Before moving through diagnostic decision making, a social worker needs to conduct an interview that builds on a biopsychosocial assessment. New parts are added that clarify the timing, nature, and se

Case D Dr. Rullo

CASE PRESENTATION - Darien

Intake Date: November 2018

Identifying Information:

A 27 year old African-American, male student was referred for a psychiatric consultation after a workup for gastrointestinal distress proved negative. Darien has consulted his family physician after months of feeling bloated and nauseated in anticipation of certain distressing events and circumstances.

History of Present Illness:

Darien 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, Darien 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.

Darien has continued to think about this situation and feels down when thinking of what happened in the past. Over the past several months his mood is low and he has had trouble staying asleep at night. Although he had previously been shy around girls, following this incident, Darien 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." More recently he does not even want to do that. He finds himself staying home more and eating to relax himself.

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. Darien finds himself being more challenged now because he is forgetting things at work and is having difficulty focusing.