ANNA CASE STUDY 1
Anna: Case Study Assignment
Robert Adler
School of Behavioral Sciences, Liberty University
ANNA CASE STUDY 2
Anna: Case Study Assignment
Symptoms Behaviors Stressors
Anxiety Irregular sleeping pattern Retirement & several
significant life changes in
a short amount of time.
Fear The mind will not stop
racing around with
different thoughts.
(Unofficial) financial
problems, family
wellbeing, health concerns.
Unhappiness Sobbing Stress within family
relationships.
Worrisome Headaches, shoulder and
neck pressures, and
restlessness.
Taking care of an older
elderly mother, family
relationship strains,
overthinking what if and
worst-case scenarios.
Assessment
Anna has presented herself with the following symptoms: apprehension, sadness, anxiety,
irritability as well as fear which can be signs of several different disorders. Mainly anxiety
disorders (APA, 2013). While determining Anna’s diagnosis, the Penn State Worry Questionnaire
(PSWQ) will be used. The PSWQ is a 16-item survey that assesses anxiety (Johnco et al., 2021).
The PSWQ scores are based on a 5-point Likert scale, with one indicating that something is not
likely and five indicating that something is highly likely. PSWQ was chosen for Anna because it
can distinguish between generalized anxiety disorder and those who have other anxiety
disorders. The Beck Anxiety Inventory and the Hamilton Anxiety Scale are both used to assess
anxiety symptoms; however, the PSWQ is more commonly used to assess concerns in later life,
which is Anna's scenario (Johnco et al., 2021).
Diagnostic Impression
ANNA CASE STUDY 3
Generalized anxiety disorder, ICD-10 code F41.1, is suspected as the origin of Anna's
persistent feelings of concern, apprehension, anger, and anxiety (APA, 2013). Anna's symptoms
are similar to those of other anxiety disorders, but they do not fit the diagnostic criteria.
Separation anxiety (F93.0), particular phobias (natural environment phobia F40.228, situational
phobia F40.248, other phobia F40.298), and social anxiety or social phobia (F40.10) were also
evaluated (APA, 2013).
DSM-5 Diagnostic Criteria:
Generalized Anxiety Disorder F41.1
Client’s Signs/Reported Symptoms:
Criterion A: Anna had excessive
anxiety and concern for more than six
months, usually daily.
Anna has been worried and anxious
about various topics for at least the past 18
months.
Criterion B: Anna has difficulty
controlling concern
Anna explained that she recognizes
that her worries are unjustified, yet she cannot
stop them from entering her head and letting
them go.
Criterion C:3 or more symptoms most
days for more than six months:
Restless- on edge
Fatigue
Irritability
Muscle tension
Sleep difficulties
Difficulty concentrating or mind going
blank.
Anna has claimed difficulty sleeping,
muscular strain in her shoulders and neck,
weariness, impatience, restlessness when she
begins to worry, and a speeding mind.
Criterion D: Anxiety, concern, or
physical symptoms create severe suffering or
impairment in social, occupational, or other
areas of functioning.
Anna's connections with her family
and friends have suffered due to her constant
checking in and fretting. Anna is experiencing
physical symptoms due to her constant
worrying, which may give her further anxiety
and stress.
Criterion E: There are no
physiological implications of drugs or other
medical disorders causing the anguish.
Anna says she consumes 5-6 glasses
of wine each week and that neither she nor
her family believes it is a concern. Anna
claims that she is free of any medical issues
or drugs that may be causing her symptoms.
Anna is on Paxil for sleep problems, although
ANNA CASE STUDY 4
she has only been on it for four weeks, and
her symptoms have been present for 18
months.
Criterion F: Anna's disturbance is not
explained by any other mental disorders.
Anna believes there is no known
mental illness within her family history that
could be causing her symptoms.
Other DSM-5 Conditions Considered
Anna's symptoms are somewhat aligned with separation anxiety, according to the DSM-
5. Anna's husband died four years ago, and two of her children reside out of state, which may
explain her concern for their wellbeing. On the other hand, Anna is not fearful of being alone and
does not mind spending time alone, ruling out the diagnosis of separation anxiety. Specific
phobias were also taken into account because Anna claimed that she frequently worries about
specific things, such as her family's wellbeing, finances, and gastrointestinal sickness. Even
though these might be valid phobias, Anna does not actively avoid certain situations or products;
therefore, a specific phobia diagnosis was ruled out (APA, 2013). Social anxiety/social phobia
was also explored for Anna since she expressed concern about what others thought of her and if
they were judging her. Due to Anna's anxiety, she is grieved by her loss of her husband and
misses interacting with others, so social anxiety/social phobia was ruled out (APA, 2013).
