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Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Email:
Symptoms
Case Study: Amara
Client Concerns
Behaviors
School of Behavioral Sciences, Liberty University
Stressors
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Anxiety
Sadness
Irritability
Fatigue
Trouble Sleeping
Drinking
Racing Thoughts
Constant Worry
Sick mother
Death of spouse
Family pressure
Relationships with
children
Assessment
Based on the present symptoms, behaviors, and stressors I would have the client preform
the Beck's Anxiety Inventory (BAI) to gather further clarity for diagnosis. The Beck's Anxiety
Inventory (BAI) assesses the level of anxiety in a person. It is a 21-question multiple-choice self-
report assessment intended to gauge a subject's mood during the previous week, with an
emphasis on somatic symptoms in particular (Beck, et. al., 1988). The assessment has a solid
scientific foundation and can be administered easily.
Diagnostic Impression
The client’s problems and history are consistent with criteria for Generalized Anxiety
Disorder (GAD). The client appears to meet six out of the six criteria for Generalized Anxiety
Disorder (GAD) and the corresponding ICD-10 code for GAD is F41.1 (Generalized anxiety
disorder) (American Psychiatric Association, 2022). I would also consider Substance-Induced
Anxiety Disorder as a secondary diagnosis. The ICD-10 Code of the secondary diagnosis would
require additional assessment and specific information regarding the impact of alcohol
consumption on Amara's anxiety symptoms (American Psychiatric Association, 2022).
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: disorder Client’s Signs/Reported Symptoms:
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name and code number
GAD: Excessive anxiety and worry about Increasing anxiety
various events or activities (F41.1)
GAD: Restlessness, difficulty controlling Insomnia, racing thoughts
worry, sleep disturbance (F41.1)
GAD: Excessive worry about a variety of Multiple, unfounded worries
topics (F41.1)
GAD: Irritability, difficulty concentrating Irritability and difficulty getting along
(F41.1)
GAD: Interference in daily functioning due toStrained relationships with family
worry (F41.1)
GAD: Muscle tension (F41.1)Tension in the body
GAD: Fatigue (F41.1)Fatigue
GAD: Restlessness or feeling on edge (F41.1)Restlessness and difficulty sitting still
GAD: Difficulty concentrating or mind going Difficulty in concentrating
blank (F41.1)
GAD: Excessive worry thoughts (F41.1)Racing thoughts
GAD: Worry about potential harm or danger Excessive concern about safety and health
(F41.1)
GAD: Worry about the well-being of others Worries about family members' safety
(F41.1)
GAD: Excessive anxiety about real-life Worry about finances
problems (F41.1)
Substance-Induced Anxiety Disorder: AlcoholIncreased alcohol consumption
use leading to anxiety symptoms (F10.92)
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GAD: Difficulty controlling worry (F41.1)
GAD: Worry about everyday matters (F41.1)
Difficulty controlling worries
Excessive worry about daily life events
Other DSM-5-TR Conditions Considered
Some symptoms and potential DSM-5-TR diagnoses that might have been considered
based on the case study, along with reasons for ruling them out:
1.Major Depressive Disorder (MDD):
Symptoms: Amara reported feeling sad, crying, and experiencing headaches. She also mentioned
a decrease in interest or pleasure in activities.
Ruling Out: While some symptoms of MDD were present, they did not meet the criteria for a
major depressive episode. Moreover, the primary complaint was excessive worry and anxiety
rather than persistent low mood.
2.Obsessive-Compulsive Disorder (OCD):
Symptoms: Amara described racing thoughts and worries about various topics, similar to
obsessions. She also reported difficulty controlling these thoughts.
Ruling Out: OCD typically involves the presence of obsessions (intrusive, unwanted thoughts)
and compulsions (repetitive behaviors). While Amara displayed obsessive-like thoughts, her
symptoms did not align with the classic presentation of OCD.
3.Panic Disorder:
Symptoms: Amara mentioned increased anxiety and restlessness, which could be related to panic
attacks.
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Ruling Out: The case study did not provide information about the presence of panic attacks, a
key feature of panic disorder. Panic disorder is characterized by recurrent unexpected panic
attacks.
4.Social Anxiety Disorder (Social Phobia):
Symptoms: Amara expressed concerns about how others perceive her, worries about saying
something stupid in social situations, and concerns about body odor.
Ruling Out: While some social anxiety-related symptoms were present, they were part of a
broader pattern of excessive worry and generalized anxiety, rather than specific to social
situations.
5.Adjustment Disorder:
Symptoms: Amara reported feeling sad after her husband's death and some difficulty adjusting to
retirement.
