Case Study Assignment

Abnormal Psychology
Ashley R. Worlock
3 March 2003

Lamanda

Lamanda is a 22 year old woman who suffers from avoidant personality disorder as described in
the DSM-IV with a comorbidity of the anxiety, generalized social phobia and adjustment
disorder with depressed mood.
AXIS I Generalized Social Phobia
AXIS II Avoidant Personality Disorder
Adjustment Disorder with Depressed Mood
AXIS III No diagnosis on this axis
AXIS IV Problems with social, occupational, and school environment: living alone, avoids coworkers and loss of interest in school.
Problems with primary support group: parents are different races.
Problems with past sexual experiences: nightmares from sexual advance from a coach that
occurred during adolescence and advances from boys.
Problems with partner: boyfriend criticizes her.
AXIS V GAF: 60 (moderate difficulty in social and occupational functioning).

Upon assessment of this case study, it is shown that Lamanda suffers from several
disorders. On Axis I, the clinical syndrome, she suffers from Generalized Social Phobia. The
personality disorders, found on Axis II that she suffers from are Avoidant Personality Disorder, a
comorbidity of social phobia, and Adjustment Disorder with Depressed Mood. There are no
general medical conditions that are relevant to the comprehension or management of her case.
However, there are several contributing psychosocial and environmental problems that have an

input into Lamandas conditions, listed on Axis IV. An overall global assessment of Lamanda is
in that out of 100 she falls around a 60. All of these conditions and problems are described and
discussed in the following evaluation of Lamanda.
Lamanda is a 22 year old female of mixed race who has had several recent difficulties in
her life. These difficulties are thus inhibiting her ability to function normally in her social and
occupational environments. The most prevalent disorder Lamanda suffers from is the avoidant
personality disorder. According to the definition outlined in the textbook, Abnormality
Psychology and Modern Life, Individuals with avoidant personality disorder have a pattern of
extreme social inhibition and introversion leading to lifelong patterns of limited social
relationships and reluctant to enter into social interactions, (Carson, 2000). Lamanda portrays
this basic definition. First of all she stated that she does not like her job and is unwilling to look
for another one. This is clearly a sign that she does not like the social interactions within her
occupation. In addition, her refusal to look for another job suggests that she does not want to
interact with others in any other social atmosphere. The anxiety over this is apparent when she
says that she feels very jittery over getting ready for work and will make excuses in order not
to go. The second evidence portrayed is that Lamanda refuses to associate with fellow
employees. She reports of having gotten very nervous when she was given a surprise birthday
party. Lamanda clearly demonstrates that she is not fond of social settings. Besides her work
and social settings she also has lost an interest in her education. There is no reason given, she just
continues to exhibit a pattern of extreme social inhibition. More of the textbook definition states
that, due to the individuals over sensitivity and fear of condemnation and rejection they do not
seek out other relationships; however, they desire affection and are often lonely and bored,
(Carson, 2000). In Lamandas case she has a boyfriend yet she avoids seeing him and as far as

her primary support group, her parents, she avoids them too in fear of disapproval. It is
Lamandas inability to relate to other people that cause her avoidant personality, which in turn
provides for a reason of her low self-esteem and self-consciousness. In accordance with the
textbook, Lamandas condition shows comorbidity with the anxiety disorder, generalized social
phobia (Carson, 2000).. This is quite common and can be seen in her by her very jittery and
very anxious feelings stated above in certain social situations. Overall Lamandas behavior is
not normal and shows signs of a textbook definition of the personality disorder, avoidant
personality disorder, with a comorbidity of generalized social phobia.
In addition to the avoidant personality disorder and social phobia, Lamanda also suffers
from a mild mood disorder known as adjustment disorder with depressed mood. The textbook
defines this mild form of depression by stating that it does not exceed six months in duration and
that a defined stressor is identified within three months before onset of depression. The
justification for the diagnosis is that the individual has impaired social or occupational
functioning and a remittenance within six months (Carson, 2000). Lamanda definitely has
impaired social and occupational functioning; she refuses to go to work and she avoids her
boyfriend and parents. She also has lost interest in cleaning and cooking for herself and
attending to her personal hygiene. Lamandas adjustment disorder with depressed mood could
stem from previous environmental factors that over the prior three months have caused her to
exhibit the previous behavior. Overall her symptoms show a mild level of this type at this stage
in her life; she has just begun to demonstrate these characteristics. Due to the fact that her
symptoms are mild, remittenance should occur with treatment within the required time.
However, if no treatment is obtained, she could develop a more severe mood disorder.

Lamanda, at this time does not show any signs of a general medical condition that would
be relevant to her diagnosis. Instead she has several problems that are included on Axis IV that
contribute to her current condition. Some of her obvious problems such as, her living alone,
avoiding coworkers, and stating that she has lost interest in further education contribute to her
avoidant personality disorder and social phobia. She also has a clear problem with her primary
support group. This problem has persisted throughout her whole life due to the fact that she is
mixed and as a child she was shy and unattractive. She recalls that she is close to her mother
but that she goes to her dad with the big problems: possible avoiding any confrontation with her
identity and wanting to avoid people. Another issue within her environment that could be an
underlining issue with her problems is the fact that as an adolescent she reported frequent
anxiety when trying to deal with sexual advances from boys. She also has had continuing
nightmares of a coach that displayed some sexual advances during this period of adolescence.
This too can be some explanation as to why she feels insecure around people and why she is
critical about what others think of her. Lastly is the current issue with her boyfriend. Lamanda
says, that he tries to be positive but always ends up criticizing her. This type of behavior
demonstrated from her boy does not help her or her self-esteem. On the contrary he reinforces
her inability to take criticism and hence, go into seclusion. These environmental factors show a
path that has led Lamanda to her current conditions and her overall global assessment.
Lamandas global assessment of functioning of 60 is based on the fact that she reveals
clear signs of moderate difficulty in her social, occupational, and school functioning. She does
not mention any friends and her boyfriend she now avoids. On the other hand she demonstrates
some mild symptoms, she still goes to work even though she changed her hours from the
daytime shift to the nighttime shift. Also she has started to evade her daily house chores. The

most damaging fact is her desire not to tend to herself personally with her grooming. With a
combination of this and both mild and moderate symptoms she still can function; nevertheless,
her condition is getting worse and as mentioned above without help it could get severe in all
aspects. Her overall assessment is fair enough not to give her the benefit that she is better than
she really is right now in her life.
In conclusion, Lamanda clearly suffers mainly from avoidant personality disorder with a
comorbidity of social phobia and not so distinguished, from adjustment disorder with depressed
mood. There are many factors that contribute to her condition. Since the avoidant personality
disorder and social phobia are quite similar in criteria except that avoidant personality disorder is
more severe, Lamandas recent behavior warranted a more severe diagnosis. With medication
and therapy Lamanda can definitely improve her life and deal with her past so that a relapse does
not occur. Her time is critical and by her getting help now she has hopefully broken the path to a
more severe condition overall.