Case Study - 8

Generalized Anxiety Disorder

CASE HISTORY

Socio-demographic Data:
 Name: Ms. G.Sxxxya.
 Age: 29 years
 Sex: Female
 Date of Birth: 5th September 1995
 Marital Status: Single
 Educational Qualification: Bachelor’s Degree in Commerce
 Residential Address: Confidential
 Phone Number: Confidential
 Native Place/Place of Birth: Andhra Pradesh
 Income: Confidential
 Current Circumstances of Living: Lived with parents and younger sister in a
rented apartment
 Religion: Hindu
 Socio-Economic Status (Kuppuswamy Scale): Upper Lower Class

Informants:
Patient herself, corroborated by her mother. Both were reliable.

Onset:
Symptoms first appeared approximately 2 years ago, after a workplace
incident involving heavy criticism from a supervisor.

Course:
The symptoms followed a fluctuating course with intermittent worsening,
especially during stressful events like office evaluations or family pressure regarding
marriage.

Duration:
Symptoms persisted for 3 years, with increasing intensity over the past 5
months.
PPM Factors:
 Predisposing Factors:

These are underlying vulnerabilities that make a person more

susceptible to developing GAD.

Biological/Genetic Factors:

Family history of anxiety or mood disorders

High trait anxiety or neuroticism (temperamental tendency to worry)

Personality Factors:

Perfectionistic tendencies

Low tolerance for uncertainty

High need for control

Early Life Experiences:

Overprotective or anxious parenting

Childhood trauma (emotional neglect, abuse)

Inconsistent or unpredictable care giving

Socio-Cultural Influences:

Social expectations on women regarding career, marriage, and family

Stigma related to mental health

 Precipitating Factors:

These are recent events or stressors that may have triggered the onset of GAD.

Recent Life Stressors:

 Job loss or excessive work pressure

Relationship difficulties or break-up

Relocation or migration

Death or illness of a close one

Situational Triggers:

Performance expectations (e.g., academic or job-related pressures)

Approaching age-related social expectations (e.g., marriage, children)

 Maintaining Factors:

These factors continue to perpetuate the symptoms of anxiety over time.

Cognitive Patterns:

Persistent worry across multiple domains (health, finance,

relationships)

Catastrophic thinking

Intolerance of uncertainty

Behavioral Factors:

Avoidance of anxiety-inducing situations

Safety behaviors (e.g., excessive reassurance-seeking)

Procrastination due to overwhelming worry

Environmental Factors:

Lack of social support

Un-supportive or invalidating relationships

Continuous stress (e.g., toxic work environment)

Lifestyle and Coping:

Poor sleep hygiene

Inadequate stress management strategies

 Overuse of social media or caffeine

Effects of Symptoms:
 A) Self:
o Constant worry, tension, and irritability; sleep disturbances
 B) Other Mental Functions:
o Excessive preoccupation with “what if” scenarios, fear of future failure
 C) Biological Functions:
o Fatigue, disturbed sleep, occasional palpitations, poor appetite
 D) Social Functioning:
o Decline in work performance, avoidance of social events
 E) Interpersonal Relations:
o Strained relationships with family due to irritability and need for
reassurance
 F) Legal:
o No known legal issues

Chief Complaints:
Patient presented with excessive worrying, muscle tension, restlessness,
irritability, poor concentration, disturbed sleep, and frequent feelings of being
overwhelmed for the past 5 years.

HOPI (History of Present Illness):

The patient reported that she began worrying excessively after being
publicly criticized at work. She initially ignored the symptoms, believing they
would go away. However, she began experiencing restlessness, frequent
headaches, sleep disturbances, and episodes of heart palpitations. These
intensified during times of stress. She became increasingly dependent on her
mother for decision-making and avoided interactions at work. She
acknowledged that her anxiety was interfering with her performance and
relationships but felt unable to control it. No suicidal ideation was reported.
She was brought to therapy after a suggestion from a family friend who
noticed changes in her behavior.
Negative History:
No history of substance use, hallucinations, delusions, mania, or seizures.

Past History:
 1) Psychiatry:
o No past psychiatric diagnosis or treatment.
 2) Therapy:
o No previous psychological interventions prior to this visit.
 3) Medical History:
o Reported mild hypothyroidism, controlled with medication.

Family History:
Mother had a history of anxiety symptoms during her youth, managed without
clinical intervention. No known history of psychiatric disorders in father or siblings.

Personal History:
She was the elder of two siblings. Childhood was described as protected and
structured. She was introverted and often worried about academic performance. No
major conduct or behavioral issues were reported.

Educational / Occupational History:

Completed graduation in Commerce. Has been working for the last 6 years in
an administrative role. Reported satisfaction with the job role but stressed by
management expectations. Recently experienced decreased productivity due to
anxiety.

Sexual and Marital History:

Unmarried. Reported no sexual relationships. Rejected a few marriage
proposals due to anxiety around commitment and perceived inadequacy.

Religious History:
Participated in family religious activities regularly. Found moderate emotional
support in spiritual practices but did not seek relief through religious counseling.

Pre-morbid Temperament/Personality:
 Described as sensitive, perfectionistic, responsible, and socially reserved. Had
a tendency to overthink and feared disapproval.

