Diagnosis of Generalised Anxiety Disorder

CASE HISTORY
ASSESSMENT AND DIAGNOSTIC PROCESS
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Mr. Tony Jenkins, a 26-year-old male, has been referred to the mental health clinic.
Tony works as a computer programmer and has been referred due to his presenting
complaints of feeling worthless and depressed, following breakup with his partner Sarah.
Since the event, Tony reports feelings of loneliness and solitude, however, these feelings
are not completely unknown to him, since Tony reports being socially awkward and shy
in front of others. His fear for being rejected, mocked and shamed have also made him
turn down a promotion at his workplace, much to his sister’s disappointment. Despite
being extremely intellectual and meticulous, Tony considered himself inadequate to take
on the new job role and also feared being rebuked at the interview for his dressing
sense. Additionally, Tony reports being subjected to antidepressant medications during
his adolescent years, which were extremely difficult for him, marked by a drastic
decrease in his self-esteem. Tony is aware of the discomfort that Tony faces at social
gatherings and cites it as a primary reason for avoiding participation in any workplace
activity or having lunch all by himself.
The main signs and symptoms were evaluated using the DSM-5 Self-Rated (Clinician)
Level 1 (CCM-1) and Level 2 (CCM-2) Cross-Cutting Symptom Measure and the WHODAS
2.0 measure. CCM-1 is a mental health valuation that assessed each realm by drawing
consideration to signs and symptoms that are significant across diagnoses. In contrast,
CCM-2 provided an in-depth explanation of disorders that were allied within the domains of
CCM-1. Hence, use of the aforementioned Cross-Cutting measures, in addition to DSM 5
diagnostic criteria facilitated appositediagnosis of the patient. There were a range of
domains in CCM-1 that had scores ranging from highest (4) to slight (1). Some domains
that were selected for evaluation, in relation to the patient Tony were namely, (I)

MAJOR DEPRESSIVE DISORDER
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depression, (III) mania, and (IV) anxiety.
Depression was initially assessed using the CCM-1, with 3 being the highest score. This
was followed by conducting a CCM-2 for depression where the t-score for depression for
Tony was 48.2 thus suggesting that there the severity of this mental distress was mild.
Hence, the score was not substantial enough for conducting further investigation in the
domain.
Anxiety was also assessed using the CCM-1 with a high score of 4 for all questions. A t-
score of 4 for anxiety demonstrated that this domain was of severe significance in the
patient, thus explaining that nearly every day, Tony experienced nervousness,
anxiousness, worry, panic, and avoided situations that made him feel concerned. Thus, the
score highlighted the need of conducting additional inquiry. CCM-2 was performed for
anxiety and the t-score was 60 thus suggesting that the mental condition of the patient was
of excessive worry. The patient was also subjected to CCM-2 for mania. However, no other
domains had high enough score that required follow up. Decision trees were used for
identifying the considered disorders.
Symptom
Domain
CCM L1 CCM L2 T score Comments. Key justification
Anxiety 4 20 60 Moderate. (excessive worry)
Depression 3 11 48.2 Mild (no reason to worry)
CONSIDERED DISORDERS
MDD was considered since Tony reported signs of hopelessness, lack of interest, and was
deeply depressed after his separation from Sarah. However, we rejected this diagnosis
since other symptoms of MDD such as, psychomotor agitation, loss of energy, or
indecisiveness were not reported.

GENERALISED ANXIETY DISORDER
ADJUSTMENT DISORDER
GENERALISED ANXIETY DISORDER
FINAL DIAGNOSIS
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Tony scored high on the mania and anxiety domain in CCM-1 and demonstrated signs of
marked distress that lead to significant impairment in his occupational and/or social areas
of functioning. However, his signs were more congruent with that of generalized anxiety
disorder.
There is evidence of excessive worry and anxiety (apprehensive expectation) in Tony that
occurred for several days, about a number of activities or events (work performance and
personal life). Tony found it difficult to control his apprehensions and also reported signs of
irritability, restlessness, and concentration difficulty.

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It was concluded that Tony met the DSM-5 criteria for Generalised Anxiety
Disorder (300.02) (American Psychiatric Association, 2013). According to this criteria,a
person suffering from Generalised Anxiety Disorder requires manifestation of the
following:
A. Excessive anxiety and worry
(apprehensive expectation), occurring
more days than not for at least 6 months,
about a number of events or activities
(such as work or school performance).
Tony reported that hewas worried about
his work performance and turned down
the offer of promotion at his company
owing to his feelings of inadequacy.
B. The individual finds it difficult to control
the worry.
Though Tony has broken up with his
girlfriend Sarah, hefinds it difficult not
to think about the incident and blames
his hypersensitivity and socializing
problems as the major reasons that led
to his breakup.
C. The anxiety and worry are associated
with three (or more) of the following six
symptoms (with at least some symptoms
having been present for more days than not
for the past 6 months):
1. Restlessness, feeling keyed up or on
edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going
blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or
staying asleep, or restless, unsatisfying
1. He reports being hypersensitive
during most circumstances and
manifests extreme emotional
response on the smallest amount of
ridicule
2. No symptoms reported by Tony
demonstrated fatigue
3. There were no symptoms that
reported Tony facing difficulty in
concentrating since it was reported
that Tony was extremely intelligent
and conscientious.
4. It was found that Tony often
became irritable under