The Allison Case Study Analysis
The case study is on the patient Allison, who presents with symptoms of anxiety. She admits having struggled with these symptoms for a long and now seeks psychological services. Allison noticed changes in her behavior after the September 11 terrorist attack and has since been struggling with anxiety that has impaired her routine functionalities.
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Relevant History and Personal Characteristics
Findings from the case study reveal that Allison had had a few episodes of panic attacks even though she had not experienced any symptoms for close to two years. The absence of attacks notwithstanding, untreated panic attacks interfere with an individual’s ability to have a quality life. Such individuals usually develop anticipatory anxiety attributable to the fear of the possibility of another attack. These individuals also tend to develop phobias associated with the triggers for their panic attacks. In this case, Alison has a history of panic attacks and even carries her Xanax to help her relax and manage any attacks she may experience in the course of duty. Xanax is a prescription-only medication that maintains high effectiveness for the symptomatic alleviation in anxiety disorders. Despite its effectiveness in treating panic attacks and generalized anxiety disorders, symptom recurrence has been observed in a few proportions of patients who use this medication. Recurrence has mostly been associated with inappropriate use and non-adherence to medication (Roy-Byrne, 2018). This, therefore, leaves an open puzzle in the interrogation of this patient’s presenting complaint as there may be a possibility of symptom recurrence.
Allison also has a positive history of significant worrying. As reported in the case study, she has always been called a “Worry Wart”. She recalls having to walk around the house confirming whether electrical appliances had been unplugged from the socket before retiring to sleep. This was in the backdrop of fear that a fire may break out and torch the house and its occupants. Upon hearing the association between smoking and cancer, she became convinced that her mother would develop cancer and die. She was even worried that other family members would develop cancer from passive exposure to smoking.
In another instance, Allison expressed her worry about one of her family members dying from a car accident. Her fear of driving and the possibility of being involved in an accident made her second guess whether or not she should learn how to drive. When she eventually learned how to drive and obtained her driving license, she got involved in two accidents, confirming her worries about how driving is a dangerous activity. These incidences are expressive of Allison’s tendency to worry. As much as some worries are warranted and are not peculiar to her, extreme worry or fear of the unknown can be characterized as anxiety (Thibaut, 2017). The potential to develop generalized anxiety disorders increases considerably in the presence of prolonged and severe stressful events in one’s life (Meek, 2022). As evident in this patient’s case, her current disease can be attributable to the stressors she experienced earlier in her life.
At the age of eight, Allison was sexually abused by their neighbor Mr. Jack, after luring her into his house with cookies and milk. She decided to keep quiet and never reported the matter to anyone. She, however, experienced an extreme amount of guilt related to the molestation and never returned to his house again. Her guilt is compounded by the belief that her ordeal was her fault and that she would have listened to her mum and never have trusted someone without proper knowledge of them. Traumatic events such as sexual abuse are risk factors for anxiety attacks and have been included in the multifactorial etiologies for mental health disorders such as anxiety and panic disorders (Maniglio, 2018). In Alisson’s case, her current illness may be attributable to the traumatic event she experienced in her childhood. The fact that she did not report it means that this problem was not addressed and that she continued living with guilt long after the actual incident.
Allison’s mother is depicted as an introverted character who never left the house and led a more private life that not even her close relatives could understand. Allison believes that her mother was agoraphobic due to her take on the world and the belief that it was a dangerous place. She would constantly tell Alison of the terrible things that happen to people if they are not cautious. Additionally, she never allowed her (Allison) to play out on the streets or visit their neighbor’s house. Despite these events and the characterization of Allison’s mother, sometimes being considered normal, they may surmount paranoia and indicate some form of mental illness. As recounted by Allison, she thinks that her mother may have had undiagnosed agoraphobia. Case information on Allison’s mother points to the possibility of a mental illness. Studies have shown that mental illnesses have a genetic predisposition, and the propensity to develop these disorders increases in the presence of a close relative with a mental illness (Ahmadzadeh et al., 2019). In this regard, Allison’s condition may be part of genetic and environmental interactions that result in symptomatic presentations of anxiety.
Assessment and Diagnosis
The patient, Allison, presented with an anxiety disorder. Anxiety disorders encompass generalized anxiety disorder (GAD), social anxiety disorders, selective mutism, separation anxiety disorders, panic disorders, agoraphobia, and substance/medication-induced anxiety attacks. These disorders differ slightly in their presentation. However, the baseline symptoms of intense fear, frightening thoughts, confusion, short attention span, distractibility, increased heart rate, and palpitations are characteristic of these disorders. These disorders have been implicated in significant morbidity and functional decline. Addressing anxiety disorders upon diagnosis is fundamental as it ensures that the affected individuals lead a normal life. Due to the nature of its presentation, an untreated disease often leads to functional debilitation, with suffering being apparent.
