Question Peggy Isaac was a 41-year-old administrative assistant who was refer

Question Peggy Isaac was a 41-year-old administrative assistant who was referredfor an outpatient evaluation by her primary care physician with a chief complaint of “I’m always on edge.” She lived alone and had never married or had children. She had never before seen a psychiatrist.Ms. Isaac had lived with her longtime boyfriend until 8 months earlier, at which time he had abruptly ended the relationship to date a younger woman. Soon thereafter, Ms. Isaac began to agonize about routine tasks and the possibility of making mistakes at work. She felt uncharacteristically tense and fatigued. She had difficulty focusing. She also started to worry excessively about money and, to economize, she moved into a cheaper apartment in a less desirable neighborhood. She repeatedly sought reassurance from her office mates and her mother. No one seemed able to help, and she worried about being “too much of a burden.”During the 3 months prior to the evaluation, Ms. Isaac began to avoid going out at night, fearing that something bad would happen and she would be unable to summon help. More recently, she avoided going out in the daytime as well. She also felt “exposed and vulnerable” walking to the grocery store three blocks away, so she avoided shopping. After describing that she had figured out how to get her food delivered, she added, “It’s ridiculous. I honestly feel something terrible is going to happen in one of the aisles and no one will help me, so I won’t even go in.” When in her apartment, she could often relax and enjoy a good book or movie.Ms. Isaac said she had “always been a little nervous.” Through much of kindergarten, she had cried inconsolably when her mother tried to drop her off. She reported seeing a counselor at age 10, during her parents’ divorce, because “my mother thought I was too clingy.” She added that she had never liked being alone, having had boyfriends constantly (occasionally overlapping) since age 16. She explained, “I hated being single, and I was always pretty, so I was never single for very long.” Nevertheless, until the recent breakup, she said she had always thought of herself as “fine.” She had been successful at work, jogged daily, maintained a solid network of friends, and had “no real complaints.”On initial interview, Ms. Isaac said she had been sad for a few weeks after her boyfriend left, but denied ever having felt worthless, guilty, hopeless, anhedonic, or suicidal. She said her weight was unchanged and her sleep was fine. She denied psychomotor changes. She did describe significant anxiety, with a Beck Anxiety Inventory score of 28, indicating severe anxiety.Question, please provide a differential diagnosis for Ms. Isaac, linking all behavioral observation to diagnostic criteria found in the DSM 5.  Health Science Science Nursing PSY 100 Share QuestionEmailCopy link Comments (0)

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