Developmental Theories and Systemic Factors
Anna is presently in Erickson's Psychosocial Development Theory's eighth stage, ego
integrity vs. despair (Maree, 2020). This is the ultimate stage of life when individuals face the
prospect of death and often ponder whether their time on earth was fruitful or disastrous (Maree,
2020). Anna may be unduly interested in her family and friends because she is grappling with the
truth that she is immortal. She is in the final stage of Erickson's hypothesis, having lost her
husband and caring for her elderly mother. Anna's family is stressed by her worry, and the
ANNA CASE STUDY 5
separation may be compounding it since Anna may believe that no one would be there to care for
her like her mother did when she was younger.
Multicultural and Social Justice Considerations
Anna is an Asian-American born in the United States to parents who immigrated before
she was born. Since culture and settings may impact and influence anxiety disorders, this must
be considered while analyzing symptoms for a diagnosis (Kring & Johnson, 2021). Like Anna's
parents, immigrant Asian-Americans had lower rates of mental health diagnoses than Asian-
Americans born in the states, like Anna. Anna upholds her cultural views of valuing family by
caring for loved ones rather than placing them in nursing homes. Anna's anxiety and concerns are
primarily based on her physical complaints and maintaining family honor by caring for her
elderly mother (APA, 2013). Anna's culture values family and tranquility, and as a result of her
worry and continuous check-ins, she is presently suffering from broken ties with her children and
grandkids.
Key Issues for Treatment
Inability to stop worrying
Physical effects of anxiety and worry
Recommendations for Individual Counseling
The failure to stop worrying can be challenging to conquer, but the feelings can be
managed or even eliminated with therapy. Psychoeducation, along with self-monitoring, is one
type of therapy for excessive worrying (LeBlanc et al., 2021). Anna will be capable of
understanding her symptoms and enhancing her goals for improvements through
psychoeducation. Anna will learn to self-monitor her worry episodes as she learns to identify her
symptoms. Anna will be able to correlate feelings with triggers, ideas, bodily sensations, and
ANNA CASE STUDY 6
behaviors if she self-monitors her feelings. Anna should be able to link triggers to episodes and
maybe reduce symptoms using psycho-educational and self-monitoring.
Treatments for Anna's physical symptoms of a generalized anxiety disorder include
applied relaxation and mindfulness techniques. Anna will learn relaxation techniques that she
may adapt to reduce stress in her body and calm her thoughts when she is having a worrying
episode (LeBlanc et al., 2021). Mindfulness methods like meditation or walking while focusing
on bodily sensations can help Anna calm her mind and body while focusing on the present
moment rather than her incessant anxieties. If Anna senses that an anxiety episode is about to
begin, she can meditate or go for a walk to help avoid or limit the incident.
Specific Considerations
Anna's culture and heritage are essential in her situation since she upholds Asian culture
ideals such as emphasizing family morality and respecting family by providing for them. She is
also distressed because her anxiety and concern are producing issues in her connections with her
family, which are very important to her. Anna's worldview, childhood experiences, ideas on
mental health, and desire to participate in therapy would provide more information about her
culture to aid in her diagnosis and treatment. One cultural divide is that Anna would be
embarrassed to place her mother in a nursing home, whereas others lack the resources or
expertise to care for loved ones at home. It is not that a person does not love their family if they
have to put them in a nursing home to acquire the professional care they deserve, but in Anna's
culture, this is unacceptable. It is critical to have culturally sensitive expectations while working
with clients from various backgrounds and to put personal beliefs and ideals aside when assisting
clients during their therapy (Kring & Johnson, 2021).
ANNA CASE STUDY 7
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders:
DSM-5 (5th ed.). American Psychiatric Association Publishing.
Johnco, C., Wuthrich, V. M., Brenes, G. A., Wetherell, J. L., Mohlman, J. (2021). Evidence-based
assessment of treatment outcomes for late-life generalized anxiety disorder using the
Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire –
Abbreviated (PSWQ-A). , 1-13. International Psychogeriatrics
https://doi.org/10.1017/S1041610221000351
Kring, A. M., & Johnson, S. L. (2021). Abnormal psychology: The science and treatment of
psychological disorders (15th ed.). John Wiley & Sons, Inc.
LeBlanc, N. J., Bartuska, A., Blanchard, L., Baker, A., Bui, E. (2021). Cognitive-behavior
treatment for generalized anxiety disorder: Theoretical foundations and empirically
supported strategies. Psychiatric Annals, 51(5), 210-215.
https://doi.org/10.3928/00485713-20210412-02
Maree, J. G. (2021). The psychosocial development theory of Erik Erikson: Critical overview.
Early Child Development and Care, 191(7-8), 1107-1121.
https://doi.org/10.1080/03004430.2020.1845163
