Abstract
The purpose of this study is to investigate the case of Sydney by using the DSM-5 criteria and other models for diagnosing psychopathologies. The symptoms described by the client indicate such differential diagnoses as paranoia, social anxiety disorder, and depression. However, the DSM-5 criteria and Beck’s cognitive model reject these differentials and determine separate anxiety disorder as a provisional diagnosis. Sydney’s treatment includes cognitive-behavioral therapy, Brief Empathic Psychotherapy, Affect Phobia Therapy, education, and anxiety management exercises. These methods will allow Sydney to control and reduce anxiety while ignoring them can lead to social impairment, relationship problems, and disorder’s transmission to children. Nevertheless, insufficient information about the case and methods of treatment of separation anxiety in adults reduces diagnosis and prognosis accuracy. Consequently, the use of different approaches to diagnosis and treatment, in this case, is a useful and necessary tool that helps to increase diagnostic accuracy in conditions of insufficient information.
Diagnosing psychopathologies, mental disorders, and diseases is a complex process that must be approached with accuracy and attention. The peculiarities of human nature and each person’s character make it impossible to use one clear set of parameters to assess the patient’s condition, since different disorders can manifest themselves in various degrees and forms. In addition, medical professionals can apply their own assessment and diagnosis methods; however, these differences should not hinder the accuracy of conclusions. For this reason, medical associations and organizations offer standard models, manuals, and guidelines for diagnosing mental illness to avoid ambiguous interpretations. The most commonly used model and source for diagnosing is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which classifies the signs of various psychopathologies and disorders. However, since all models have inaccuracies due to human nature’s peculiarities, the most optimal approach is to combine and use them to establish a more accurate diagnosis and treatment.
This paper will study the case of Sydney, a 30-year-old mother of four sons, who seek help because she is concerned about her emotional and mental state. Sydney’s main issues are that she feels “on edge” because of the need to deal with many household chores, but at the same time, she cannot entrust her children to other people because of her constant worries about their lives and health. Sydney’s other problems are irritation, feeling of insecurity, and unwillingness to socialize. DSM-5 describes these problems as signs of separation anxiety disorder; however, they can also refer to symptoms of depression or paranoia (American Psychiatric Association, 2013). Consequently, this paper aims to diagnose Sydney to suggest treatment options for this case and justify her diagnosis by using DSM-5 and alternative models.
Provisional and Differential Diagnoses
Sydney sought help from specialists during a regular check-up for her six-month-old son because she did not have time for herself, but she seized the opportunity. Later, at the appointment with a psychotherapist, Sydney talked about her feelings and concerns that can relate to different diagnoses. Issues noted by Sidney include fatigue, sleep problems, depressed moods, unfounded suspicions, problems with concentration and memory, and constant worrying about her children. The signs described by the client can refer to such diagnoses as depression, paranoia, social anxiety disorder, and separation anxiety disorder. However, one can see that there are not enough signs to diagnose the first three disorders after closer inspection.
The Differential Diagnoses
Sydney is the mother of four children, including a six-month-old baby, which is a risk factor for the development of depression. Depression is a common diagnosis for mothers, especially in the first months after childbirth due to the high weight of responsibilities and changes in hormonal levels (National Institutes of Health, 2020). Sydney takes care of four children, and her duties include cooking, cleaning, paying bills, and driving the children to school, which is a difficult task for one person. This level of stress can trigger depression; however, according to DSM-5, Sydney does not have five of the eight symptoms to match this diagnosis (American Psychiatric Association, 2013). These symptoms include depressed mood throughout the day, loss or increase in appetite, loss of interest in all or almost all activities, slowing down thoughts, and a reduction of physical movement. Other symptoms are fatigue, a sense of worthlessness or guilt, loss of concentration, repetitive thoughts of death, and suicide (American Psychiatric Association, 2013). Sydney exhibits only a few signs, such as fatigue, occasionally depressed mood or guilt, and partial loss of concentration. In addition, most of these signs can be explained by the number of tasks that she needs to complete during the day.
