Diagnostic boundaries in psychiatry often hinge on precise symptom duration and the exact nature of the triggering event. For each of the following patient encounters, determine the single most appropriate DSM-5 diagnosis by differentiating between overlapping clinical features.
- A 22-year-old man avoids attending university lectures and eating in the cafeteria due to intense palpitations and sweating. He is terrified that others will notice his hands shaking and judge him as weak. He is completely comfortable in densely crowded places, such as large music festivals, as long as he remains anonymous.Social Anxiety Disorder
- A 45-year-old woman presents with severe muscle tension, fatigue, and insomnia. For the past 7 months, she has been unable to control her excessive worry concerning her husband's health, her work performance, and minor home maintenance. Her husband had a mild myocardial infarction 8 months ago, but her anxiety has since generalized to unrelated domains.Generalized Anxiety Disorder
- A 30-year-old paramedic responded to a catastrophic multi-vehicle collision 25 days ago. He reports experiencing intrusive visual memories of the scene, marked physiological reactivity when hearing sirens, and an inability to experience positive emotions. He now takes a longer route to work to avoid the highway.Acute Stress Disorder
- A 29-year-old woman was unexpectedly terminated from her corporate job 4 months ago. She experiences recurrent, distressing thoughts about the day she was fired, avoids driving past her former office building, feels socially detached, and has severe insomnia. She frequently states her life is permanently ruined.Adjustment Disorder
- A 38-year-old woman has spent the past year avoiding flying on airplanes, traveling on subways, and visiting enclosed shopping malls. She has never had a full panic attack, but she is terrified of suddenly developing incapacitating, panic-like symptoms (such as dizziness or loss of bowel control) and being unable to escape or obtain help.Agoraphobia
Answer
The clinical vignettes demonstrate subtle diagnostic boundaries. The correct matches are: the student avoiding lectures has Social Anxiety Disorder; the woman with multi-domain worry has Generalized Anxiety Disorder; the paramedic at 25 days post-trauma has Acute Stress Disorder; the fired corporate worker has Adjustment Disorder; and the woman avoiding travel has Agoraphobia.
Each diagnosis is established by strictly applying DSM-5 exclusionary criteria. Social Anxiety Disorder involves fear of scrutiny. GAD requires more than 6 months of multi-domain worry. Acute Stress Disorder is restricted to trauma symptoms lasting less than 1 month. Adjustment Disorder applies to significant distress from non-Criterion A stressors. Agoraphobia involves fear of entrapment without necessitating recurrent unexpected panic attacks.
Step-by-Step Solution
Key Concept
Accurate psychiatric diagnosis requires strict adherence to DSM-5 criteria regarding the precise duration of symptoms, the specific definition of a Criterion A trauma, and the patient's core underlying fear.