Ben’s Case study
Identification of the disorder:
The case presented deals with Ben, a 52 years old man suffering from obsessive-compulsive disorder as well as generalized anxiety disorder, personality disorder and social anxiety disorder. Since Ben has been unmarried his whole life and has always been anxious with girls and he avoids making any social approaches with women. Since he also mentioned that all of the young people in his area dislike him. Thus, Ben is diagnosed with Social anxiety disorder (Social phobia). According to the Social anxiety disorder diagnostic criteria published in DSM-5 (American Psychiatric Association, 2013), 1. The social situations almost always provoke fear or anxiety in individuals with social phobia, 2. The social situations are avoided with intense fear or anxiety, and this is what happens with Ben when he deals with women. Generalized anxiety disorder is the second disorder that Ben is suffering from, one of the diagnostic criteria of generalized anxiety disorder published in DSM-5 (American Psychiatric Association, 2013) is Excessive anxiety and worry, this point can be summarized when Ben became very careful to avoid making mistakes after his incident at work. Ben admits to check all of the locks on his house at night and disconnects his phone to avoid possible threatening phone calls, he also double-checks all of his deliveries after the incident, all of these acts confirms the presence of obsessions and compulsions, which are one of the diagnostic criteria of Obsessive-Compulsive Disorder published in DSM-5 (American Psychiatric Association, 2013). One of the diagnostic criteria of general personality disorder published in DSM-5 (American Psychiatric Association, 2013). is that “c. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning” and this is characterized by Ben’s social interaction during the past few years, He smiles when he is angry and seems upset when everyone is laughing.
Identification of the separate themes:
Ben has reported that he enjoys interacting with people but in the same time he has always been anxious with girls and avoid any social contact with them he also has not been married his whole life, this can indicate Ben’s social anxiety disorder. Social anxiety disorder also known as social phobia is a type of anxiety disorder characterized by excessive fear, anxiety, distress, and self-consciousness in social events (psycom,2018). The other thing that emphasize his social anxiety disorder maintenance is his incident at work, the error he made became known around his work place, and his colleagues teased him for several weeks. According to DSM-5 Onset of social anxiety disorder may follow a stressful or humiliating experience (e.g., being bullied) the people who appreciate Ben’s involvement in the church find him a bit abnormal. According to the cognitive theory, persons with social anxiety disorder tend to overestimate the level of threat in social situation and Expect negative outcomes from interactions with people (Huppert, 2003), these beliefs and expectations are characterized in Ben disconnecting his phone at night to avoid possible threatening phone calls because he thinks that all of the young people in his neighborhood dislike him and they may be planning to break into his house. According to diagnostic and statical manual of mental disorder (DSM-5), the weak elderly, worries about safety may limit their activities. This can be shown in some of the themes that characterize the development and maintenance of general anxiety disorder in Ben, one of them was losing his interest in the walks at night claiming that the streets are too dangerous , and after his incident at work he became very careful to avoid making any mistakes , also he double checks all his deliveries, finally during the past six months Ben admits that he carefully checks all of the locks on his house and disconnect his phone at night. According to the cognitive theory (Wells, 1999), individuals with generalized anxiety disorder develop a sequence of expectations and beliefs about worry, there are Two types of belief which are relevant to the problem: (a) positive beliefs about worry in which the individual believes that worrying serves a protective or coping function, can be characterized by Ben disconnecting his phone at night, and (b) negative beliefs about worry. Some of the themes that characterize the development and maintenance of Obsessive-Compulsive Disorder in Ben is when he checks all of the locks on his house at night and double-checks all of his deliveries after the incident. According to diagnostic and statistical manual of mental disorder (DSM-5), Onset after age 35 years is unusual but does occur. According to the biological perspective (Kelly, 2018) individuals with Obsessive-Compulsive Disorder suffer from repetitive actions called compulsions and irrepressible thoughts called obsessions. According to the behavioral prospective, fear in people with obsessions and compulsions is triggered by fear associated with stimuli (e.g. young adult in the area doesn’t like me) that are unlikely to cause actual harm. Moreover, according to the cognitive perspective, individuals suffering from Obsessive-Compulsive Disorder have an exaggerated sense of personal responsibility (e.g. Ben double-checking all of his deliveries ) and so feel they must carry out their compulsive rituals to avoid adverse consequences, During the past two years, Ben’s colleagues have noticed some changes in him, he always seems unusual also his social communication seemed unsuitable, he smiles when he is angry and seemed upset when everyone else is laughing, one of his coworkers reported that Ben may be using hallucinogenic drugs. Although Ben attended church on regular basis, the people in the church finds him a bit strange. All of these themes characterize the development and maintenance of general personality disorder, according to DSM-5 (p647) ‘personality disorder is a continuing pattern of thinking, feeling, and behaving that is relatively stable over time’. Personality Disorders Institute at Cornell University states that: borderline personality disorder is “more predominant than schizophrenia, autism, and bipolar illness joint”. (Personality Disorders Institute).
Identification of appropriate intervention
Ben’s case reveals that he has signs and symptoms of four disorders, first: Social anxiety disorder, some of the interventions that can help Ben overcome his social phobia are: 1. counselling 2. psychodynamic therapy 3. The treatment should involve confronting the feared stimulus in his real life (Marks, 1975), which is dealing and socializing with women. 4. Develop individual or group social anxiety cognitive behavioral therapy (based on the Clark and Wells model), individual cognitive behavioral therapy for social anxiety disorder according to Clark and Wells model should consist up to fourteen sessions of 90 minutes duration over four months and include education about social anxiety, empirical exercises to determine the adverse effects of self-focused attention and safety-seeking behaviors, CBT involves exposure in vivo and cognitive restructuring with training in relaxation and social and conversational skills training. cognitive behavioral therapy can be in groups or individual. Second disorder is generalized anxiety disorder which can also be treated by cognitive behavioral therapy, according to Combined Treatment for GAD (2017) Patients will be educated about the nature of anxiety and be trained in the recognition and monitoring of situational, physiological, cognitive, and behavioral cues associated with anxious responding. Other therapy options for generalized anxiety disorder and social anxiety disorder are pharmacological intervention. A Study of 75 patients with generalized social anxiety disorder was conducted from 2007 to 2010 and consisted of 16 sessions of individual Cognitive Behavioral Therapy for social anxiety disorder. This study resulted in great reduction of negative emotion ratings, this indicates the effectiveness of Cognitive-Behavioral Therapy for social anxiety. Cognitive Behavioral Therapy can also be used for treating Obsessive-Compulsive Disorder and personality disorder. According to (Treating Personality Disorders – Personality Disorder Treatment Options, n.d.) there are Other therapy options for personality disorder: Dialectical behavior therapy (DBT), Interpersonal therapy (IPT) and Family-focused therapy. In dialectical behavior therapy the psychotherapist assures the patient that their behavior and actions are clear and valid. By the end of the therapy, the patient should be able to change his disruptive or unhealthy behavior to good ones.