ANXIET Y

DISORDERS

N I G E L TA N & M A V I E C R U Z
CLIENT PROFILE
Morty, who is the youngest son, has much older
siblings who more often than not neglect and push him
around. He lives in a middle income family. He always
has a lack of interest in school. He also has a few
friends but is quite unattached to them. He has feelings
for a girl but worries about intimacy.
CASE #1
Ever since Morty was young, Morty was always a shy and timid person. Having always scolded by his
siblings during his childhood years, Morty feels that he isnt good enough, and thought that others saw him as boring
and unlikeable. Morty only has two friends, and thus the few times he is with them, he just lets them do the talking.
When Morty goes out to eat with his friends or his family, he is never the one to order in the restaurant. Morty also
does not like standing in line to wait for a jeep because hes afraid that everyone around him is watching him and
thinks of him as weird and awkward. Last summer, Morty was asked by his aunt if he wanted to do an internship.
Even though he wanted to join, he declined his aunts offer because he was afraid of situating himself in a
workplace, because this meant that he would have had to meet new people and interact with them.
Morty does not like going to school because this meant he has to interact with his classmates. For the first
day of the new school year, Morty did not attend classes because from past experience, he knows that teachers will
instruct them to introduce themselves. For Morty, just thinking about sitting there, waiting to introduce himself to a
room full of people that will be staring at him, already makes him start to sweat and tremble. Thus, he skips the first
day to avoid the possibility of having to introduce himself in class. Morty also knows that many people go to the
cafeteria during lunch, so he tries to stay away from going there as much as possible. Also, when Morty has a
presentation during class, he experiences sweating and goes over his presentations for days in advance. The night
before he has a presentation, he cannot sleep just thinking about having to present. When it is time to finally present,
Morty starts to tremble and blush, and he stumbles over his words. He also limits his eye contact as much as
possible, because he thinks that everyone in class is laughing at him and judging him. If Morty is invited to events in
school (such as extracurricular activities or leisure activities with his classmates), Morty rarely goes because he is
scared to interact with those around him. Too many people will be there and crowds only make things worse for
him. The rare times Morty attended such events, Morty was very ill-at-ease and did not talk to people, which made
him feel that he made those around him uncomfortable.
CASE #1
Ever since Morty was young, Morty was always a shy and timid person. Having always scolded by his
siblings during his childhood years, Morty feels that he isnt good enough, and thought that others saw him as boring
and unlikeable. Morty only has two friends, and thus the few times he is with them, he just lets them do the talking.
When Morty goes out to eat with his friends or his family, he is never the one to order in the restaurant. Morty also
does not like standing in line to wait for a jeep because hes afraid that everyone around him is watching him and
thinks of him as weird and awkward. Last summer, Morty was asked by his aunt if he wanted to do an internship.
Even though he wanted to join, he declined his aunts offer because he was afraid of situating himself in a
workplace, because this meant that he would have had to meet new people and interact with them.
Morty does not like going to school because this meant he has to interact with his classmates. For the first
day of the new school year, Morty did not attend classes because from past experience, he knows that teachers will
instruct them to introduce themselves. For Morty, just thinking about sitting there, waiting to introduce himself to a
room full of people that will be staring at him, already makes him start to sweat and tremble. Thus, he skips the first
day to avoid the possibility of having to introduce himself in class. Morty also knows that many people go to the
cafeteria during lunch, so he tries to stay away from going there as much as possible. Also, when Morty has a
presentation during class, he experiences sweating and goes over his presentations for days in advance. The night
before he has a presentation, he cannot sleep just thinking about having to present. When it is time to finally present,
Morty starts to tremble and blush, and he stumbles over his words. He also limits his eye contact as much as
possible, because he thinks that everyone in class is laughing at him and judging him. If Morty is invited to events in
school (such as extracurricular activities or leisure activities with his classmates), Morty rarely goes because he is
scared to interact with those around him. Too many people will be there and crowds only make things worse for
him. The rare times Morty attended such events, Morty was very ill-at-ease and did not talk to people, which made
him feel that he made those around him uncomfortable.
SOCIAL ANXIET Y
DISORDER
S . A . D.