Beck’s cognitive model can also be used to confirm the inappropriateness of this diagnosis. The first element of this model is the cognitive triad of depression, which refers to people’s tendency to see themselves, the world, and the future in a negative light (Whitfield & Davidson, 2018). The second aspect is faulty information processing, which helps to support negative ideas. Another element is a cognitive schema expressed in core irrational beliefs that creates negative perceptions and psychological vulnerability of a person to depression (Whitfield & Davidson, 2018). Sydney partially displays signs of triad and belief as she perceives the world as something dangerous and evil. For example, looking for bruises on his son after school camp, fearing for children’s lives when they are not around, and the phrase “the world still keeps turning despite terrible things happening” are manifestations of such signs. However, Sydney’s fears are partially rational, since bad things do happen in the world, and she does not see herself, her husband, or children in a negative light. Consequently, while some of the symptoms are related to depression, they are not sufficiently significant to this diagnosis.
Sydney’s fears and reluctance to socialize also indicate signs of paranoia or social anxiety disorder; however, as in the case of depression, they are insufficient to make a diagnosis. The DSM-5 model requires four out of seven features to be diagnosed for paranoid personality disorder. Symptoms are people’s suspicions that others using or harming them, doubts about friends’ trustworthiness, and unwillingness to trust and disclose personal information (American Psychiatric Association, 2013). Other signs are also holding grudges, looking for derogatory meanings in others’ words or actions, noticing attacks on reputation and aggressive response, doubting a spouse’s infidelity (American Psychiatric Association, 2013). Sydney shows some of these signs as she does not trust other people of her children because of fear that they are harmed, and also thinks that her friends are discussing and judging her behind her back.
However, the mother’s concerns are directed more towards her children but not towards herself, and she does not show mistrust in her husband in matters that relate to herself. In addition, despite her fears, she still allows the children to be separated from her, although she experiences constant anxiety. Sydney is also relieved to share personal information with the therapist and the GP. Social anxiety disorder can also explain only the fear of being embarrassed or judged by friends, but Sidney does not express concern about interactions with people in general (American Psychiatric Association, 2013). For example, Sydney did not talk about her fear of eating or drinking in front of people, talking to strangers or being in public places. Her only concern is being judged by friends; however, this fear may be adequate as Sydney realizes that her worries about her children are often exaggerated. Consequently, Sydney’s symptoms do not correspond to paranoid personality disorder or social anxiety disorder.
The Provisional Diagnosis
The most likely provisional diagnosis in Sydney’s case is a separation anxiety disorder. Sydney exhibits more than three DSM-5 criteria to diagnose her. Sydney is constantly worried about her children’s lives and fears that they will be traumatized or kidnapped when she is not around. The most notable manifestation is the situation in which Sydney searched for bruises on her son’s body after visiting the camp, although there was no reason for this. Because of this fear, she does not want to leave the house even when the children’s father looks after them and secretly checks them through the window. These signs are described in the criteria of the DSM-5 and are unambiguous for the diagnosis (American Psychiatric Association, 2013). Even in the therapist’s waiting room, Sydney runs to check that she did not leave the child in the car, although she knows that he is not there.
Sydney’s constant anxiety also causes sleep problems and fatigue, although the woman did not talk about other physical issues. Besides, Sydney is aware of her behavior, so she is worried about the opinions of others. Thus, this feature can explain Sydney’s unwillingness to socialize. All these signs appear within six months, which is sufficient time for a diagnosis. Besides, while separation anxiety is more common in children, it also occurs in the 2 percent of US adults who are overly concerned about their offspring, which is Sydney’s case (American Psychiatric Association, 2013). Therefore, separation anxiety disorder is the most likely diagnosis for Sydney because her concern is driven by her desire to protect her children.
However, for confirmation of provisional diagnosis and reject of the differentials, the therapist needs more information. For example, Sydney can have nightmares involving her children, or experience nausea and headaches when separating from them, which reinforces the diagnosis of separation anxiety disorder. On the other hand, thoughts of suicide or self-worthlessness can support the diagnosis of depression, and fear of socially uncomfortable situations can indicate a social anxiety disorder. These diagnoses can also be combined; for example, depression can develop because of separation anxiety disorder or simultaneously with it (Manicavasagar Silove, 2020). Therefore, while known symptoms indicate the provisional diagnosis, additional information can change the picture.
Treatment and Prognosis
Treatment and control of the disorder are necessary for Sydney, since ignoring the problem can lead to functional impairments, problems with her husband, and negatively affect the children. Therapeutic and drug treatment physical activities are the most common remedies for any anxiety disorder. However, since until 2014 separation anxiety was considered only as a disorder diagnosed in childhood, the methods of its treatment in adults have not been sufficiently researched (“DSM-5 changes,” 2016; ) Bandelow et al., 2017). Nevertheless, several features demonstrate that, in the case of Sydney, medication treatment should be avoided and therapy and non-medical methods should be applied.
