Week 5: Anxiety Disorders, Obsessive Compulsive and Related Disorders, and Cultural Idioms of Illness
Anxiety disorders and obsessive-compulsive disorders (OCD) have a devastating impact on an individual’s ability to live, work, and conduct relationships. These disorders are often harder to identify than other conditions. Difficulty in diagnosis is compounded by the fact that expressions of anxiety differ widely from culture to culture. Anxiety is often co-occurring with depression and with OCD, as well as with trauma disorders. The boundaries between these illnesses can be blurred.
This week you examine those boundaries by analyzing a case from the anxiety and OCD spectrums. You also consider cultural idioms and the cultural formulation interview (CFI) of the DSM-5. The CFI is designed to help a social worker adapt diagnosis and treatment both to cultural variations and to the individual experience of a person within that culture. Given that anxiety may manifest in diverse ways due to cultural influences, you practice using the CFI to guide treatment conceptualization for anxiety.
- Analyze a case study focused on an anxiety disorder utilizing steps of differential diagnosis
- Recommend an intervention for treating anxiety disorder
- Role-play a client interaction to complete a Cultural Formulation Interview
- Analyze cultural variables in mental health treatment planning
Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 12, “Diagnosing Anxiety, Fear, Obsessions and Worry” (pp. 167–184)
American Psychiatric Association. (2013a). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05
American Psychiatric Association. (2013l). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm06
American Psychiatric Association. (2013d). Cultural formulation. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.CulturalFormulation
Diáz, E., Añez, L. M., Silva, M., Paris, M., & Davidson, L. (2017). Using the cultural formulation interview to build culturally sensitive services. Psychiatric Services, 68(2), 112–114. doi:10.1176/appi.ps.201600440
TEDx Talks. (2015, May 29). Living with #OCD | Samantha Pena | TEDxYouth@TCS [Video file]. Retrieved from https://www.youtube.com/watch?v=btO3kE2RrEY&feature=youtu.be
TEDx Talks. (2016a, October 11). My hidden OCD exposed | Anne Swanson | TEDxVermilionStreet [Video file]. Retrieved from https://www.youtube.com/watch?v=A3f4Gf5Q_2w
American Psychiatric Association. (2013i). Glossary of cultural concepts of distress. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.GlossaryofCulturalConceptsofDistress
Dominguez, M. L. (2017). LGBTQIA people of color: Utilizing the cultural psychology model as a guide for the mental health assessment and treatment of patients with diverse identities. Journal of Gay & Lesbian Mental Health, 21(3), 203–220. doi:10.1080/19359705.2017.1320755
Document: Suggested Further Reading for SOCW 6090 (PDF)
Discussion: Diagnosis of Anxiety and Obsessive Compulsive and Related Disorders
Social workers take particular care when diagnosing anxiety due to its similarity to other conditions. In this Discussion, you carefully assess a client with anxiety disorder using the steps of differential diagnosis. You also recommend an intervention for treating the disorder.
To prepare: Read the case provided by your instructor for this week’s Discussion. Review the decision trees for anxiety and OCD in the Morrison (2014) text and the podcasts on anxiety. Then access the Walden Library and research interventions for anxiety.
By Day 3
Post a 300- to 500-word response in which you address the following:
- Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
- Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
- Discuss other disorders you considered for this diagnosis and eliminated (the differential diagnoses).
- Describe an evidence-based assessment scale that would assist in ongoing validation of your diagnosis.
- Recommend a specific intervention and explain why this intervention may be effective in treating the client. Support your recommendation with scholarly references and resources.
Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You do need to include an APA reference for the assessment tool and any other resources you use to support your response.
By Day 6
Respond to at least two colleagues who identified a different diagnosis or intervention in the following ways:
- Explain whether you agree with your colleague’s identified diagnosis and recommended treatment and why.
- Explain any additional factors that your colleague should take into consideration for treatment planning.
- Response 1
Amber Alanis Week 5 – DB 1 – Amber AlanisCOLLAPSE
F41.1 Generalized Anxiety Disorder, Moderate
F63.2 Kleptomania, Severe
Z56.9 Other Problem Related to Employment
Z65.3 Problems Related to Other Legal Circumstances
I would diagnosis Lanelle with GAD due to worrying about many things, it started in childhood, worrying about things beyond her control, intense discomfort/feeling dizzy/sweating/nausea, worries about her house not being in order if people would drop in, agitation with her fiancé, feeling her life is spinning out of control, restlessness, trouble sleeping, and trouble breathing at times. I would diagnosis her with Kleptomania because she takes things regardless of the consequences, feels excited/tension before taking the item and when she gets away with it.
For GAD, Lanelle meets criteria: A, B, C (1, 4, 5, 6), D, E, & F.
For Kleptomania, Lanelle meets criteria: A, B, C, D, & E.
The differential diagnosis listed under GAD is anxiety disorder due to another medical condition, however no medical condition has been identified so she would not qualify for this diagnosis. She is also not using any illegal substances and is only drinking alcohol socially. As for social anxiety, Lanelle’s anxiety seems to be more general and she worries about everything.
For Evidence-based assessment scale, I would use the Generalized Anxiety Disorder Scale (GAD-7). For Kleptomania, I would use the Kleptomania Symptom Assessment Scale.
Cognitive behavioral treatment (CBT) would be the most appropriate evidence-based treatment intervention to use with Lanelle because it can address both GAD and Kleptomania. Hodgins & Peden (2008) points out that CBT has assisted many clients in seeing a decrease in impulse control related to kleptomania episodes.
