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Difficulty: HardAnxiety, OCD, and Trauma-Related Disorders

Review the following psychiatric patient histories and pair each presentation with its definitive diagnosis according to established clinical criteria.

  • A patient in their late twenties actively avoids driving over bridges and flying in airplanes for 8 months solely because they fear the structures will collapse or the vehicle will crash; they do not fear having a panic attack or being trapped.Specific Phobia
  • An individual describes a 5-week history of intrusive memories, emotional numbing, avoidance of driving, and exaggerated startle response following a severe motor vehicle collision.Post-Traumatic Stress Disorder
  • A middle-aged executive demands that subordinates strictly follow exact rigid schedules and insists on meticulously organizing the shared workspace, believing this method is the only correct way, which causes severe interpersonal conflict.Obsessive-Compulsive Personality Disorder
  • A university student experiences pronounced anxiety, insomnia, and difficulty concentrating beginning 1 month after a non-life-threatening romantic breakup; these symptoms cause significant distress but do not meet criteria for another mental disorder.Adjustment Disorder
  • A young professional declines all invitations to networking events and parties for the past 2 years due to an intense, persistent worry that colleagues will perceive them as awkward or incompetent.Social Anxiety Disorder

Answer

The correct matches require applying diagnostic thresholds: the first history is Specific Phobia, the second is Post-Traumatic Stress Disorder, the third is Obsessive-Compulsive Personality Disorder, the fourth is Adjustment Disorder, and the fifth is Social Anxiety Disorder.
Correctly matching these diagnoses requires a nuanced application of exact DSM-5 criteria: identifying the specific cognitive driver of avoidance (fear of harm in Specific Phobia vs. fear of negative evaluation in Social Anxiety Disorder), distinguishing conditions based on exact duration thresholds (PTSD requires symptoms > 1 month), separating ego-syntonic personality traits (OCPD) from ego-dystonic clinical syndromes (OCD), and recognizing that non-life-threatening stressors causing functional impairment warrant an Adjustment Disorder diagnosis.

Step-by-Step Solution

1
Analyze the first clinical history regarding avoidance of bridges and planes.
The avoidance is driven by a fear of structural collapse or crashing (direct harm), pointing to a situational phobia.
Distinguishing the core cognitive fear is essential; fear of harm from the object/situation defines Specific Phobia, unlike fear of panic which indicates Agoraphobia.
2
Evaluate the timeline of symptoms in the second history involving a motor vehicle collision.
Symptoms of intrusion, avoidance, and hyperarousal have lasted for 5 weeks.
The 1-month duration threshold is the critical differentiator between Acute Stress Disorder (< 1 month) and Post-Traumatic Stress Disorder (> 1 month).
3
Examine the third history focusing on rigidity, perfectionism, and control in the workplace.
The individual's behavior is ego-syntonic (they believe their way is the only correct way) and lacks true repetitive obsessions or compulsions.
Ego-syntonic perfectionism without true obsessions or compulsions is the hallmark of Obsessive-Compulsive Personality Disorder, differentiating it from OCD.
4
Assess the nature of the stressor in the fourth history concerning the university student.
Significant emotional distress and impairment developed within 3 months of a non-life-threatening stressor (a breakup).
Non-Criterion A stressors that cause significant impairment but do not meet criteria for another specific psychiatric disorder are diagnosed as Adjustment Disorder.
5
Identify the primary fear driving avoidance in the fifth history about the young professional.
The avoidance of social and networking events is driven by a persistent fear of negative evaluation and being perceived as awkward.
Fear of negative evaluation or scrutiny by others is the defining characteristic of Social Anxiety Disorder.

Key Concept

Differentiating anxiety, trauma-related, and obsessive-compulsive related disorders requires strict adherence to DSM-5 criteria regarding symptom duration (e.g., ASD vs. PTSD), the nature of the inciting event (life-threatening vs. non-life-threatening), the core cognitive fear driving avoidance (e.g., negative evaluation vs. inability to escape vs. specific harm), and assessing whether symptoms are ego-syntonic or ego-dystonic.
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Topics

Anxiety, OCD, and Trauma-Related Disorders

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