There are several reasons against taking medication in Sydney’s case. First, medication, such as antidepressants during severe depression or panic attacks, is a short-term solution to relieve symptoms. At the same time, studies have shown that placebo, in this case, often has the same effectiveness and helps patients reduce anxiety (Bandelow et al., 2017). However, Sydney has no panic attacks or suicidal thoughts and carries out her daily duties, which reduces the need for medication. In addition, since the woman has a six-month-old son, she can still breastfeed him, and taking pills can negatively affect her health and baby (Bandelow et al., 2017). Therefore, medication is not a viable option for Sydney at this stage.
Nevertheless, therapy is a necessity for the woman to fight her problems and fears. One of the most common treatment options is cognitive-behavioral therapy, which has a significant effect on the treatment of separation anxiety disorder because it helps combat phobias (Bandelow et al., 2017). For example, Mowlaie et al. (2018), showed that Brief Empathic Psychotherapy (BEP) significantly reduces anxiety and depression in adults, as well as Affect Phobia Therapy (APT) combat fears (Mowlaie et al., 2018). In this case, BEP allows adults to reduce guilt and distinguish their concerns through the therapist’s empathy, which evokes the same feeling in the patient’s toward themselves. At the same time, APT helps patients understand their phobias to build barriers and adaptive strategies to mitigate their effects (Mowlaie et al., 2018). Therefore, these methods will help Sydney reduce anxiety about her children, others’ opinions, and symptoms of depression.
Furthermore, a person’s knowledge about his or her condition, the use of techniques to control anxiety, and exercise are suitable methods for treating. First, according to Manicavasagar and Silove (2020), an understanding of symptoms and effects of the disorder by a person helps her or him to use her knowledge toward the surrounding reality. In other words, if Sydney realizes that she worries about something because of her diagnosis, then it will be easier for her to deal with feelings. In addition, there are some anxiety management techniques such as deep breathing, meditation, or relaxation exercises to handle fears (Weber, 2019; Manicavasagar & Silove, 2020). These techniques will also help Sydney to reduce her anxiety at critical moments. Exercising or running is also a distraction from separation anxiety. In Sydney’s case, the time away from her family can be training for her and a break from household chores. Thus, a combination of a professional therapist and emotional self-management is the most appropriate treatment for Sydney.
However, if treatment is ignored, Sydney can face functional problems that interfere with her social life and work, as well as the development of her children. Firstly, Sydney already has issues with socialization due to reluctance to leave children and fear of condemnation, and, in the future, this feeling can worsen. Sydney’s depression can also be exacerbated by her helplessness in the face of fears, and together with anxiety, these disorders cause social impairment (Durbano, 2015). The inability to communicate with people and the reluctance to leave the children also hinders Sydney’s ability to work if the need arises.
Moreover, if in the event of a serious incident with children, anxiety can only intensify and cause panic attacks. Lack of trust in the husband and overprotection of children can also damage their relationship and lead to a breakup. In addition, such intense protection of sons can harm their development, since they will be deprived of regular activities for children. Besides, some research proves the inheritance of the diagnosis in children, and the mother’s constant anxiety can give rise to fears in the sons (American Psychiatric Association, 2013; Kim, 2020). Consequently, the lack of treatment threatens the disorder’s progression, which will cause or exacerbate other illnesses and harm Sydney’s social relationships. However, intervention and the absence of risk factors such as illness or injury to children can solve the problem and help Sydney to control her emotional state.
Conclusion
Sydney’s case has several flaws to determine diagnosis and treatment; however, using different models and approaches helps obtain the most accurate result. The problem with diagnosis separation anxiety in adults is that its definition is relatively new to psychopathology, so the availability of proven models for diagnosis and treatment is insufficient. For this reason, the DSM-5 criteria were the only available for diagnosis, although the same model in combination with others helped to reject the differentials. Thus, this model is useful for the situation. However, the lack of data in Sydney’s case also makes possible changes in the provisional diagnosis and treatment. However, the available literature and DSM-5 criteria are sufficient to support Sydney’s diagnosis regarding the available information.
References
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