CASE STUDY ASSIGNMENT 3
Case Study Assignment: Amara
Client Concerns
Symptoms Behaviors Stressors
Anxiety Social isolation, Alcohol
use
Life transitions,
Relationship problems,
Cultural and family
expectations
Irritability Difficulty getting along
with others
Persistent anxiety and
emotional drainage
Physical symptoms
(headaches, muscle tension,
and restlessness)
Difficulty sitting still,
alcohol consumption
Anxiety-related
Sleep disturbances Difficulty falling asleep
and waking up with
anxiety
Intrusive thoughts and
mental preoccupation
Sadness and grief Ruminates on memories Husband’s death, Life
transitions and retirement
Amara is dealing with excessive anxiety and worry, which is having negative effects on
her relationships, physical and emotional health, and overall mental well-being. She is also
struggling with the loss of her husband, a tough life transition into retirement, and the
expectations she feels from her culture and family. Her behaviors indicate that she is actively
attempting to resolve her anxiety, but her coping mechanisms she engages in disrupts her ability
to process her emotions and adds additional stress.
Assessment
The Generalized Anxiety Disorder 7 (GAD-7) assessment is a widely recognized
assessment to test the severity of generalized anxiety disorder symptoms in adults. This
assessment is useful in Amara’s case because the GAD-7 links anxiety and physical symptoms
such as headaches and muscle tension (Ronaldson et al., 2023). This assessment consists of
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seven items that inquire about how often the symptoms occur and the severity of the symptoms,
such as excessive worrying and sleep disturbances.
Clarifying Diagnosis
The GAD-7 assessment can provide quantifiable evidence that measures Amara’s anxiety
symptoms. Quantifiable evidence helps assess the extent of her anxiety and can therefore inform
adequate treatment plans. Ronaldson et al. (2023) suggests that anxiety that causes physical
symptoms can in turn worsen the anxiety and depression. I chose this assessment over other
anxiety inventories because this idea of circular symptomatology suggests that accounting for the
physical symptoms is essential to determine the level of Amara’s overall anxiety.
Diagnostic Impression
Based on the conclusive information of Amara’s mental state with support of the DSM-5-
TR (American Psychiatric Association, 2022), the primary diagnostic impression is Generalized
Anxiety Disorder (GAD) (ICD-10 code: F41.1, Generalized anxiety disorder).
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder (GAD)- 300.02
Client’s Signs/Reported Symptoms:
Criterion A: Excessive anxiety and worry
about various events or activities
Anxiety, Social isolation (as a result of
anxiety), alcohol use (as a possible coping
mechanism)
Criterion B: The individual finds it
challenging to control the worry
Anxiety (as reported by the client), Alcohol
use (to potentially alleviate anxiety)
Criterion C: The anxiety and worry are
associated with three (or more) of the
following symptoms, with some of them
being present more days than not for the past
six months:
1.Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going
blank
-Physical symptoms, including headaches,
muscle tension, and restlessness
-Difficulty sitting still (as a behavior in
response to physical symptoms)
-Sleep disturbances (difficulty falling asleep
and waking up in anxious state)
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4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or
staying asleep, or restless unsatisfying sleep)
Criterion D: The anxiety, worry, or physical
symptoms cause significant distress or
impairment in social, occupational, or other
important areas of functioning.
Social isolation (as result of anxiety),
difficulty getting along with others (result of
irritability and emotional trouble),
relationship problems (due to irritability and
anxiety), persistent anxiety and internal
emotional havoc
Criterion E: The disturbance is not
attributable to the physiological effects of a
substance (e.g. a drug of abuse, a medication)
or another medical condition (e.g., overactive
thyroid)
Although alcohol use is exercised, it is
because of the anxiety.
Criterion F: The disturbance is not better
explained by another mental disorder (e.g.,
anxiety or worry about having panic attacks in
panic disorder)
Other anxiety or depressive disorders do not
better explain Amara’s symptomatology.
