CASE STUDY ANNA 1
Case Study Anna
David J Popick
Liberty University
Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to David J Popick
Email: DJPopick@liberty.edu
CASE STUDY ANNA 2
Client Concerns
Symptoms Behaviors Stressors
Anxiety Constant worry, alcohol
consumption to ease stress
Taking care of elderly
Mother, worried if her
Children are successful,
If her condo will fall into
sink hole, feels sad over
strained relationship,
husband’s passing,
cultural approval from
extended family
Fatigue No motivation Constant worry, can not
Fall asleep at night,
Muscle Tension Frequent headaches, body pain,
Can not sit still/relax, sleep
deprivation, difficulty
concentrating
Retirement, family
relationship, caring for
elderly mother,
Fear uncontrollable thoughts Misses coworkers,
Retired in her mind too
Soon, extended family
Relationship if 90 year
Old mother needs to
Go in nursing home.
Social isolation Losing touch with friends and
family
Stopped speaking with
Coworkers, children are
Not taking her calls
Relationship harmony/isolating Calls adult children to speak
about numerous fears causing
children to not take her calls
Constantly fearsome and
worrisome, friends have
expressed they liked her
Before the stress. Grand
Children do not want to
Spend time due to her
Worry,
Assessment
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As a counselor, I would assess Anna in a culturally competent way so that she can
hopefully open up and be honest with me. I would need to do more research of people with the
Hindu religion so she can feel comfortable. I think in her situation, this will help us deal with
Generalized Anxiety Disorder which she is suffering from. The tool that I would utilize for Anna
is the Spielberger state—trait anxiety inventory short version. This test will aid me in diagnosing
her and since it’s a short version she should not feel that I have not listened to her in the initial
visit. The STAI short has the same reliability as the regular and is for people ages 16-90 (Zsido et
al, 2020).
Diagnostic Impression
For this section I will provide diagnostic impressions on Generalized Anxiety
Disorder300.02(F41.1) (APA, 2022) for Anna. Anna has stated the following signs of Anxiety.
They signs are present and constant in her daily life. Generalized Anxiety Disorder criteria
includes:
Excessive worry for more days than not for at least 6 months. Anna has been dealing
with heightened anxiety for more than 18 months.
Restlessness or feeling on edge. Anna has reported that after retirement her symptoms
have worsened. Anna reported that three years ago she began having some trouble sleeping but
attributed it to her life changing so much in such a short time. She reported that she started
noticing that her mind would race with various worries for part of the day 2-3 days a week about
2 years ago. In the past 18 months the worry has increased to daily for most of the day.
Difficulty sleeping or staying asleep. It has been reported that Anna has experienced
fatigue for at least 12 months. Anna has been struggling to sleep for the past 18 months. She
stated that in the past 12 months she has struggled to get to sleep nightly, lying in bed awake
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worrying for at least 1-2 hours every night and waking up worrying after 5-6 hours of sleep.
Prior to retirement, she slept 7-8 hours a night.
Irritability. Anna has stated she rationally knows that her worries are unfounded, but she
is unable to stop them from popping into her head. “Once they are in my head, I cannot seem to
let them go.
Body Tension. Anna reported that over the past 24 months she has felt increasing
tension in her body. “I used to get a headache 1-2 times a year. I now have a headache 3-4 times
a week”. Additionally, she states for the last 12 months she has difficulty sitting still when she
starts to worry and will often get up and walk around due to feeling like she might “jump out of
my skin at times”. As for the theories for of normal and abnormal development, it has been
identified that there may have been several risks factors that could have caused Anna to develop
Generalized Anxiety Disorder. A possible reason could be the loss of her husband. She spoke
very highly of him during the meeting. Environmental factor that might play a role is the fact that
Anna is a loving daughter who is the care taker of her 90-year-old mother. She is concerned for
her mother’s health and also what her extended family would say if her mother was to be placed
in a nursing home. This causes more worry about her own mother’s health. One the other hand,
Anna is a mother and worries about her children’s well-being all the time. She calls them and
speaks about this worry which is causing her children to not answer her calls.
Signs and Symptoms
DSM-5 TR Diagnostic Criteria: General
Anxiety Disorder (GAD) F41.1 (APA, 2022).
Client’s Signs/Reported Symptoms:
Criterion A- Excessive worry and anxiety for
Most days for more than six months (APA,
2022).