Anxiety and Depression Association of America, ADAA (n.d.). The generalized anxiety disorder
scale (GAD-7). Retrieved from: https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf.
Francisco Adame Week 5 DiscussionCOLLAPSE
(F41.1) Generalized Anxiety Disorder
Lanella experiences symptoms of always being concerned, about germs, serious disease, family, finances, the house not being in order. Her worrying triggers minutes of intense discomfort followed by dizziness, sweating, feeling nauseous, trouble breathing but Can calm herself. She has trouble sleeping, restlessness, irritability, which has interfered with her life, but anxiety has always been normal to her. The symptoms match to the criteria of the diagnosis by excessive anxiety or worry about several events, the individual finds it difficult to control the worry, and is associated with restlessness, irritability, and sleep disturbances as well as causing impairments or distressing areas of functioning. It meets criteria for associated features supporting the diagnosis of experiencing somatic symptoms of sweating, nausea, and autonomic hyperarousal of shortness of breath and dizziness.
Differential diagnosis I considered was Panic Disorder due to the symptoms she described as minutes of intense discomfort followed by sweating, nausea, dizziness, trouble breathing, and feeling her life is now spinning out of control. Although she does not experience a concern or worry about additional panic attacks or their consequences as she can calm herself down and has not experienced significant maladaptive behavior related to the attacks. The other diagnosis considered was Obsessive-Compulsive Disorder as she presented with taking small things from stores as she experiences tensions right before taking the item. The criteria of thoughts or persistent thoughts or urges as well as compulsions for repetitive behavior contributed to the consideration. Nevertheless, she experiences excitement from the experience which is not a symptom and has not caused her any anxious, or persistent thoughts about the action.
An evidence-based scale that would assist invalidation of the diagnosis would be the GAD-7 assessment scale. GAD-7 is a 7 item scale which assesses for anxiety over the last 2 weeks on feelings of anxiety, worrying, trouble relating, restlessness, irritability and feeling afraid by assigning scores 0-3 based on categories of not at all, several days, more than half the day’s and nearly every day. Total score ranges from 0-21 from minimal, mild, moderate to severe anxiety. The scale was concluded to be valid and an effective took for screening of GAD and can be used to assess change in the severity over time (Spitzer, Kroenke, Williams, Löwe 2006).
A specific intervention that can help is Cognitive Behavioral Therapy. Reinecke and colleagues (2013) discuss CBT focuses on changing people’s attitudes and behavior by focusing on their thoughts and cognitions, beliefs, and attitudes that have to process them and deal with emotional problems. The negative thoughts, excessive worry with a range of topics from health, financial security, the relationship among others are a result of GAD. CBT shows to be effective in reducing anxiety, somatic symptoms, worries, and the impairments of patient worries can be successfully targeted by it. This intervention would be effective in treating Lanelle as she is experiencing worrying on a range of topics and has resulted in those somatic symptoms and impairments. As mentioned previously CBT helps with those symptoms and allows the client to endure and confront their worries while making efforts to avoid or suppress worries no longer necessary.
Reinecke, A., Hoyer, J., Rinck, M., & Becker, E. S. (2013). Cognitive-behavioral therapy reduces unwanted thought intrusions in generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44(1), 1–6. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jbtep.2012.06.003
Note: You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum. If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.
Submission and Grading Information
To access your rubric:
Week 5 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 5 Discussion
Assignment: Role-Playing Practice: Using the CFI to Individualize Anxiety Care
Social workers need to be able to identify cultural conceptions of illness and mental illness. Because studies show that anxiety and depression differ from culture to culture and within cultures, it is important to build skill using the Cultural Formulation Interview (CFI) to elicit how an individual has actually incorporated their cultural beliefs. While the core interview is a set of 16 questions, more detailed versions expand on each area. In this Assignment, you sensitively apply the CFI to your case collaboration partner as well as research how to address and individualize anxiety resources for your partner’s culture and needs.
- Read the Diaz (2017) article and take note of their experience using the CFI and the advantages they found in the process. Also note the minority stress concerns that arise in those working with anxiety issues in different cultures.
- Review the CFI questions and readings in the DSM-5 on cultural variations, syndromes, and idioms.
- Meet your collaboration partner and take turns administering the CFI questions (and any needed subsections) to each other. Your partner will role-play an anxiety issue but otherwise be as true to their own situation as possible.
- Observe how the CFI administration process goes and take any notes needed. Based on what you learn about your partner’s needs and culture, you may need to do further research in the suggested readings and library before submitting your Assignment.
By Day 7
Submit a 4-page paper, using the Diaz article as well as additional resources about culture, in which you do the following:
- Describe the skills or techniques you used to engage your partner during the CFI.
- Explain which aspects of the CFI were the most helpful in learning about your partner’s personal view of the problem and situation from a cultural perspective.
- Describe the cultural components (e.g., race/ethnicity, religion, geographic region, socio-economic status, etc.) that may influence your partner, and analyze how those cultural components influence their mental health experience.
- Identify which relevant subsections of the CFI you used. Explain why you did (or did not) use a subsection as part of your assessment.
- Analyze how you, as a social work treatment provider, might adjust interventions for the client (your partner), their individualized circumstances, and culture of origin. Be specific and demonstrate critical thought through application of concepts in resources.
- Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment. Explain any cultural considerations you made when determining an appropriate instrument, including whether or not the instrument was validated with diverse populations.
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