1. Describe how psychiatric assessment could differentiate between a phobia and obsessive-compulsive disorder.
According to the DSM-5-TR (2022), phobias are identified by a marked fear or anxiety about a specific object or situation. In addition, the anxiety or fear is out of proportion to the actual danger posed. For a phobia to be accurately diagnosed, the symptoms must last at least six months and has to cause significant impairment in daily functioning (DSM-5-TR, 2022). According to Rapp et al., (2016) for obsessive-compulsive disorder to be diagnosed using DSM-5 criteria the patient must experience “recurrent, unwanted and intrusive thoughts and/or repetitive behaviors or rituals intended to relieve fear, anxiety and/or distress associated with obsessions.” These compulsions must also occupy at least one hour per day or cause significant impairment on quality of life.
According to O’Connor et al. (2019), with phobias “the complete category of object is feared (e.g. big and small spiders are feared), while in OCD specific types of objects are feared, mostly for their symbolic meaning (e.g. germs may be feared on glue and mud, but not on door handles).” This may seem like a minor difference, but it is the brains perception of how each one is processed that differs. With phobias, it is a known fear with avoidance. In patients with OCD, there is a habitual repetition that must be performed to alleviate stress and anxiety. Therefore, it is the job of the clinician to determine if the patient is experiencing fear/anxiety about an object or are they afraid of a specific item and how it might impact them. In order to do this, a clinician will have to observe the patient and understand what part of daily life is impacted by behaviors. After understanding the impacts of thoughts/behavior on the patients well-being, the clinician can then formulate the best treatment plan for the individual.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.
O’Connor, K., & Audet, J. S. (2019). OCD is Not a Phobia: An Alternative Conceptualization of OCD. Clinical neuropsychiatry, 16(1), 39–46.
Rapp, A. M., Bergman, R. L., Piacentini, J., & Mcguire, J. F. (2016). Evidence-based assessment of obsessive–compulsive disorder. Journal of Central Nervous System Disease, 8. https://doi.org/10.4137/jcnsd.s38359
2. Describe the comprehensive assessment of panic disorder. In consideration of the multiple symptoms that can accompany this condition, describe how you would determine that a client had this disorder as opposed to a medical disorder.
Panic Disorders are uncommon in children (1%-2%) and familiar in adolescents (2%-4%), (Beesdo et al. 2009). Panic attacks do not always develop into panic disorders. Panic Disorder is frequent unforeseen panic attacks. Panic attacks are blunt events of fear, embarrassment, distress, or a sense of losing control even when a known danger is present (Dulcan et al., Concise guide to child and adolescent psychiatry 2018).
I would introduce myself and explain to the individual I’m there to help them manage their current condition. I would start by asking the client what brought them in. The next step would be for them to explain their current situation. With an individual with panic disorder, I would ask questions regarding the leads to their panic attacks. What triggered your panic attacks? Expected panic attacks are cues or triggers. What helps alleviate panic attacks? I would begin with this to help the patient feel comfortable and to be cautioned not to exacerbate a panic attack. I would also have to be cautious about asking about history because I want to be able to distinguish anxiety disorders from panic disorders. I would complete a medical examination assessment to rule out any medical conditions that provoke the occurrence of a panic attack. I would educate the individual and explain the diagnostic criteria for panic disorder. The Diagnostic criteria are developing frequent panic attacks and producing four or more of the following symptoms, palpitations, fast heart rate, chest pain or discomfort, sweating, trembling, Shortness of breath, feeling dizzy, unsteady, faint, lightheadedness, abdominal distress, nausea, chills, heat sensation, numbness & tingling sensation, being detached from oneself, feeling of unreality, fear of losing control or going crazy, and the fear of dying. Symptoms lasting more than four weeks (Diagnostic and statistical manual of mental disorders: DSM-5 2013). I would ask about emotional, psychological, or financial abuse. I would gather information regarding being a victim of sexual assault. I would extend questions to activities of daily living and moods. Ask the individual when you have a panic attack, are you sad, scared, nervous, anxious, or happy? (Zuckerman, Clinician’s thesaurus: The guide to conducting interviews and writing psychological reports 2019). Ask the individual if they ever used a scale such as Panic Disorder Severity Scale (PDSS). This scale evaluates the gravity of panic attacks and disorder symptoms. It presents an outline of the simplicity of the various panic disorder indications (Buchanan, Panic disorder severity scale (PDSS) 2021). The PDSS scale can follow manifestation over time and is transient and susceptible to change. The scale is aimed at adolescents. It consists of seven items that are rated on a 5-point scale. The scale focuses on the frequency of panic attacks, anticipatory anxiety, distress during an attack, phobic avoidance situations and sensitivity, and impairment in work and social functioning (Buchanan, Panic disorder severity scale (PDSS) 2021). Educating is the most efficient way to decrease the exacerbation of panic disorders. Cognitive Behavior Therapy (CBT) is to help reduce triggers that cause anxiety. Educate on relaxation techniques, deep breathing, cognitive strategies, and guided imagery. Medication will also be covered in the treatment plan, such as Selective Serotonin Reuptake Inhibitors (SSRI).