Temperament Profile:
 Activity Level: Moderate
 Rhythmicity: Regular
 Distractibility: High during stress
 Approach/Withdrawal: Hesitant with unfamiliar people
 Adaptability: Low in new environments
 Persistence and Attention Span: Good but impaired under anxiety
 Intensity of Reaction: Moderate
 Threshold Level: Low (easily triggered by stress)
 Quality of Mood: Predominantly anxious and apprehensive

Impression:
Ms. G. Sxxxya showed consistent symptoms of Generalized Anxiety
Disorder (GAD) with both psychological and somatic features. She presented with
significant cognitive distortions (e.g., catastrophizing) and poor coping mechanisms.
She was suitable for Cognitive Behavioral Therapy aimed at restructuring anxious
thought patterns, enhancing emotional regulation, and building adaptive coping
strategies.

MENTAL STATUS EXAMINATION (MSE)

General Appearance and Examination:

The patient was neatly dressed and appropriately groomed. She maintained
hygiene, wore formal office attire, and sat with slightly slouched posture. She
appeared anxious, constantly clasping her hands. No physical abnormalities were
observed.

Psychomotor Activity:
Psychomotor activity was mildly increased. She displayed signs of
restlessness, such as tapping her feet and frequently adjusting her seating posture.

Speech:
 Speech was spontaneous, coherent, and goal-directed. However, her tone was
low and hesitant at times. She responded appropriately but often required prompting
to elaborate.
Mood/Affect:
Subjectively, the patient described her mood as “worried and overwhelmed.”
Affect was anxious, mildly restricted in range but congruent with mood.

Thought/Perception:
Thought content revealed excessive worrying about the future, self-doubt, and
fears of failure. There were no delusions, hallucinations, or thought blocking. No
obsessions or compulsions were reported during the session.

Higher Cognitive Functioning:

 Attention:
Attention was mildly impaired; she was destructible when asked open-ended
questions.
 Orientation:
She was oriented to time, place, and person.
 Concentration:
Concentration was mildly impaired; she had difficulty completing serial
subtraction but could perform simple tasks with redirection.
 Memory:
Immediate, recent, and remote memory were intact.
 Intelligence:
Average intelligence level based on vocabulary and abstract reasoning.
 Abstract Thinking: Abstract thinking was mildly concrete. She struggled to
interpret proverbs metaphorically, giving literal meanings.
 Judgment:
Personal judgment was intact, but social judgment was occasionally
compromised by anxiety-driven avoidance.
 Insight:
Insight was fair. She acknowledged her symptoms as problematic and was
open to therapeutic help, although unsure about progress.
Behavioral Observation:
The patient was cooperative but tense. She avoided prolonged eye contact and
frequently rubbed her palms together. She appeared preoccupied and overly cautious
with her responses.

Psychological Test Used:

GAD-7 (Generalized Anxiety Disorder 7-item scale)

Psychological Formulation:
Ms. G.Sxxxya. exhibited persistent and excessive anxiety consistent with
Generalized Anxiety Disorder. Psychological symptoms included cognitive
distortions, anticipatory fear, and physical symptoms like fatigue and sleep
disturbance. Personality traits of perfectionism, low assertiveness, and dependency
contributed to the onset and maintenance of symptoms. She was highly suitable for
structured psychological intervention.

Provisional Diagnosis (ICD-10):

Generalized Anxiety Disorder

Differential Diagnosis:
 Depressive Episode with anxiety (ruled out as anxiety was primary and
persistent)
 Social Phobia (no performance fear or avoidance of social settings
specifically)

Treatment Plan:
 Psychoeducation about anxiety and its management.
 Cognitive restructuring to challenge irrational thoughts.
 Training in relaxation techniques (e.g., deep breathing).
 Behavioral activation and activity scheduling.
 Problem-solving and decision-making skill enhancement.
 Graded exposure to anxiety-provoking situations.
 Assertiveness training and communication skills.
 Weekly symptom monitoring using GAD-7 scale.
  Family involvement to strengthen support system.
 Relapse prevention planning and follow-up sessions.

Conclusion :

The present case of a 29-year-old female diagnosed with Generalized Anxiety

Disorder (GAD) highlights the complex interplay of biological, psychological, and
environmental factors contributing to the onset and maintenance of the disorder. The
client's predisposition toward anxiety, shaped by early life experiences and
personality traits such as perfectionism and low tolerance for uncertainty, made her
vulnerable. The recent psychosocial stressors, including job instability and
interpersonal issues, acted as precipitating factors triggering the symptoms.

Furthermore, cognitive distortions, excessive worry, avoidance behavior, and a

lack of adequate coping mechanisms continue to maintain the disorder. The client's
condition reflects a persistent pattern of worry that is difficult to control and
significantly impairs her daily functioning, emotional well-being, and interpersonal
relationships.

A comprehensive therapeutic approach, primarily grounded in Cognitive

Behavioral Therapy (CBT), along with stress management and lifestyle modification,
is recommended for effective symptom management. Psychoeducation, relaxation
techniques, and building problem-solving skills can further aid in improving her
quality of life. Early intervention and consistent therapeutic support are crucial to
prevent the chronic progression of GAD and promote long-term recovery.