Case History #1: Jenny

The following case report is provided by a social worker at a university counseling office. It is based on a two hour interview with a female student who made an appointment at the facility.

Jenny is 19 years old and is attending college at a large liberal arts university in Raleigh, North Carolina. Jenny was raised in a conservative small town in North Carolina. Her parents divorced when she was quite young, and she grew up with her mother. Jenny's mother was fairly progressive, allowing her to attend concerts and occasionally go on over-night excursions with her friends. Jenny reports that her mother was often criticized for this by members of the community. Twice a year, Jenny would visit her father. She describes these visits as pleasant, but dull.

Jenny was a good student in high school and was active in many activities at her small school. At the university, however, her lifestyle has changed. Immediately on her arrival at college, Jenny was intimidated by the size of the campus, and has remained socially isolated throughout the past year and a half. She has not joined any organizations, and avoids going to sporting events or other activities in order to avoid being around large numbers of people. She says that she does not have a single friend at school. Her university grades have been sporadic; she has earned an "A" in difficult classes, while receiving "D"s and "F"s in other classes.

Jenny is a reasonably attractive young woman, 5'3" with dark blond hair and dark eyes. She weighed 124 when she arrived at college, though she lost more than 8 pounds during the last two years.

During the interview, Jenny seems to have a firm grasp on reality. She does not report any hallucinations or delusions. However, she does seem to express an excessive amount of anxiety. She was highly agitated during the interview, and was reluctant to make eye contact. She also admitted to enormous anxiety about going to the cafeteria for meals. She explains that this probably contributed to her weight loss over the past two years. She also admits to skipping class, especially ones where there is a risk that the instructor might call on her during lecture.

Jenny goes home every weekend and occasionally misses a day or two of class to have an extended period at home. Even at home, however, she has become isolated. She avoids parties and only occasionally gets together with a friend.

Jenny's only significant social connection at school is with her psychology professor. Jenny likes him, and says that he reminds her of her grandfather. He recommended that Jenny seek help at the campus counseling center.

Diagnosis: Jenny

What is your diagnosis for Jenny? One plausible diagnosis is that she is suffering from anxiety and (perhaps) episodes of panic attacks. Does this agree with your assessment?

Once you think you know the diagnosis, what would be your plan for treatment? In thinking through this issue, you might want to review both Chapter 16, which focuses on diagnosis, and Chapter 17, which is organized in terms of the mode of therapy. Is there an obvious choice for how you would proceed with Jenny?

In addition, the Internet offers an enormous amount of information about mental health and psychotherapy. For example, you might explore the link below, or seek other alternatives by using search phrases such as "anxiety + panic + treatment".

The Anxiety / Panic Internet Resource. This site describes itself as a "grass roots project involving thousands of people interested in anxiety disorders such as panic attacks, phobias, shyness, generalized anxiety, obsessive-compulsive behavior and post traumatic stress." It is a self-help network dedicated to the overcoming and cure of overwhelming anxiety.

One problem, though, is that the world wide web includes a number of truly excellent, well-informed, helpful sites, and also sites that may be of much lower quality. (After all, almost anyone, saying anything they like, can put a page up on the web.)

As you browse websites related to anxiety (or any other issue) think of how you might decide whether the website is a good one or not. Is it enough if the website is clearly written and seems plausible? (Probably not — it's possible to write well and to be badly informed, so that you clearly present bad information!) Does the website have documentation for its claims, from credible sources? Do the authors have the right sorts of training, suggesting that they are legitimate authorities? Does the website have a commercial interest in a product or service they're recommending? Thinking through these issues will make you a much better "consumer" of web information!

>>Continue to Case History #2: Hiro
>>Proceed to Conclusion

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