We're coming near the
end of anxiety disorders to include in these blog questions. If
you've been following along from the
start, you may be able to get this one by process of
elimination. What's left?
Instead of putting the name of the disorder in the title and
listing out criteria up top, let's leave some mystery
here--especially helpful for folks who find the blog before
question-only social media post. (If you're not already following
SWTP on Facebook,
A question about this anxiety disorder might look something like
A client who has sought help for persistent depressive
disorder has recently been experiencing episodes of severe anxiety
for the first time in her life. She reports "awful" periods of
increased heart rate, "terrified" sweating, and shortness of
breath, among other symptoms. "It all comes out of nowhere," she
says. The client says her sadness has lessened recently, which she
credits in part to "the Wellbutrin kicking in." She hypothesizes
that either the depression was masking her anxiety or that
revisiting childhood memories in therapy has been having an
unwanted negative effect. What is the BEST way to diagnose the
client's anxiety symptoms according to DSM-5?
A) Unspecified Anxiety Disorder
B) Substance/Medication-Induced Anxiety
C) Panic Disorder
D) Persistent Depressive Disorder with Anxious
What do you say?
First of all, the client is nicely psychologically minded. Those
are good, psychodynamic hypotheses! But they're not in the answer
Let's narrow down. Persistent depressive disorder with anxious
distress? Maybe. But take a look at the "with anxious distress"
specifier in the DSM. These are the symptoms:
1. Feeling keyed up or tense
2. Feeling unusually restless
3. Difficulty concentrating because of worry
4. Fear that something awful may happen
5. Feeling that the individual might lose control of himself
Two of these are required "during a majority of days" to tack
the specifier onto MDD or persistent depressive disorder. But what
the client in the question describes isn't these. It isn't anxious
distress, it sounds more like panic. We move on.
Unspecified anxiety disorder is used when the full criteria for
another diagnosis aren't met. Also not the case.
So what about panic disorder? Panic is what the client appears
to be experiencing. However--and this is a big however--there's
something that's very likely triggering the recent panic attacks,
the recent start of Wellbutrin. Wellbutrin can exacerbate anxiety
symptoms for some. Lots of medications can do that (as, of course,
can alcohol and many narcotics). But whether or not you knew that
about this medication, you might've noted the mention of
the medication in the stem of the item. As a general rule, there's
little to nothing included in a question that doesn't hint in some
way at the correct answer. The prescription may have helped the
client escape dysthymia, but it seems to have brought on panic
symptoms. While there's too little information here to make the
diagnosis definitive, the best of these answer
choices--the one to rule out first--is B)
Substance/Medication-Induced Anxiety Disorder.
Make sense? Great!
For reading about the diagnosis try:
For some specifics re Wellbutrin and anxiety:
And for more practice questions about anxiety disorders and a
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