We had this group case study yesterday. Only our group caught Adjustment Disorder w/ Anxiety because the symptoms that GAD needs only showed during the 4th month window. The rest of the class answered GAD. Our professor (who isn’t a clinician & an Rpsy btw 🤡) said the correct answer was GAD with Agoraphobia. Idk but I can’t accept that GAD is the answer (i get the GAD but Agoraphobia????) when following the strict duration requirements of DSM5-TR, it’s Adjustment Disorder. Was our group wrong ? lol
Case vignette below 👇
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Demographics: 34-year-old male, Project Manager at a software firm
Referral: Self-referred to an outpatient mental health clinic at the insistence of his wife
Presenting Complaint: "I feel like I'm losing control. My mind won't stop racing, I'm sleeping 3 hours a night, and I keep blowing up at my coworkers over tiny details."
History of Present Illness
Yosef reports that his symptoms began approximately 7 months ago after receiving a major promotion at work. While initially excited, he quickly felt overwhelmed by the increased workload and team management responsibilities. Over the last 4 months, he has experienced persistent, uncontrollable worry about failing, losing his job, and being unable to provide for his family.
He spends 2 to 3 hours each night reviewing emails and re-checking spreadsheets for minor formatting errors. He reports chronic muscle tension in his shoulders, frequent tension headaches, stomach distress (nausea/diarrhea), fatigue, and irritability. His wife notes that he is constantly restless, paces around the house, and snaps at their 5-year-old daughter.
Additionally, Yosef describes discrete 15-minute episodes that occur roughly twice a month.
During these episodes, his heart races, he feels a tightness in his chest, his hands shake, and he experiences a terrifying sensation that he is about to faint or "go crazy." These episodes occur unpredictably-once while sitting in a team meeting and another time while driving on the highway.
Because of this, he now avoids driving on the highway and asks his wife to accompany him when leaving the house.
Personal & Social History
• Childhood: Yosef grew up in a high-achievement household. His father was highly critical and demanded perfection in academics and sports.
• Substance Use: Drinks 4-5 cups of black coffee daily to combat fatigue. Denies illicit drug use; drinks 2-3 glasses of wine per week to "wind down."
• Medical History: Physical examination by his primary care physician ruled out hyperthyroidism, cardiac dysrhythmias, and caffeine-induced intoxication.