Diagnostic Report: Generalized Anxiety Disorder Case Study Analysis

This report provides a comprehensive analysis of a case study involving Mr. Tony Jenkins, a 26-year-old computer programmer presenting with symptoms of depression and worthlessness following a breakup. The assessment utilized the DSM-5 Self-Rated Cross-Cutting Symptom Measure (CCM-1 and CCM-2) and the WHODAS 2.0 measure to evaluate symptoms and functional impairment. Initial assessments considered depression, mania, and anxiety, with anxiety demonstrating the most significant findings. The diagnostic process led to a final diagnosis of Generalized Anxiety Disorder (GAD), meeting DSM-5 criteria including excessive worry, difficulty controlling worry, and associated symptoms like restlessness and irritability. The report also discusses rejected diagnoses and the clinical significance of GAD, along with recommendations for treatment, including cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT).

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

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sleep) circumstances whenhehad to
socialize, participate in workplace
events, or even when Sarah made a
joke of certain matters or
unintentionally hurt his feelings and
sentiments.
5. Tony did not report any signs of
muscle tension
6. There were no symptoms of muscle
tension in Tony
D. The anxiety, worry, or physical
symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
The apprehensions and anxiety faced by
Tony made him display reluctance in
expressing his feelings towards his
partner, which eventually took a toll on
their relationship and resulted in their
separation. In addition, persistent worry
often made it problematic for him to
develop close association with any person.
Furthermore, Tony also said that Tony did
not have any close friends and had
restricted social networking owing to his
mental distress.
E. The disturbance is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
It has often been found that substance
abuse and anxiety disorders co-occur and
exposure to a particular drug often
increases the likelihood of a person to
suffer from anxiety disorder. In addition,
there are several medications that
heighten anxiety symptoms such as,
aspirin, acetaminophen, ergotamine, and
caffeine. However, Tony met this criteria
since Tony did not have any history of

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substance abuse or did not suffer from any
medical condition. Tony was currently not
being administered any prescribed
medications and did not report any signs of
communication impairment or ignorance of
distinguishing social cues.
F. The disturbance is not better explained
by another medical disorder (e.g., anxiety
or worry about having panic attacks in
panic disorder, negative evaluation in social
anxiety disorder [social phobia],
contamination or other obsessions in
obsessive-compulsive disorder, separation
from attachment figures in separation
anxiety disorder, reminders of traumatic
events in posttraumatic stress disorder,
gaining weight in anorexia nervosa,
physical complaints in somatic symptom
disorder, perceived appearance flaws in
body dysmorphic disorder, having a serious
illness in illness anxiety disorder, or the
content of delusional beliefs in
schizophrenia or delusional disorder).
The presenting complaints
reported by Tony were not
accredited to any other mental
disorder since Tony did not have
a history of any other ailment.
However, Tony reported
development of low self-esteem
during his adolescent years and
considered that phase to be
extremely difficult since Tony
could not socialize with his peers
and was continuously worried
about being ridiculed or rebuked
by them. This made him stay
indoors most of the time, and
resulted in huge absenteeism
from his school. However, these
problems made his GP prescribe
some antidepressant medication
to Tony at that time, meant for
treating signs and symptoms of
depression and anxiety.

CLINICAL SIGNIFICANCE AND RECOMMENDATIONS
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Therefore, it can be stated that Tony exhibits signs and symptoms that are related to
generalized anxiety disorder owing to the fact that Tony manifested signs and
symptoms that were characterized by uncontrollable and excessive worry and
apprehensions about events and activities. Tony fulfilled criteria A, B, D, E, and F, thus
confirming diagnosis of generalized anxiety disorder. The excessive worry and anxiety
that Tony had about his personality and social interaction interfered with his daily
functioning and also remained concerned about regular affairs such as, interpersonal
relationship, workplace issues and friendship problems. Furthermore, the symptoms
also made him irritable and restless, though they did not create any significant
impairment on his sleep pattern. In addition, it can also be stated that the condition was
not a consequence of long-term consumption of any drugs such as benzodiazepines
that have been found to worsen the mental health condition. It can be stated that
perhaps Tony developed this mental disorder, following the separation of his parents
that occurred when Tony was aged 8 years. Though Tony did not have any substance
abuse history, lack of emotional attachment with his mother during his adolescent
period can be recognized as a contributing factor to his social isolation and social
anxiety, thus confirming development of the symptoms discussed above.
Oneanalysis were used for evaluating the severity of generalized anxiety disorder
symptom reported by Tony. The World Health Organization Disability Assessment
Schedule 2.0 (WHODAS 2.0) was also used for gaining a sound understanding of the
health problems that Tony was suffering from. This helped in assessing difficulty
experienced by Tony in six different domains namely, mobility, cognition, getting along,
self-care, life activities, and participation. It was found that Tony scored high on the
domains that focused on getting along with people (D4), participation in society (D6),
and life activities at school or work (D5). Scoring high on the aforementioned three
domains provided an indication for the fact that persistent anxiety prevented Tony from
dealing with individuals whom Tony did not know. It also prevented him from developing
friendship or association, as was the case with Sarah and also created problems in
getting along with individuals who were close to him. This was confirmed by the fact that

