Donald is a
54-year-old paper mill employee. He has adult children and 7
grandchildren with his wife of 30 years. Donald began to experience
problems with worrying during his first few years of marriage. He
would worry excessively about finances, his job security and
performance, fixing up the house, his children and their futures, and
his parents’ health. Since that time he has also worried
uncontrollably about the car breaking down, his grandchildren being
harmed, saving enough for retirement, his own health, and his wife's
Donald's worry has interfered with his
ability to enjoy his life, including holidays and special occasions,
as he always feels tense, restless, and on guard. He has also turned
down multiple promotions at work due to excessive worry that he
couldn't handle the increased stress, responsibilities, and being
around others. He often worries about whether his coworkers like him.
In addition, Donald worries that he will not be able to keep up with
the new technology being used at his job. His worrying also prevented
him from exploring other jobs outside of the mill due to worry he
would fail and end up losing the family home. His back and neck
constantly ache from the tension. His worrying has also led to
long-term problems falling asleep. He has become dependent on
over-the-counter sleeping pills and is still easily fatigued most
Friends and family complain that Donald
is always on the go and never sits still, but this is the only way he
knows how to block the worries from his mind. Sometimes he
experiences upsetting images about his grandchildren being injured or
harmed when worrying about them. Twice in the past, these images have
been accompanied by feelings associated with a heart attack including
sweating palms, dizziness, heart palpitations, and shortness of
breath. Each time he went to the emergency room, he was released
after tests were run confirming that he was not going to have a heart
Around times of stressful life events
(e.g., during his daughter's divorce) Donald tends to experience an
increase in his worrying frequency and intensity, but his reaction is
always stronger than other people's. After a bad period of worry he
often feels depressed for weeks afterwards, including having no
pleasure or interest in his usual activities. Donald feels envious of
the enjoyment and relaxation other people seem to get from life and
he often feels hopeless when it comes to managing his worry. He just
does not understand why he is not able to relax the way others are.
He is very concerned that he may develop health problems due to his
excessive worrying and he sometimes wonders whether his worrying
actually increases the odds of bad things happening to him.
Follow the example below as you complete your Case Study assignment.
You will have 3 major areas to your case study response: (1) key
issues, (2) diagnostic impressions, and (3) treatment
recommendations. This assignment does need an APA-formatted title
page, and you are required to cite the sources for the treatment
recommendations and include a reference page. It should be 3–4
pages for content. The case study assignment is an opportunity for
you to think through a clinical case, identify and prioritize key
issues involved, consider and clarify relevant diagnostic issues, and
formulate treatment recommendations that are most likely to be
helpful to the client.
List in order of importance the key issues you believe are involved
in the case study, as if you were the client’s counselor. Provide
a rationale for the order in which you prioritized issues. What are
the most important features to you, and why?
Link your rationale to what you believe outcomes of treatment
should be for this client. How will your order of priority
contribute to a successful outcome for the client?
Based on the information provided in the case study, use the
current version of the DSM to accurately diagnose the type(s) of
disorder(s) involved. Refer to specific diagnostic criteria when
presenting your impressions. What category could this be in? What
disorder in that category does this appear to be and why? Provide
rationale for diagnosis, giving consideration to differential
diagnostic considerations. In other words, what disorders in this
category or other closely related categories were considered? Why
could this not be any of those disorders?
Be sure to consider other disorders in addition to the main
disorder. Is there more than one diagnosis? Provide rationale for
diagnosing any additional disorders.
Recommendations (cite sources in this section)
List your recommendations (e.g., 1., 2., 3., etc.) so that you can
clearly delineate what you believe will be of most help to your
client. Consider recommendations that will be motivating to your
client and reflective of a collaborative approach.
Be sure to consider the biopsychosociospiritual aspects of the
case. Make sure your recommendations are relevant to the case, able
to be implemented by the client, and have some basis of support
from professional literature—include academic sources here (2–3).