Ruling Out: While Amara did experience sadness and some adjustment issues, her symptoms
appeared to go beyond what is typically seen in an adjustment disorder. Her excessive and
generalized worry was a more prominent feature.
Developmental Theories and/or Systemic Factors
Understanding human growth, functioning, and behavior requires taking into account a
variety of ideas and elements that affect a person's well-being and difficulties. The theories and
elements listed below were taken into account when evaluating Amara.
According to Erikson's theory of psychosocial development, people go through phases,
each of which includes a different psychosocial crisis or difficulty. The "Generativity vs.
Stagnation" stage, which normally occurs in middle adulthood, seems to be where Amara is at
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this time. The desire to make a difference for the world and the next generation defines this stage
(Sekowski, 2022). One may argue that Amara's caretaking of her mother and grandkids is an
example of generativity. However, it's possible that her excessive concern and anxiety are
impeding her capacity to find fulfillment and purpose in this stage.
According to family systems theory, the family is a networked system in which each
member's behavior and feelings have an impact on the others (Erdem & Safi, 2018). Amara's job
as her mother's primary caretaker and her children's tense connections point to a complicated
family structure. Conflicts connected to caregiving obligations and family pressures may have an
impact on her excessive concern and irritation. To deal with these challenges, family counseling
or support may be helpful.
Environmental variables might cause stress and have an affect on mental health,
including the recent death of her husband, retirement, and increasing caregiving obligations.
These stresses might have started Amara's anxiousness or made it worse. It's important to think
about how these past experiences have impacted her general functioning and well-being.
Amara's South Asian heritage and observance of cultural customs, including avoiding
nursing homes, can have a big impact on her beliefs and actions. One's coping strategies, views
toward mental health, and help-seeking behaviors can all be influenced by cultural variables
(Smith & Trimble, 2016). Approaching her therapy with cultural sensitivity and understanding of
these aspects is essential.
Multicultural and/or Social Justice Considerations
It is important to take into account Amara's religious and spiritual identity since it may
have an impact on her experiences and symptoms. This raises a number of issues related to social
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justice and diversity. Amara adheres to numerous South Asian customs and identifies as a Hindu.
Her religious habits and beliefs are probably important components of her identity.
There may be stigmas attached to obtaining mental health therapy in various South Asian
communities (Kagawa-Singer & Blackhall, 2001). People may believe that their mental health
problems are the product of karma or divine will, which may affect how they approach getting
care. It is impressive that Amara was willing to seek counseling despite cultural prejudices.
Hinduism frequently places an emphasis on mindfulness, yoga, and anxiety-management
techniques (Kagawa-Singer & Blackhall, 2001). It's critical to investigate if Amara uses these
behaviors in her life and how they influence her symptoms.
While the case study does not explicitly mention experiences of discrimination or
marginalization related to Amara's religious identity, it is important to take into account the
potential negative effects of cultural prejudice or preconceptions on her mental health. Her
background may be the source of discrimination or microaggressions that cause her discomfort
or pain.
Treatment Recommendations
Key Issues for Treatment
Based on the case study, the top 2-3 symptoms/issues that appear to be of primary
importance for Amara are:
Generalized Anxiety Disorder (GAD):
Excessive and uncontrollable worry about various events or activities.
Restlessness, muscle tension, irritability, and sleep disturbances.
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Difficulty controlling worry and its interference with daily functioning.
Family and Interpersonal Relationships:
Strained relationships with adult children and grandchildren due to excessive worry and
irritability.
Desire to maintain positive family connections and address concerns about family
dynamics.
Cultural and Spiritual Identity:
Balancing her South Asian cultural traditions, religious beliefs, and her willingness to
integrate these aspects into counseling.
Exploring the influence of cultural factors on her mental health and well-being, including
potential stigma related to seeking mental health treatment.
Addressing Amara's generalized anxiety disorder and its impact on her daily life, family
relationships, and cultural identity should be the primary focus of intervention and support.
Recommendations for Individual Counseling
Here are two recommendations for individual counseling based on the main difficulties
mentioned in Amara's case study:
An evidence-based therapeutic technique known as cognitive-behavioral therapy (CBT)
for generalized anxiety disorder (GAD) is well-known for treating anxiety disorders, including
GAD. It focuses on recognizing and altering erroneous thought patterns and actions that cause
anxiety (Hofmann et. al., 2012).
Amara can benefit from CBT by receiving useful advice on how to control her excessive
concern, racing thoughts, and physical strain. It can also help her confront unreasonable attitudes
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and actions linked to her fear. By being flexible enough to take the client's cultural and religious
background into account, this strategy is in line with multicultural considerations.
