According to the DSM, the major symptoms of Panic Disorder with Agoraphobia are recurrent panic attacks with anxiety about experiencing another attack. Also present is anxiety being in a public place where escape will be difficult or embarrassing or where it will be difficult to receive assistance in an emergency. Briefly outline the client’s background (age, race, occupation, etc.

) The clients name is Annie and she is a 24 year old Caucasian woman. She has held a variety of jobs but has consistently had trouble holding on to a job for any length of time.Both of her parents are still living but they do not get along. She currently lives with a group of her friends. Please describe any factors in the client’s background that might predispose her to this disorder.

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In Annie’s interview, she states that she remembers her childhood as being normal but later in the interview, reveals that she experienced abusive experiences at a young age. Also, women are 3 times more likely than men to be diagnosed with Panic Disorder with Agoraphobia. Furthermore, Annie remembers having night terrors at age 4 and of her parents trying to calm her down.

Finally, Annie was also diagnosed with major depression and Obsessive Compulsive Disorder at age 15. In the demographics section of this program it was stated that people diagnosed with panic attacks are also prone to other disorders such as major depression. Observations Please describe any symptoms that you have observed which support the diagnosis. In the interview, Annie speaks of having a feeling of dissociation at a young age. She also describes the physiological symptoms of having a panic attack, rapid heart rate, trembling hands, sweating, numbness, unexplained terror and unknown fear.Annie also describes the reasons she is unable to perform simple, routine tasks such as going to the grocery store. She stated that she was afraid she would have to run out of the store suddenly or get sick and throw up. She also speaks of “feeling like I am going to die.

” Please describe any symptoms or observations that are inconsistent with the diagnosis. There was nothing in her interview that stood out to me as inconsistent with her diagnosis. Describe any information you observed about the development of this disorder.Annie describes having night terrors at age 4 where she would wake up screaming and not knowing what she was doing or where she was. She also describes seeing things that terrified her. She also talks about a feeling of dissociation, unreality and anxiety during puberty.

In the video, Annie stated that at age 15 was when things “broke down” for her and started seeing a psychiatrist to seek a diagnosis for her symptoms. This is in line with the demographics section of the program, which states that the average onset of panic disorder is between adolescence and your 30’s.Diagnosis Did you observe any evidence of any Axis 3 issues (general medical conditions) that might contribute to this disorder? Annie talks about having high fevers as a young child and stomach cramps when eating in front of others. Did you observe any evidence of any Axis 4 issues (psychosocial and environmental problems) that might contribute to this disorder? I think Annie definitely has psychosocial issues that contribute to her disorder.

From what I gathered from her interview, she suffered substantial abuse from both of her parents.She speaks of not being validated as a child. Even though she doesn’t go into detail about what happened, she mentions having a chaotic, stressful and traumatic childhood. Also, she talks about having “angels” that would help her deal with things that were happening around her. Finally, she speaks of building an alternate reality to be able to cope with her childhood. Based on your observations, what is the client’s overall functioning (Axis 5)? Please use a 1-100 scale where higher numbers indicate higher functioning.

I would give Annie a ranking of 55.Although she cannot hold a steady job, establish intimate relationships or function normally all of the time, she does have friends and seems to manage taking care of her basic physical needs. Therapeutic Intervention In your opinion, what are the appropriate short term goals for this intervention? I think her first short term goal should be to hold down a steady job. She needs to learn and practice coping techniques to control her anxiety while at work. She could start by working part time and slowly work up to normal work hours.I don’t think she will ever be able to have a normal or fulfilling life while depending on other people or government assistance to provide for her basic needs.

In your opinion, what are the appropriate long term goals for this intervention? The long term goal is to relieve Annie’s anxiety and panic related symptoms so as to relieve the feeling of helplessness. Which therapeutic strategy seems most appropriate in this case? Why? According to research and this program, the most successful strategy seems to be Cognitive Behavioral Therapy in combination with medication.The client learns to recognize when she is having anxious thoughts and the physical reactions to them and learns techniques to control them, which includes in vivo exposure, breathing and relaxation techniques. Which therapeutic modality seems most appropriate in this case? Why? 10-20 weekly sessions with a therapist or psychiatrist, group therapy with others who have the same disorder in tandem with medication. Being able to relate to others with Panic Disorder and Agoraphobia gives the client a sense of relief that they are not alone.