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REFERENCES
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thoughTony was in a relationship with Sarah, Tony found it difficult to express his love
and affection for his partner. Similarly, Tony was not able to perform additional
responsibilities at his workplace. In addition, Tony found it particularly problematic to
join community activities owing to his recluse nature and was emotionally affected by
the prevailing health condition.
Once generalized anxiety disorder has developed, it can develop into chronic mental
disorder, however, can be eliminated and/or managed with adequate treatment. Both
medications and cognitive behavioural therapy (CBT) can be used for lowering the
signs and symptoms of anxiety. Some components of this therapy would comprise of
self-monitoring, psychoeducation, relaxation, stimulus control techniques, cognitive
restructuring, self-control desensitization, worry behaviour alteration, worry exposure,
and problem-solving, all of which will help in informing Tony about the issues that
Tony is facing, followed by providing a plan for addressing the issue (Andrews et al.,
2018).
Furthermore, Acceptance and Commitment Therapy (ACT) will also act as an
effective intervention in treating Tony since this behavioural treatment is dependent on
acceptance-based model and has been formulated with the aim of targeting three
particular therapeutic goals namely, (i) lowering usage of avoiding policiesenvisioned
to evade feelings, memories, thoughts,and sensations, (ii) lessening the individual’s
literal rejoinder to their opinions, and (iii) snowballing the capability of the individual for
keeping commitments to altering their behaviors (Andrews et al., 2018). Hence, the
therapy will facilitating switching the attempts taken by Tony for controlling particular
events, in order to work towards changing his behaviour.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders: DSM-V (5th ed.). Arlington.
https://doi.org/10.1176/appi.books.9780890425596
Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., ...& Wilkins, G.
(2018). Royal Australian and New Zealand College of Psychiatrists clinical

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practice guidelines for the treatment of panic disorder, social anxiety disorder
and generalised anxiety disorder. Australian & New Zealand Journal of
Psychiatry, 52(12), 1109-1172. https://doi.org/10.1177%2F0004867418799453

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Appendix
DSM-5 Self-Rated Level 1 Cross-Cutting Symptom
Measure—Adult
Name: Tony Jenkins Age:
26
Sex:  MaleFemale Date:

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Ifthisquestionnaireiscompletedbyaninformant,whatisyourrelationshipwiththeindividual?
Inatypicalweek,approximatelyhowmuchtimedoyouspendwiththeindividual?
_hours/week
Instructions:Thequestionsbelowaskaboutthingsthatmighthavebotheredyou.Foreachquestion,circlethenumberthatbest
describeshowmuch(orhowoften)youhavebeenbotheredbyeachproblemduringthepastTWO(2)WEEKS.
DuringthepastTWO(2)WEEKS,howmuch(orhowoften)haveyoubeen
botheredbythefollowingproblems?
None
Notata
ll
Slight
Rare,les
s
thanada
y
or
two
Mild
Sever
al
days
Moderate
Morethanhalfth
e
days
Sever
e
Nearl
y
every
day
Highes
t
Domai
n
Score
(clinician
)
I. 1. Little interest or pleasure in doing things? 0 1 2 3 4 3
2. Feeling down, depressed, or hopeless? 0 1 2 3 4
II. 3. Feeling more irritated, grouchy, or angry than usual? 0 1 2 3 4 2
III. 4. Sleeping less than usual, but still have a lot of energy? 0 1 2 3 4 1
5.Startinglotsmoreprojectsthanusualordoingmoreriskything
sthan usual?
0 1 2 3 4
IV. 6. Feeling nervous, anxious, frightened, worried, or on edge? 0 1 2 3 4 4
7. Feeling panic or being frightened? 0 1 2 3 4
8. Avoiding situations that make you anxious? 0 1 2 3 4
V. 9.Unexplainedachesandpains(e.g.,head,back,joints,abdomen,leg
s)?
0 1 2 3 4 0
10. Feeling that your illnesses are not being taken seriously
enough?
0 1 2 3 4
VI. 11. Thoughts of actually hurting yourself? 0 1 2 3 4 0
VII
.
12.Hearingthingsotherpeoplecouldn’thear,suchasvoicesevenwhe
nno one wasaround?
0 1 2 3 4 0
13.Feelingthatsomeonecouldhearyourthoughts,orthatyoucouldhe
ar whatanotherpersonwasthinking?
0 1 2 3 4
VIII
.
14. Problems with sleep that affected your sleep quality over all? 0 1 2 3 4 1
IX. 15.Problemswithmemory(e.g.,learningnewinformation)orwithlocation
(e.g.,findingyourwayhome)?
0 1 2 3 4 0
X. 16.Unpleasantthoughts,urges,orimagesthatrepeatedlyenteryourm
ind?
0 1 2 3 4 0
17.Feelingdriventoperformcertainbehaviorsormentalactsoverandover
again?
0 1 2 3 4
XI. 18.Feelingdetachedordistantfromyourself,yourbody,yourphysical
surroundings, or yourmemories?
0 1 2 3 4 0
XII. 19. Not knowing who you really are or what you want out of life? 0 1 2 3 4 0
20.Notfeelingclosetootherpeopleorenjoyingyourrelationshipswitht
hem?
0 1 2 3 4
XIII
.
21. Drinking at least 4 drinks of any kind of alcohol in a single
day?
0 1 2 3 4 0
22.Smokinganycigarettes,acigar,orpipe,orusingsnufforchewingtobac 0 1 2 3 4