The Diagnostic and Statistical Manual (DSM) of mental Illness recognizes and classifies anxiety disorders as mental health illnesses requiring medical address. According to the DSM-5, a positive diagnosis of generalized anxiety disorders is made in the presence of excessive anxiety and worry that have lasted for at least six months, difficulty in controlling the worrying whenever they occur, and anxiety associated with at least three symptoms characteristic of anxiety disorders. Symptoms that characterize anxiety disorders include fatigue, restlessness, distractibility, sleep disturbance, irritability, and muscle tension. Three of these symptoms must have appeared alongside anxiety for the past six months for a diagnosis of GAD to be made.
Diagnosing anxiety disorders may sometimes present considerable challenges. This is partly because of the predominance of somatic symptoms over psychological symptoms in some instances. These somatic symptoms may sometimes be vague, with less clear indication pointing to the disorders. These symptoms include but are not limited to increased heart rate, palpitation, fatiguability, headaches, and dizziness. These symptoms are a common presentation in many illnesses, and their non-specific nature makes the diagnosis difficult. Taking an elaborate history may enable the distinction of the disorders. The history should not only encompass the presenting symptoms but also cover various factors that may be contribute to the development of the disorder. Common associated risk factors for anxiety disorders include the female gender, poor health, low education, presence of stressors, and history of substance abuse and alcohol consumption. The median age for the onset of anxiety disorders is 30. Anxiety resulting from organic illnesses has been seen in individuals aged 35 years and above and in those without any familial history of the disease. In the presence of these risk factors, the propensity to develop anxiety disorders increases. Additionally, some of these factors have been associated with anxiety.
Initial assessment of anxiety disorders addresses somatic and behavioral symptoms. In this regard, psychological difficulties and stressors are evaluated together with any developmental issue that may be apparent. Other information that may assist in making a diagnosis and is obtained during the assessment of the patients include a history of drug and substance abuse, history of trauma and psychiatric illnesses, and a review of past medication history. Specific laboratory diagnostics may also be requested to eliminate organic causal factors for anxiety disorders. These include thyroid function tests to exclude hypo- and hyperthyroidism, blood glucose levels to eliminate poor glycemic control as a factor for anxiety, echocardiography to exclude cardiac arrhythmias and other cardiovascular illnesses that may cause anxiety, and toxicological screening to eliminate drug use as a cause of anxiety.
Careful evaluation of all patients presenting with anxiety symptoms enables the determination of the symptoms of the disorders and allows for symptom classification as either behavioral or somatic. This information enables accurate diagnosis and the establishment of an appropriate plan of action. Some symptoms may not be easily determinable due to their vagueness and non-specific nature. Therefore, this may require the necessary experience and expertise in handling mental health illnesses to accurately determine these symptoms. Somatic symptoms, for instance, confer considerable difficulties in their determination. A combination of an elaborate history and diagnostics may enable the exclusion of all differential diagnoses for anxiety disorders.
In Allison’s case, there is significant evidence of anxiety. The symptom of anxiety has been present for quite some time, and she has been having difficulty executing her duties because of the anxiety. She also exhibits symptoms of fatigue, a feeling of being overwhelmed, and insomnia. These presentations are indicative of generalized anxiety disorders. According to the DSM-5, a positive diagnosis for generalized anxiety disorder is made in the presence of anxiety that lasts for more than six months, evidence of difficulty in executing routine tasks caused by the anxiety, and the coexistence of anxiety and other accompanying symptoms for the past six months. All the findings in Allison are consistent with the definition of anxiety described in the DSM 5.
Causal Factors
Anxiety disorders are mental health disorders with multifactorial etiologies. Several conceptual models have been hypothesized to explain the etiology of generalized anxiety disorders. These theories include the cognitive avoidance model, emotional dysregulation theory, and the intolerance of uncertainty theory.
Conceptual Models for Anxiety Disorders
The cognitive avoidance model of generalized anxiety disorder posits that persons with the disorder avoid negative emotional shifts by creating negative emotions through worry. This theoretical model stresses the role of worry as a mechanism to avoid distressing events or situations. Individuals with GAD tend to overestimate the potential of danger by imagining the worst possible scenario when faced with situations in their lives. According to the theory, the first reaction when these individuals are faced with such situations is worrying rather than confronting the fear (Fisher & Wells, 2018). This theory adequately explains why Allison may have developed her disease. In her case, the negative emotions of worry appeared upon being triggered by the 9/11 terrorist attack. Ever since she has been experiencing multiple episodes of worry and fear whenever she remembers the traumatic event or when confronted by situations that refresh her memory of the same.