DIAGNOSTIC CRITERIA FOR SOCIAL
ANXIETY DISORDER
Marked fear or anxiety about social situations wherein the individual is exposed to possible
scrutiny by others
In children, the anxiety must occur in peer settings and not just during interactions with adults
The individual fears that he or she will be negatively evaluated and fears that he or she will act
or appear in a certain way or show anxiety symptoms in social situations
Symptoms: blushing, trembling, sweating, stumbling over one's words
In children, fear may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to
speak in social situations
The social situations almost always provoke fear or anxiety
The social situations are avoided or endured with intense fear or anxiety
The fear and anxiety is persistent, and typically lasts for 6 months or more
The fear and anxiety causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning
CASE #2
Morty was raised by rather over controlling parents who constantly worried about possible
inconveniences and mishaps about their family and work. His siblings would also display such a mindset as they led
their own lives away from their parents. Early in his pre-school years, there were times in Mortys childhood when
his siblings would scold him and make him redo chores for simple slips such as when Morty left the refrigerator half
closed or did not wash the dishes properly. They reasoned that these had larger implications later on that would
affect the entire family. Morty becomes more aware of the effects of his actions on people he cares for.
Morty, as a kid, grew up constantly worrying about many things. He would worry about his family and his
parents in particular if they had fought. Being aware he came from a middle income family, he was also worried
whether or not he would be able to finish school.
In school, Morty became overly sensitive to the jokes and slights of his fellow classmates, interpreting
them as signs of conflict. He becomes irritated by such verbal jests but says nothing as he becomes worried that his
friends will see him as a bully himself or that his parents will find out about it. During class, he worries if he is
capable of keeping up with the lesson and becomes overwhelmed by the first instances of confusion during earlier
parts of discussion that he doesnt engage himself fully in class. He finds that he is incapable of dealing with a
situation head on and becomes worried about his constant need to worry. Because of Mortys constant worrying,
Morty has difficulty sleeping and thus he oftentimes feels restless. When he is worried, Morty feels tensions in his
shoulders and is easily fatigued and irritable. Morty is also fickle-minded, in that he is unable to make decisions,
since he worries too much about what would happen if he makes the wrong decision.
CASE #2
Morty was raised by rather over controlling parents who constantly worried about possible
inconveniences and mishaps about their family and work. His siblings would also display such a mindset as they led
their own lives away from their parents. Early in his pre-school years, there were times in Mortys childhood when
his siblings would scold him and make him redo chores for simple slips such as when Morty left the refrigerator half
closed or did not wash the dishes properly. They reasoned that these had larger implications later on that would
affect the entire family. Morty becomes more aware of the effects of his actions on people he cares for.
Morty, as a kid, grew up constantly worrying about many things. He would worry about his family and his
parents in particular if they had fought. Being aware he came from a middle income family, he was also worried
whether or not he would be able to finish school.
In school, Morty became overly sensitive to the jokes and slights of his fellow classmates, interpreting
them as signs of conflict. He becomes irritated by such verbal jests but says nothing as he becomes worried that his
friends will see him as a bully himself or that his parents will find out about it. During class, he worries if he is
capable of keeping up with the lesson and becomes overwhelmed by the first instances of confusion during earlier
parts of discussion that he doesnt engage himself fully in class. He finds that he is incapable of dealing with a
situation head on and becomes worried about his constant need to worry. Because of Mortys constant worrying,
Morty has difficulty sleeping and thus he oftentimes feels restless. When he is worried, Morty feels tensions in his
shoulders and is easily fatigued and irritable. Morty is also fickle-minded, in that he is unable to make decisions,
since he worries too much about what would happen if he makes the wrong decision.
GENERALIZED
ANXIET Y
DISORDER
G . A . D.
DIAGNOSTIC CRITERIA FOR
GENERALIZED ANXIETY DISORDER
Excessive anxiety and worry about life circumstances and social spheres
Duration: At least 6 months
The individual finds it difficult to control the worry
The anxiety and worry are associated with three (or more) of the following six
symptoms: restlessness, being easily fatigued, difficulty concentrating or mind going
blank, irritability, muscle tension, sleep disturbance
In children, only one symptom is required
The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning
Excessive not manageable, interfering in psychosocial stability, untimely
CASE #3
When Morty was young, he accidently tipped over his elder brothers laptop. Upon
discovering, his brother accidently hit him creating a large bruise in Mortys arm. At that moment, Morty
experienced an increased heart rate, sweating, shaking, feelings of overall numbness. He also felt
distance from reality as he wanted to escape the situation. This episode grew in intensity after a few
moments and lasted for 20 minutes. This was the first time Morty was harmed physically by his peers
and his brother quickly apologized.
