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Difficulty: HardAnxiety, OCD, and Trauma-Related Disorders

Assess the following diverse clinical presentations of patients experiencing fear-based or stress-related psychiatric symptoms. Select the most appropriate diagnosis for each patient presentation based on symptom duration and clinical characteristics.

  • A patient experiences unexpected, abrupt surges of intense fear with palpitations, followed by persistent concern about having additional episodes for the past two months.Panic disorder
  • A patient develops intrusive nightmares, hypervigilance, negative mood, and dissociative symptoms lasting for exactly three weeks after surviving a life-threatening industrial accident.Acute stress disorder
  • A patient demonstrates marked, unreasonable fear and avoidance of flying on airplanes for the past eight months, without fear of other enclosed spaces or public transit.Specific phobia
  • A patient reports nine months of pervasive, uncontrollable worry about multiple everyday domains, accompanied by chronic muscle tension, irritability, and sleep disturbance.Generalized anxiety disorder
  • A patient develops significant anxiety and mild depressive symptoms causing academic decline, beginning shortly after a non-life-threatening relationship breakup two months ago.Adjustment disorder

Answer

The correct matches align each clinical vignette with its DSM-5 diagnostic category based on specific symptom duration thresholds and trigger characteristics.
Each vignette provides pathognomonic combinations of symptom type, duration, and triggering events that exclusively align with one specific DSM-5 diagnostic category in the anxiety and trauma spectrum.

Step-by-Step Solution

1
Analyze the first patient's presentation of unexpected abrupt fear followed by persistent concern.
Matches Panic disorder.
The key criterion is the presence of unexpected panic attacks followed by at least 1 month of anticipatory anxiety about future attacks.
2
Evaluate the second patient's post-trauma symptoms lasting exactly three weeks.
Matches Acute stress disorder.
Trauma-related symptoms lasting between 3 days and 1 month define Acute stress disorder. If symptoms persist beyond 1 month, the diagnosis changes to PTSD.
3
Assess the third patient's isolated fear of flying lasting eight months.
Matches Specific phobia.
Persistent fear of a single specific situation lasting 6 or more months defines Specific phobia. The absence of other feared situations excludes agoraphobia.
4
Review the fourth patient's pervasive worry and muscle tension lasting nine months.
Matches Generalized anxiety disorder.
Uncontrollable worry across multiple domains lasting at least 6 months with associated physical symptoms like muscle tension is the hallmark of GAD.
5
Analyze the fifth patient's symptom onset following a relationship breakup two months ago.
Matches Adjustment disorder.
Symptoms developing within 3 months of a psychosocial stressor and causing functional impairment, without meeting criteria for another disorder, characterize Adjustment disorder.

Key Concept

Accurate psychiatric diagnosis relies on identifying the nature of the triggering event (e.g., severe trauma, non-life-threatening stressor, specific object, or unexpected panic) and verifying that the symptom duration meets DSM-5 time thresholds.
Estimated Time:1m 30s
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Topics

Anxiety, OCD, and Trauma-Related Disorders

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