Emotional Dysregulation Theory
Another theoretical model is the emotional dysregulation model. This model asserts that a triggering event will result in a negative or a positive effect in the presence of an existing psychological stressor. Mood and anxiety disorders are hypothesized in this theoretical model as a consequence of emotional dysregulation with a negative effect and deficient positive effects. According to the theory, the tendency toward either positive or negative effects is dependent on the individual’s affective style (Hofmann et al., 2017). The symptoms of anxiety that are characteristic of the disorder, such as anxiety, fear, and irritability, are a consequence of the negative effects.
The Intolerance of Uncertainty Theory
The intolerance of uncertainty theory suggests that the development and maintenance of worry result from intolerance of uncertainty, cognitive avoidance, positive beliefs of worry, and negative problem orientation. Intolerance to uncertainty defines an individual’s incapacity to endure an aversive response triggered by the perceived absence of adequate information and by associated uncertainty. The affected individuals find situations that are not under their control to be threatening and undesirable, irrespective of the low propensity of such events or situations to inflict harm upon them. Negative problem orientation defines a negative attitude towards problems or presenting stressors. Affected individuals often respond to such situations with negative emotional reactions. These individuals have low self-confidence in their problem-solving abilities, are pessimistic, and exhibit poor control of self when confronted with a life problem. Cognitive avoidance is a cognitive process activated to suppress unfavorable mental content such as mental images that induce fear. Cognitive avoidance often leads to sustained worry (Bottesi et al., 2017). All these components interplay in the development and maintenance of worry and anxiety.
Biological, Psychosocial and Sociocultural Causal Factors
Biological, psychological, and sociocultural factors have all been implicated in anxiety. Biological factors define factors of the human body associated with the disease. Abnormalities in the brain, neurochemistry, genetics, and underlying pathologies are causal factors for anxiety. Studies on the brain’s neurochemistry reveal low serotonergic activity and high noradrenergic activity in anxiety disorders. Anxiety has also been shown to have a high genetic predisposition, with evidence that the risk of developing the disease is higher in individuals whose parents have the disease. Several somatic pathologies are known to cause the symptoms of anxiety. These pathologies include but are not limited to cardiac arrhythmias, hyper- and hypothyroidism, uncontrolled blood sugars as seen in uncontrolled diabetes, vestibular dysfunction, congestive heart failure, and pneumonia (Roy-Byrne, 2018). In Allison’s case, there is minimal evidence of genetic involvement in her disease. There is a high index of suspicion of an undiagnosed mental health illness in her mum. Further clinical interrogation can be conducted to rule out genetic involvement. There is also a very low index of suspicion for underlying somatic pathology. This is because of the presence of other conspicuous risk factors such as gender, age, history of trauma, and previous panic attacks.
Several psychological factors have also been implicated in anxiety disorders. These include traumatic events, stress, substance abuse, alcohol consumption, personality, other mental health disorders, and the accumulation of emotional stressors, among others (Roy-Byrne, 2018). In Allison’s case, there is evidence of several psychological factors that predispose her to her current disease. Traumatic events in her life, such as sexual abuse and the 9/11 terrorist attack, contribute to the development of anxiety disorders. Previous panic attacks may also be contributory to her disease. Her personality and upbringing may also have contributed to her disease as her upbringing was introverted and with constant reminders from her mother of how dangerous the world was.
Sociocultural factors implicated in anxiety include temperament, new social or work demands, negative experiences, and family history. In Allison’s case, no significant sociocultural aspects are shown to contribute to her disease. However, her introverted upbringing may predispose her to the disease. In addition, her negative experiences growing up may also have contributed to her disease.
Treatment
Upon positive diagnosis of anxiety, treatment is warranted. Acute anxiety often requires aggressive treatment with drugs to relieve symptoms and ensure that the individuals lead a normal life. Chronic anxiety requires an elaborate treatment plan that utilizes pharmacological and non-pharmacological agents.
Acute Anxiety
Acute anxiety is characterized by intense and excessive worry and fear about presenting life situations. Acute anxiety is managed with pharmacological interventions using drugs. Several drug classes have been developed that maintain effectiveness in symptomatic relief. Benzodiazepines such as alprazolam, clonazepam, diazepam, and lorazepam have been used in the short-term management of anxiety. These medications cause relaxation and release muscle tension. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, and escitalopram have also been used in this regard. These drugs are considered the first line in treating all forms of anxiety disorders. Tricyclic antidepressants such as imipramine and amitriptyline also find use in treating these disorders (Roy-Byrne, 2018). Other agents useful in managing anxiety disorders include buspirone, venlafaxine, and duloxetine.
