychiatric Disease and Treatment, 15, 1557-1562. Web.
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1). Web.
Natarajan, G., Louis, S. P., & Arathil, P. (2019). A care report of psychotic symptoms in social anxiety disorder. Indian Journal of Psychological Medicine, 41(3), 291-293. Web.
The National Alliance on Mental Illness. (n.d.). Psychosis. NAMI. Web.
The National Institute of Mental Health. (2016). Social anxiety disorder: More than just shyness. Web.
Ng, C. W. M., How, C. H., & Ng, Y. P. (2016). Major depression in primary care: Making the diagnosis. Singapore Medical Journal, 57(11), 591-597. Web.
Pinkham, A. E., Harvey, P. D., & Penn, D. L. (2016). Paranoid individuals with schizophrenia show greater social cognitive bias and worse social functioning than non-paranoid individuals with schizophrenia. Schizophrenia Research: Cognition, 3, 33-38. Web.
Stein, D. J., Costa, D. L., Lochner, C., Miguel, E. C., Reddy, Y. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019). Obsessive–compulsive disorder. Nature Reviews Disease Primers, 5(1). Web.
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(37), 611-620. Web.
Wardenaar, K. J., Lim, C. C. W., Al-Hamzawi, A. O., Alonso, J., Andrade, L. H., Benjet, C., Bunting, B., de Girolamo, G., Demyttenaere, K., Florescu, S. E., Gureje, O., Hisateru, T., Hu, C., Huang, Y., Karam, E., Kiejna, A., Lepine, J. P., Navarro-Mateu, F., Oakley Browne, M., … de Jonge, P. (2017). The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychological Medicine, 47(10), 1744–1760. Web.
Witthauer, C., Ajdacic-Gross, V., Meyer, A. H., Vollenweider, P., Waeber, G., Preisig, M., & Lieb, R. (2016). Associations of specific phobia and its subtypes with physical diseases: an adult community study. BMC Psychiatry, 16(1). Web.