Other DSM-5-TR Conditions Considered
While Generalized Anxiety Disorder (GAD) concludes to be the primary diagnosis, there
are other symptoms that Amara describes that warrant the consideration of other possible
disorders. Amara reported sadness and moments of sadness following her husband’s passing,
which is a symptom of major depressive disorder (MDD). However, she does not have a
persistently depressed mood or loss of interest in activities, and a MDD diagnosis requires five
present symptoms associated with MDD to be given. While she does avoid some social
interaction, it is a direct result of her anxious feelings. The client’s sadness can be directly
attributed to related grief and recent life transitions, rather than a pervasive depressive episode.
Additionally, I considered adjustment disorder, as sadness can be a result of challenging
adjustment to life transitions and the loss of her husband. However, the presence of significant
CASE STUDY ASSIGNMENT 6
anxiety, excessive worry, and physical symptoms indicate that adjustment disorder does not
satisfy most of her symptomatology.
Developmental Theories and/or Systemic Factors
Amar’s case can be conceptualized from the perspective of developmental theories and
systemic/environmental factors that attribute to her current cognitive functioning and behavior.
According to Erik Erikson’s psychosocial development theory, Amara is in her later stages,
experiencing the challenge of ego integrity vs. despair. What it means to be human at this age is
to reflect on one’s life, find meaning in the past, or choose to succumb to despair and regretting
life decisions (Maree, 2021). Amara describes that she does have positive memories of her
husband, and her joy in this aligns with the ego integrity aspect of this psychosocial stage.
However, her constant worry and anxiety may also reflect that there are some unresolved
elements of her life that she has not yet faced. Moving from resistance to acceptance of her life
transitions would satisfy the evolvement of her current psychosocial stage.
Amara’s South Asian cultural background and familial values play a significant role in
her view on life. She feels as though she must adhere to cultural expectations, such as caring for
her mother at home, so she does not put her in a nursing home. This cultural and familial context
has shaped her beliefs towards how she makes decisions that also affect her own life. She feels it
is important to respect age and provide care when needed within her family system.
Multicultural and/or Social Justice Considerations
In conceptualizing Amara’s case, her cultural and ethnic/racial identity greatly attributes
to her symptomatology and cognitive processes. Specifically, her South Asian cultural identity
heavily influences her perception of caring for her family and cultural expectations which
impacts her excessive worry and anxious thoughts. Her cultural beliefs and values shape her
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beliefs such as the importance of strong family ties and respect for elders. These cultural norms
can promote her fears of potential shame if she places her mother in a nursing home and does not
take care of her. Awan et al. (2022) also describe that individuals of South Asian descent often
present physical symptomology because of emotional distress and anxiety. Sometimes only
physical symptoms can be present or verbally relayed to a clinician, which can be challenging to
adequately diagnose and manage the individual’s anxiety. In Amara’s case, she is self-aware of
her ruminating thoughts and anxiety along with her physical symptoms, which helps provide a
clearer diagnosis.
Treatment Recommendations
Addressing the most important symptoms or issues, with the primary focus being the
diagnosis of Generalized Anxiety Disorder, will help construct an appropriate treatment plan to
best serve the client.
Key Issues for Treatment
Excessive and uncontrollable worry
Negative social functioning in general and in close relationships
Fear of shame associated with not meeting cultural or familial expectations
Recommendations for Individual Counseling
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References
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
Awan, H., Mughal, F., Kingstone, T., Chew-Graham, C. A., & Corp, N. (2022). Emotional
distress, anxiety, and depression in South Asians with long-term conditions: A qualitative
systematic review. The British Journal of General Practice, 72(716), e179.
https://doi.org/10.3399/bjgp.2021.0345
Ronaldson, A., Prina, M., Armstrong, D., Das-Munshi, J., Hatch, S., Stewart, R., Hotopf, M., &
Dregan, A. (2021). Associations between physical multimorbidity patterns and common
mental health disorders in middle-aged adults: A prospective analysis using data from the
UK Biobank. The Lancet Regional Health - Europe, 8.
https://doi.org/10.1016/j.lanepe.2021.100149
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