Mortys parents and siblings continued to be quite critical of Morty, however they stopped
when Morty exhibited some of the symptoms he had during the incident with the laptop. This became a
source of embarrassment for Morty who decided to avoid stressful situations with his family members
so that he wouldnt experiences such physical discomforts. However, when Morty exercises and feels
his heart pace and his breathing shorten, he starts to sweat and shake uncontrollably. Afraid that this
could be the start of another episode, he breathes deeply to quickly calm himself down. When Morty
finds himself in strenuous environments like in warm, enclosed classrooms (as in his school), he
becomes afraid that another episode may arrive and he quickly excuses himself to leave class. This
fear also comes when he joins a stimulating, ecstatic conversation with his friends about common
interests wherein his heart rate involuntarily increases. As such, he has a difficult time keeping up with
his studies and is unable to interact with his peers properly. Morty usually retreats to a cool, isolated
space to calm himself down.
CASE #3
When Morty was young, he accidently tipped over his elder brothers laptop. Upon
discovering, his brother accidently hit him creating a large bruise in Mortys arm. At that moment, Morty
experienced an increased heart rate, sweating, shaking, feelings of overall numbness. He also felt
distance from reality as he wanted to escape the situation. This episode grew in intensity after a few
moments and lasted for 20 minutes. This was the first time Morty was harmed physically by his peers
and his brother quickly apologized.
Mortys parents and siblings continued to be quite critical of Morty, however they stopped
when Morty exhibited some of the symptoms he had during the incident with the laptop. This became a
source of embarrassment for Morty who decided to avoid stressful situations with his family members
so that he wouldnt experiences such physical discomforts. However, when Morty exercises and feels
his heart pace and his breathing shorten, he starts to sweat and shake uncontrollably. Afraid that this
could be the start of another episode, he breathes deeply to quickly calm himself down. When Morty
finds himself in strenuous environments like in warm, enclosed classrooms (as in his school), he
becomes afraid that another episode may arrive and he quickly excuses himself to leave class. This
fear also comes when he joins a stimulating, ecstatic conversation with his friends about common
interests wherein his heart rate involuntarily increases. As such, he has a difficult time keeping up with
his studies and is unable to interact with his peers properly. Morty usually retreats to a cool, isolated
space to calm himself down.
PANIC
DISORDER
DIAGNOSTIC CRITERIA FOR PANIC
DISORDER
Recurrent and unexpected panic attacks. An abrupt surge of intense fear or intense
discomfort that reaches a peak within minutes, and during which time four (or more)
of the following symptoms occur, otherwise these will be called fearful spells
Palpitations and/or pounding heart
Sweating
Trembling or shaking
Shortness of breath or a sense of being smothered
Feelings of choking
Chest pain or discomfort
Nausea
Feeling dizzy, unsteady, lightheaded, or faint
Hot flashes or chills
Numbness or tingling sensation
Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
Fear of losing control or "going crazy
Fear of dying
DIAGNOSTIC CRITERIA FOR PANIC
DISORDER
At least one of the attacks has been followed by 1 month (or more) of one or both of
the following:
Worry about additional panic attacks or their consequences
Significant maladaptive change in behavior
Constant or intermittent feelings of anxiety that are more broadly related to health and
mental health concerns
Restricting usual activities to avoid situations that may cause attacks
Unexpected (calm anxiety; i.e. nocturnal), expected/situationally predisposed
SOCIAL ANXIETY
DISORDER VS
GENERALIZED
ANXIETY
DISORDER
S.A.D. VS G.A.D.
S.A.D.
worries focus on social
performance and others'
evaluation
anticipatory anxiety: focused
on upcoming social situations
in which they must perform or
be evaluated by others
G.A.D.
worries can pertain to social
performance; however, they
also often pertain to non-
social performance and when
the individual is not being
evaluated by others
i.e. individuals worry whether
or not they are being
evaluated
SOCIAL ANXIETY
DISORDER VS
PA N I C D I S O R D E R
S.A.D. VS PANIC DISORDER
S.A.D. PANIC DISORDER
concern is about fear of concern is about the panic
negative evaluation attacks themselves
GENERALIZED
ANXIETY
DISORDER VS
PA N I C D I S O R D E R
G.A.D. VS PANIC DISORDER
G.A.D.
Ongoing distress over longer
periods
No surges of temporary
physical or mental distress
PANIC DISORDER
Short, intense attacks
Symptoms of autonomic
hyperarousal (e.g.,
accelerated heart rate,
shortness of breath, dizziness)
are more prominent
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC.