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The development of the human mind is often complicated by various phenomena, that are called phobias, the essence of which lies in the fact that a human being fears something without obvious grounds for such a fear, and this causes the person to avoid certain people, events, places, etc. The case of Mr. Petersen is an example of the situation when a person acquired a phobia although other mental health areas seem to be intact.
Step 1: Diagnoses
|Probable Diagnosis||Possible Diagnosis||Not Probable Diagnosis|
|Acute Stress Disorder||Generalized Anxiety Disorder||Substance Induced Anxiety Disorder|
|Paranoid Personality Disorder||Panic Disorder Without Agoraphobia||Anxiety Disorder Due to General Medical Condition|
|Social Phobia||Posttraumatic Stress Disorder||Schizophrenia|
Step 2: Decision Trees
The analysis of the three possible diagnoses reveals that the generalized anxiety disorder is an incorrect diagnosis because it is associated mainly with such physical symptoms as sleep problems, possibility to fatigue, etc (APA, 2000, p. 429). Panic disorder without agoraphobia is also incorrect for this case because it is impossible to check its symptoms in the patient. Posttraumatic stress syndrome is incorrect as well, as Mr. Petersen not merely avoids his job, but has reasons for this as he thinks his boss wants to kill him and all his colleagues are hostile to him.
Drawing front this, the three probable diagnoses allow developing the single correct one. Although the symptoms of acute stress disorder and paranoid personality disorder can be partly observed in Mr. Petersen’s behavior, the most correct diagnosis for him is social phobia, the symptoms of which are almost fully observed in Mr. Petersen’s daily activities and fears. In more detail, the acute stress disorder can be observed in Mr. Petersen as probably a result of his working problems, while the paranoid personality disorder can be assessed as the logical consequence of the acute stress disorder.
Finally, both disorders combined can be viewed as the grounds for the development of the social phobia. In simpler terms, Mr. Petersen experienced considerable mental pressure, the continuing character of which resulted in the paranoid ideas; finally, these experiences and ideas conditioned a social phobia in this patient.
Step3: Diagnostic Criteria
The criteria for diagnosing the established disorders, i. e. acute stress disorder, paranoid personality disorder, and social phobia, in Mr. Petersen are the symptoms of the issues observed in the patient’s behavior. Thus, the major typical feature of the social phobia is the fear that people experience when exposed to common social situations like daily communication in the street, transport, or at work.
This fear is usually groundless, although the people suffering from the social phobia attribute it to the negative activities, like judgments or physical violence, which the society can resort to in their respect (APA, 2000, p. 431). Obviously, Mr. Petersen displays this symptom, which is persistent and uncontrollable for him.
At the same time, Mr. Petersen displays the sings of acute stress disorder, which include the stress situation in the background and the conscious, or unconscious, avoidance of similar situations. According to APA (2000), such a symptom is a mark of acute stress disorder, as a person is in a state of permanent stress although there are no factors that would condition it. Thus, the diagnosis that Mr. Petersen suffers from the acute stress disorder is also correct. Another proof of the correctness of the above diagnosis is that the acute stress disorder can serve as a background factor for social phobia.
Finally, facts also allow arguing about Mr. Petersen suffering from and the paranoid personality disorder. He is suspicious of his colleagues and his boss, is afraid of attending his job, faces horror while having to be in the stress alone and while seeing those cars in the street. So, the proof of acute stress disorder, paranoid personality disorder, and social phobia in Mr. Petersen is that his mental issue is not accompanied by disorders like sleeping or eating ones, which is a sign of the opening stage of the social phobia conditioned by acute stress disorder and paranoid personality disorder.
Step 4: Multiaxial Evaluation
Axis 1: Acute Stress Disorder:
- Social Phobia.
Axis 2: Paranoid Personality Disorder:
- Delusional Disorder.
The symptoms that can be observed from the case of Mr. Petersen allow diagnosing his mental issue as the social phobia, which is complicated by the acute stress disorder and paranoid personality disorder. The correctness of the diagnosis is supported by the matching of symptoms displayed by Mr. Petersen and the symptoms that characterize the social phobia according to the data presented in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR by APA (2010).
APA. (2000) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. American Psychiatric Publishing, Inc., 4th Ed.