Chronic Anxiety
Management of chronic anxiety uses pharmacological agents, psychotherapy, or both. Adjunctive therapy with medication and psychotherapy has been found to produce superior outcomes than either modality when used alone. The most effective psychotherapeutic modality used in treating anxiety disorders is cognitive-behavioral therapy (CBT). CBT is a form of structured goal-oriented therapy that helps individuals overcome their fears by confronting rather than running away from these fears. This modality equips individuals with behavioral skills that enable them to react more adaptively when confronted by stressful events in their lives that elicit anxiety attacks (Roy-Byrne, 2018). In Allison’s case, a combination of CBT and SSRIs would be necessary. This is because of evidence of uncontrolled disease even with the use of Xanax; the longer duration of her symptom presentation suggests chronicity and functional difficulties attributable to her symptoms.
Prognosis
With effective management with CBT and selective serotonin reuptake inhibitors, the prognosis is likely to be good, and Allison is expected to return to normal life. This notwithstanding, anxiety disorders cause significant morbidity and functional debilitation. These effects are compounded in the presence of comorbidities with substance and alcohol abuse, as most individuals tend to revert to alcohol as a coping mechanism for their stressors. Constant anxiety and chronicity increase the risk for cardiovascular-related events such as hypertension (Ströhle et al., 2018). Anxiety may also rob individuals of their social life by impairing their ability to develop social interactions. The consequence of this is evident in poor quality of life. Severe cases of the disease have also been implicated in suicidal tendencies. In Allison’s case, the success of treatment intervention will be a significant reduction in anxiety attacks and regaining of normal life. The intervention’s success or failure will depend on her adherence to the treatment plan outlined by the psychologist.
Summary
The case study depicted a patient called Allison struggling with anxiety. Findings from the case study were positive for an anxiety disorder diagnosis. This case is a replica of how individuals suffer not only from anxiety disorders but also other mental health illnesses within contemporary society. Several challenges still exist in the access to mental healthcare, recognition of mental health illnesses within society, and health-seeking behavior for individuals suspecting to be having these illnesses. As a professional, I plan to be at the forefront of creating mental health awareness, championing access to mental healthcare, and providing quality care to the affected individuals.
The character portrayed in the case had issues that predisposed her to the disease and continuously experienced symptoms of the disease. She was, however, hesitant to seek mental health care. Her family history also revealed that her mother never received mental healthcare despite the existence of suspicion of a mental health illness. Addressing such disparities in mental healthcare and enhancing the health of communities by ensuring their psychological well-being should be a fundamental role of all professionals. In this regard, I will utilize the knowledge I have obtained from this case study to find individuals in society who may be experiencing similar problems and then talk them into embracing mental health as a societal issue and modalities that can be employed to help them. I will also be ready to work with other healthcare professionals in designing treatment plans for patients to ensure that they all receive quality care and resume their normal lives.
References
Ahmadzadeh, Y., Eley, T., Leve, L., Shaw, D., Natsuaki, M., & Reiss, D. et al. (2019). Anxiety in the family: a genetically informed analysis of transactional associations between mother, father, and child anxiety symptoms. Journal Of Child Psychology And Psychiatry, 60(12), 1269-1277. https://doi.org/10.1111/jcpp.13068
Bottesi, G., Ghisi, M., Carraro, E., Barclay, N., Payne, R., & Freeston, M. (2017). Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from the UK and Italian Undergraduate Samples. Frontiers In Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01723
Esbjørn, B., Normann, N., Christiansen, B., & Reinholdt-Dunne, M. (2018). The efficacy of group metacognitive therapy for children (MCT-c) with generalized anxiety disorder: An open trial. Journal Of Anxiety Disorders, 53, 16-21. https://doi.org/10.1016/j.janxdis.2017.11.002
Fisher, P., & Wells, A. (2018). Psychological Models of Worry and Generalized Anxiety Disorder. Oxford Handbooks Online. https://doi.org/10.1093/oxfordhb/9780195307030.013.0017
Hofmann, S., Sawyer, A., Fang, A., & Asnaani, A. (2017). EMOTION DYSREGULATION MODEL OF MOOD AND ANXIETY DISORDERS. Depression And Anxiety, 29(5), 409-416. https://doi.org/10.1002/da.21888
Maniglio, R. (2018). Child Sexual Abuse in the Etiology of Anxiety Disorders. Trauma, Violence, &Amp; Abuse, 14(2), 96-112. https://doi.org/10.1177/1524838012470032
Meek, W. (2022). What Could Cause Generalized Anxiety Disorder?. Verywell Mind. Retrieved 6 June 2022, from https://www.verywellmind.com/gad-causes-risk-factors-1392982.
Roy-Byrne, P. (2018). Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Dialogues In Clinical Neuroscience, 17(2), 191-206. https://doi.org/10.31887/dcns.2015.17.2/proybyrne
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2018.0611
Thibaut, F. (2017). Anxiety disorders: a review of current literature. Dialogues In Clinical Neuroscience, 19(2), 87-88. https://doi.org/10.31887/dcns.2017.19.2/fthibaut
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Question 
Allison is the patient for this assignment.
The Allison Case Study Analysis
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