PS440 Unit 4 Anxiety Disorder Case Analysis Example

Nine Days Without Leaving the Dorm: A PS440 Unit 4 Anxiety Disorder Case Analysis

[Student Name]

Purdue University Global

PS440: Psychopathology

Unit 4 Anxiety Disorder Case Analysis

[Instructor Name]

[Date]

The guest, his family and the crisis center are composite; the manual, model and meta-analysis cited are real.

The Case

Eli is a 19-year-old first-year engineering student at a university in Rapid City, South Dakota. His resident assistant walked him over to the center after noticing that he had not left his room in nine days except to use the bathroom at night. Eli had stopped going to class, ordered food to his door and let his phone battery die so that no one could reach him. When the resident assistant knocked, Eli said he wanted to disappear. He denied any plan to harm himself, and a safety assessment found no intent, but he accepted a short stay.

The precipitating event was small. In a chemistry lab, his group had to present results to the class. Eli froze after two sentences, felt his face burn and heard someone laugh. He left the room, skipped the next lab and then the lecture that met in the same building. Each day it felt harder to go back.

His history shows a long pattern. Eli was a quiet, anxious child who avoided raising his hand. In high school he ate lunch in the library to avoid the cafeteria, turned down a part-time job because it involved talking to customers, and spoke only when called on, though he earned excellent grades. At home in a small town, a few close friends and a familiar school let him manage. College removed that structure.

Diagnosis

Social anxiety disorder, as the DSM-5-TR defines it, centers on fear of being watched and judged. The fear must arise in social situations where others might scrutinize the person, focus on behaving in a way that will be judged badly, appear nearly every time those situations come up, and lead to avoidance or grim endurance. It must also be larger than the real danger, persist for six months or more, and bring marked distress or impairment (American Psychiatric Association, 2022).

Eli meets each criterion. He fears scrutiny in class, at meals and in conversation, and his central fear is being seen as stupid or strange. Those situations reliably provoke anxiety, and he avoids them whenever he can. The fear is out of proportion; one laugh in a lab does not threaten his future. The pattern has lasted for years. The impairment is now severe: he has stopped attending college.

Two alternatives needed to be considered. Shyness is common and is not a disorder; what separates Eli is the degree of fear and the impairment it causes. Panic disorder was considered because his face burned and his heart raced in the lab, but his symptoms occur only in social situations and center on fear of judgment, not fear of the sensations themselves. Depression was also screened for, since he wanted to disappear; he has some low mood, which the counselor judged to be a consequence of his isolation rather than a separate disorder at this point.

What separates Eli from a shy student is not the feeling of blushing in a lab, but that one moment of it emptied his college schedule.

Why It Persists

Rapee and Heimberg (1997) proposed a cognitive-behavioral model of social anxiety. People with the disorder form a mental picture of how they appear to an audience, built from internal cues such as feeling flushed, and they compare that picture with what they believe the audience expects. When the gap seems large, they predict negative evaluation, become more anxious and turn their attention inward and toward signs of disapproval, which makes the picture worse. Avoidance and subtle safety behaviors prevent them from discovering that the audience is less critical than they imagine.

The model fits Eli closely. In the lab, the burning in his face became his image of himself: he assumed everyone could see he was red and incompetent. His attention narrowed to the one laugh, which he read as aimed at him, though he does not know that it was. Skipping the next lab spared him the fear but also the chance to learn that no one remembered. Each skipped class added a new fear: of being asked where he had been. Avoidance grew from one lab to his whole schedule.

His high school safety behaviors fit too. Eating in the library and speaking only when called on kept anxiety manageable but meant he never tested his beliefs. College, with larger classes, group projects and a crowded dining hall, demanded exposure he had never practiced.

Treatment Evidence

Mayo-Wilson et al. (2014) conducted a network meta-analysis of psychological and pharmacological treatments for adult social anxiety disorder, combining evidence from more than a hundred randomized trials. Many treatments outperformed waiting-list controls, including several classes of medication and several forms of psychological therapy. Individual cognitive behavioral therapy had the largest effects among psychological treatments, and the authors recommended it as the first-line treatment, with selective serotonin reuptake inhibitors as an alternative for people who prefer medication or do not respond.

Individual cognitive behavioral therapy for social anxiety targets the processes in the model. It helps clients shift attention outward during social situations, drop safety behaviors, test predictions through behavioral experiments and correct distorted self-images, for example by watching video of themselves speaking.

A Plan for Eli

Eli's immediate need is to return to school before he loses the semester. The crisis center's counselor, with Eli's permission, contacted the university counseling center and the dean of students. The plan has three parts. First, a meeting with the dean to arrange incompletes or late withdrawals where needed, which reduces the stakes of returning. Second, a referral to individual cognitive behavioral therapy at the university counseling center, which offers it. Third, a set of first behavioral experiments planned before discharge: eating one meal in the dining hall, emailing one instructor and attending one lecture while sitting in the back row, with a prediction written down beforehand and compared with what actually happens.

Medication could be considered if therapy alone is not enough or if his low mood deepens. His family history includes a mother with anxiety who did well on an SSRI, which may make him more open to that option.

Conclusion

Eli's freeze in a chemistry lab looked like a small event, but it exposed a social anxiety disorder he had managed for years through avoidance. The diagnostic criteria distinguish his condition from shyness and panic, Rapee and Heimberg's model explains how one avoided lab grew into nine days alone, and the strongest available evidence favors individual cognitive behavioral therapy. The same avoidance that kept him safe in high school is what treatment now has to undo.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376. https://doi.org/10.1016/S2215-0366(14)70329-3

Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741-756. https://doi.org/10.1016/S0005-7967(97)00022-3