discussion

History of Present Illness:

D described 3 years of anxiety attacks accompanied by palpitations, shortness of breath, hot flashes, sweating and parathesias, in addition to abdominal discomfort. Their onset was clearly traced to a blind date arranged by a close friend. On the way with his friend to pick up the girl he suddenly felt extreme nausea and was forced to pull the car off to the side of the road. He got out for a breath of fresh air and promptly vomited. Although his friend forced him to go through with the date, D was extremely nervous and preoccupied throughout, took his date home immediately after the movie was over and sped away without even walking her to the door.

Although he had previously been shy around girls, following this incident, D panicked at the thought of a date. There were girls to whom he felt attracted, but whenever he brought himself to even consider asking one out, he became symptomatic. The anticipation generalized so that he became anxious going to local basketball games, bars and concerts with friends because he might see girls he was interested in meeting, talking to or dating. He frequently felt like staying home but forced himself with the help of some peer pressure to go out at least "with the boys."

As he neared completion of his MSW program he had to go for job interviews, these began to cause anticipatory anxiety. He described feeling "trapped" in the interview with "no way out." He then developed a fear of talking on the phone to people to arrange appointments for interviews or follow-ups. He was hired by a large municipal welfare agency and stayed mostly to himself on the job. His telephone fear extended to conversations with clients.