Social workers take particular care when diagnosing anxiety due to its similarity to other conditions. In this Discussion, you carefully assess a client with anxiety disorder using the steps of differential diagnosis. You also recommend an intervention for treating the disorder.

To prepare: Read the case provided by your instructor for this week’s Discussion. Review the decision trees for anxiety and OCD in the Morrison (2014) text and the podcasts on anxiety. Then access the Walden Library and research interventions for anxiety.

By Day 3

Post a 300- to 500-word response in which you address the following:

· Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention).  Keep in mind a diagnosis covers the most recent 12 months.

· Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

· Discuss other disorders you considered for this diagnosis and eliminated (the differential diagnoses).

· Describe an evidence-based assessment scale that would assist in ongoing validation of your diagnosis.

· Recommend a specific intervention and explain why this intervention may be effective in treating the client. Support your recommendation with scholarly references and resources.

CASE of STORMÉ Intake Date: November 2020

IDENTIFYING/DEMOGRAPHIC DATA: Stormé is a 62-year-old, single, Lesbian, African American female who receives Social Security income and is not currently employed. Stormé is financially comfortable, the social security is decent, although her living expenses are always a concern to her. She lives alone in a subsidized apartment in the same building as her 72-year-old, unmarried sister so increasing the rent will not happen.

CHIEF COMPLAINT/PRESENTING PROBLEM: Stormé seeks treatment for anxiety. She says she is very concerned and the anxiety has led to pulling her hair out and it has become noticeable on top of her head. She is taking to wearing hats and wigs to hide the bald spots. Stormé reports that germs have been a regular concern of hers since adolescence, when she learned in health classes about the risks of serious diseases including sexual transmittable disease. Her sister encouraged her to seek treatment rather than “hiding her ways.” She agreed to this session even though she is pessimistic about anything working.

HISTORY OF PRESENT ILLNESS: After Stormé move to her own apartment and began pulling her hair out she reported feeling better but does not always notice how much she is pulling. She fears losing control of herself. Her sister learned of her hair pulling after Stormé’s wig slipped off one evening to reveal bald spots. She set up a schedule over the past few months with her sister to help stop the hair pulling. Sometimes it worked and sometimes it didn’t. She is worried that she will be disappointing her sister by not sticking to the schedule to reduce her hair pulling. Stormé feels tired a lot trying to keep up with the cleanliness of the house especially with her lack of mobility and finds herself napping often. This then interferes with a restful sleep at night.

PAST PSYCHIATRIC HISTORY: Stormé worries about so many things, which is not new to her and she finds that by scrubbing her home clean is her best therapy to ease her anxiety. SUBSTANCE USE HISTORY: Stormé denies any abusive use of alcohol and denies any drug use.

PAST MEDICAL HISTORY: Stormé has arthritis in her spine and knees and uses a walker to help her manage mobility safely. With her physical disabilities it is challenging sometimes to scrub clean the house daily. This worries her in case she gets a visitor and the house is not in order as she would like. Luckily she is no longer working so the amount of time it takes her to scrub the house clean doesn’t delay her daily schedule as it used to. FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC: Stormé shared that when she was 2 years old her mother died from tuberculosis, and the following year her father, an army officer, died from colon cancer. After his death, Stormé lived with her paternal aunt from whom she felt no love. Her older brother and sister were placed in an orphanage and Stormé was permitted to see them on Sundays. When it became apparent that the children were entitled to death benefits, Stormé aunt agreed to take custody of all three siblings. The household then consisted of Stormé paternal aunt, her husband (who Stormé described as an alcoholic), their three children, Stormé and her two older siblings. Stormé was briefly married in her early 20s (4 years) but was disappointed and hurt by her husband’s infidelity. She moved in with her sister at that time. Stormé reported it as an “anxious” time but denied hair pulling then. Stormé also enrolled in a cosmetology school and liked her work. She had to stop working “for health reasons” when she was 58 years old. CURRENT FAMILY ISSUES AND DYNAMICS: Stormé shared an apartment for over 30 years with her sister, beginning when each of their marriages dissolved. Stormé reported that when her sister began a romantic relationship 5 years ago, Stormé began to feel very anxious and cried often. She continues to cry periodically for no known reason. Stormé moved into an apartment down the hall in the building and began to pull the hair from her head, hiding her hair loss by wearing wigs. This behavior occurred at different times and resulted in scabbing. is reliant upon her sister for transportation and for a sense of social and emotional connection. Stormé worries about bothering the sister due to her transportation needs and worries if she doesn’t have her sister what would she do. She knows she is edgy with her sister often and worries that might be from lack of good sleep. The worrying has interfered with her concentration.

MENTAL STATUS EXAM: Stormé presented with meticulous grooming, although the knees of her pants were noted as worn. She looks her stated age. Stormé was collaborative during this assessment and engaged after a reluctant start. She denies suicidal and homicidal ideation. There was no evidence of hallucinations or delusions