Again, my apologies for the delay in getting the post up. This week, we’re looking at Anxiety Disorders. These can come up on the exam in a variety of ways: in reference to medications, treatment modalities, diagnoses…the list is long. Here’s a sample question to get us thinking about differential diagnoses:
A social worker at a VA clinic is assigned a new client: a 26 year-old male who was sent home after a roadside bomb killed several members of his unit 3 weeks ago. Since the explosion, the man has been unable to sleep and has been refusing to sit in the front seat of the car. When the social worker asks about the event, the man reports that he has no recollection of what happened but feels panicked and irritable most of the time. What is the most likely diagnosis in this case?
A. Acute Stress Disorder
B. Post Traumatic Stress Disorder
C. Panic Disorder
D. Generalized Anxiety Disorder
So, what are the major differences between Acute Stress Disorder and Post Traumatic Stress Disorder? The major difference is time frame: symptoms of Acute Stress Disorder last between 2 days and 4 weeks and have to occur within 4 weeks of the traumatic event; symptoms of Post Traumatic Stress Disorder last more than 1 month and can occur at any time after the traumatic event (there’s even a “delayed onset” specifier for cases in which onset of symptoms is at least 6 months after the event). In addition, according to the DSM-IV-TR, Acute Stress Disorder involves the experience of dissociative symptoms during or after the event, which can include depersonalization, numbing or dissociative amnesia. The two disorders do share the 3 major components of: persistent reexperiencing of the trauma, persistent avoidance of stimuli associated with the event, and persistent symptoms of anxiety/increased arousal.
The answer is, in this case, A. The stem tells us that the time frame has only been 3 weeks and that the client is experiencing a sleep disturbance (increased arousal), refusal to sit in the front seat (likely avoidance), irritability and feelings of panic (more arousal), and lack of memory around the event (dissociative amnesia). None of the other diagnoses fit here.
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