Anna stated she has had increased anxiety
and worry both day and night for 18 months
Criterion B- Difficult to control worry Anna stated it is difficult with letting go of
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worry. She continues to worry even if she
knows they will not happened (IE worry
about children and numerous phone calls to
them)
Criterion C- Anxiety and worry are associated
with at least three of the six symptoms most
days for at least 6 months (APA, 2022).
-Restlessness
-Fatigue
-Irritability
-Muscle tension
-Sleep Disturbance
-Difficulty Concentrating
Anna stated she is restless quite often and has
difficulty standing still. She has been
fatigued for the past 12 months which had
made her lose motivation. Family conflict
due has increased over the past 18 months
because of being irritable. For 24 months, she
has had tensing in her body. 12 months her
sleep has shortened, and she finds it hard to
fall asleep. Constant thoughts
Criterion D- Anxiety, worry, or physical
symptoms cause significant distress or
impairment in social, occupational, or other
important areas of functioning (APA, 2022).
Anna states that her increased worry has
caused conflict with her children and
grandchildren. She is also being isolated by
her peers and friends due to her worry.
Criterion E- Disturbance is not caused by
physiological effects of substances, or another
medical condition (APA, 2022).
Anna denies having any other preexisting
medical conditions. She began taking Paxil
which was prescribed four weeks ago by her
medical doctor.
Criterion F- Disturbance is not better
explained by another mental disorder (APA,
2022).
Anna’s symptoms do not meet the criteria for
any other mental disorders currently.
Other DSM-5-TR Conditions Considered
-Substance/Medication- Induced Anxiety Disorder
I briefly considered this due to her alcohol use but it seemed that her drinking developed
more after the current symptoms. Also, GAD is a better fit due to her history of anxiety.
-Prolonged Grief Disorder
I thought this but the case study does not explain how often she speaks about her
husband. She would need a response everyday for at least a month in section B of this diagnosis.
In section C, she has emotional pain but has kept her life going it seems.
Developmental Theories and/or Systemic Factors
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I believe that Anna can thrive from counseling if she and the counselor work together on
each issue. It seems she needs to mend the relationship with her children especially her daughter
that lives nearby. This can reduce the load of care for her 90-year-old mother. With that stressor
lessened, she can work on time to rebuild her social life and maybe get a hobby or part-time job
that she enjoys which can also reduce stress and give her the meaning she had when she was
working and also caring for her husband and mother. I do believe she needs to work one these
things and it will help her.
Multicultural and/or Social Justice Considerations
Anna seems to be assimilated to American society and has held on to some family
traditions. As for Social Justice, I would look into if there are state grants that may help her with
aid for her mother. NJ has a program where a family member can get paid by the state to care for
an elder family member. I would get the information for Anna so she can see if she or her
daughter would qualify) https://www.payingforseniorcare.com/new-jersey/jacc).
Treatment Recommendations
In order to give Anna, the best help possible, I would recommend that she follow through
with getting involved with psychotherapy, finding a support group of individual who also suffer
from GAD and being prescribed certain medications. The top three areas of concern that I would
focus on would be:
Getting Anna to find time for herself and use it for positive things such as a part time
job or hobby.
Provide structure and care for her 90-year-old mother through some type of aid.
Work on communication skills with family and friends so that she has less stress with
them.
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A 2017 (Borza, 2017) study showed that cognitive behavior therapy was successful with
generalized anxiety disorder. This study showed that CBT can reduce GAD the same or better
than medication in as little as six months. This is exceptional for Anna since her medical doctor
does not know what medication can work best for her. Instead of trying numerous medications
and the inherent side effects, she can use CBT and hopefully increase her wellbeing.
I believe that CBT can help Anna the most. I personally think a more holistic approach
can help a person rather than any medication masking the symptoms. Also, if she wanted to
bring any Hindu rituals or treatments to help herself. I think that can be a great benefit to her.
As a culturally competent counselor, I would ask Anna if this something she wants to do. The
counseling is for her benefit and with so many stressors it seems she is at her end. I feel for
Anna and the stress she is going through. All in all I would be a good listener and hope to help
her improve her anxiety and family relationships any ethical way I could.
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References
American Psychological Association. (2022). Diagnostic and statistical manual of mental
disorders (5th ed.).
Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical
neuroscience 19, (2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza
https://www.payingforseniorcare.com/new-jersey/jacc
Andras N. Zsido, Szidalisz A. Teleki, Krisztina Csokasi, Sandor Rozsa, Szabolcs A.
Bandi,
Development of the short version of the spielberger state—trait anxiety inventory,
Psychiatry Research,
Volume 291,
2020,
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