Culturally sensitive psychoeducation and integration of spiritual practices will be
essential to incorporate aspects of Amara's culture and spirituality into treatment because of
her
strong South Asian and Hindu cultural identities. It may be advantageous to provide her with
culturally appropriate psychoeducation on mental health as well as Hindu mindfulness and
meditation techniques (Kim-goh, 2015).
Amara will feel more at ease and engaged in treatment thanks to this strategy's
recognition and tolerance of her cultural and religious values. It promotes a therapeutic
connection that is cooperative and culturally aware. Additionally, by addressing any potential
stigma associated with mental health treatment in her cultural setting, it is in line with social
justice issues (Pargament, 2013). These two suggestions show how individual counseling can
be
collaborative and culturally sensitive while still honoring Amara's distinctive cultural and
religious identity and offering evidence-based therapies to deal with her main issues.
The choice to refer a client for a medication evaluation is one that must be carefully
considered in light of the client's requirements, symptoms, and the gravity of their illness. A
referral for a pharmaceutical evaluation in Amara's case might be justified given the severity of
her symptoms and her diagnosis of Generalized Anxiety Disorder (GAD).
Based on the severity of the symptoms, referrals for medication evaluation are made.
Amara describes physical symptoms like headaches, excessive and uncontrollable concern,
restlessness, tension in her muscles, impatience, and disturbed sleep. Her daily life and social
interactions are being severely impacted by these symptoms.
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One may think about combining two methods of treatment, even though psychotherapy
has a chance of having a limited effect. GAD can be effectively treated with cognitive-behavioral
therapy (CBT), while some people may also benefit from taking medication (Baldwin &
Polkinghorn (2005). Amara's reaction to treatment should be observed, and medication can be
explored as an adjuvant to therapy if development is slow or limited.
Increasing treatment effectiveness Studies have shown that GAD can be successfully
treated with drugs such selective serotonin reuptake inhibitors (SSRIs) and serotonin-
norepinephrine reuptake inhibitors (SNRIs) (Baldwin & Polkinghorn (2005). If counseling is
unable to adequately reduce Amara's anxiety, medication may be used to treat some of her
symptoms.
In Amara's instance, drug categories may be taken into account. One class of
pharmaceuticals that can quickly relieve the symptoms of anxiety is the anti-anxiety group,
which includes benzodiazepines (Cuijpers et. al, 2014). However, because the possibility of
dependence and tolerance, they are normally only prescribed for short-term use. For the long-
term therapy of GAD, antidepressants such as SSRIs and SNRIs are more frequently given. The
first-line treatment for GAD is frequently one of these drugs (Cuijpers et. al, 2014). The primary
symptoms of GAD, including excessive worry, tension, and somatic symptoms, have been found
to be successfully treated with SSRIs like Sertraline and SNRIs like Venlafaxine (Cuijpers et. al,
2014).
The usefulness of SSRIs and SNRIs in treating GAD symptoms, such as excessive worry,
is highlighted in this evidence-based study of pharmacotherapy choices for the condition . It also
sheds light on the use of medicine as a supplement to psychotherapy (Baldwin & Polkinghorn
(2005). It is crucial to stress that the choice to refer a client for a medication evaluation should be
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done in collaboration with the client and after consulting with a licensed psychiatrist or medical
expert. The client's preferences and cultural views should be taken into account in the decision-
making process, together with a detailed discussion of the medication's possible advantages and
hazards.
Specific Considerations
In this situation, Amara's cultural background is crucial because it affects the way she
thinks and behaves, as well as how she views mental health and how she seeks for support.
Effective treatment requires an understanding of her South Asian cultural background, especially
her Hindu customs and values. It is crucial to learn more about her particular cultural traditions,
such as how she incorporates her faith into her everyday life, any cultural norms pertaining to
family duties and caregiving, and any possible stigma connected with receiving mental health
treatment in her society (Kagawa-Singer & Kassim-Lakha, 2003).
If there are different viewpoints on mental health, treatment modalities, or the role of
family in care, values conflicts may develop. The counselor must maintain cultural humility
when working with Amara in order to manage personal values. The counselor must respect
Amara's views and choices while also offering evidence-based therapies and advancing her well-
being in accordance with her cultural context.
This study explores methods for enhancing cross-cultural communication in the
healthcare industry, highlighting the value of cultural sensitivity and modesty while dealing with
clients from various cultural backgrounds (Kagawa-Singer & Kassim-Lakha, 2003). It gives
suggestions for resolving ethical disputes and advancing improved health outcomes through
culturally competent treatment.
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