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co?
23.UsinganyofthefollowingmedicinesONYOUROWN,thatis,witho
uta
doctor’sprescription,ingreateramountsorlongerthanprescribe
d[e.g.,
painkillers(likeVicodin),stimulants(likeRitalinorAdderall),sedative
sor
tranquilizers(likesleepingpillsorValium),ordrugslikemarijuana,co
caine or crack, club drugs (like ecstasy), hallucinogens (like
LSD), heroin,
inhalantsorsolvents(likeglue),ormethamphetamine(likespeed
)]?
0 1 2 3 4

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LEVEL 2—Anxiety—Adult*
*PROMIS Emotional Distress—Anxiety—Short Form
Name: Tony Jenkins Age: 26 Sex:  MaleFemale Date:

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Ifthemeasureisbeingcompletedbyaninformant,whatisyourrelationshipwiththeindividual?
Inatypicalweek,approximatelyhowmuchtimedoyouspendwiththeindividual? hours/week
Instructionstopatient:OntheDSM-5Level1cross-cuttingquestionnairethatyoujustcompleted,youindicatedthatduring
thepast2weeksyou(individualreceivingcare)havebeenbotheredby“feelingnervous,anxious,frightened,worried,oron
edge”,“feelingpanicorbeingfrightened”,and/or“avoidingsituationsthatmakeyouanxious”atamildorgreaterlevelof
severity.Thequestionsbelowaskaboutthesefeelingsinmoredetailandespeciallyhowoftenyou(individualreceivingcare)
havebeenbotheredbyalistofsymptomsduringthepast7days.Pleaserespondtoeachitembymarking(orx)onebox
perrow.
Clinician
Use
In the past SEVEN (7) DAYS.... Item
Never Rarely Sometime
s
Often Always Score
1. I felt fearful.  1  2  3  4  5 3
2. I felt anxious.  1  2  3  4  5 3
3. I felt worried.  1  2  3  4  5 3
4. Ifoundithardtofocusonanything
other than myanxiety.  1  2  3  4  5 2
5. I felt nervous.  1  2  3  4  5 3
6. I felt uneasy.  1  2  3  4  5 3
7. I felt tense.  1  2  3  4  5 3
Total/Partial Raw Score: 20
Prorated Total Raw Score:
T-Score: 60.0
©2008-2012PROMISHealthOrganization(PHO)andPROMISCooperativeGroup.

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LEVEL 2—Depression—Adult*
*PROMIS Emotional Distress—Depression—Short Form
Name: Tony Jenkins Age: 26 Sex:  MaleFemale Date:

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Ifthemeasureisbeingcompletedbyaninformant,whatisyourrelationshipwiththeindividualreceivingcare?
Inatypicalweek,approximatelyhowmuchtimedoyouspendwiththeindividualreceivingcare?hours/week
Instructions:OntheDSM-5Level1cross-cuttingquestionnairethatyoujustcompleted,youindicatedthatduringthepast2
weeksyou(theindividualreceivingcare)havebeenbotheredby“nointerestorpleasureindoingthings”and/or“feeling
down,depressed,orhopeless”atamildorgreaterlevelofseverity.Thequestionsbelowaskaboutthesefeelingsinmore
detailandespeciallyhowoftenyou(theindividualreceivingcare)havebeenbotheredbyalistofsymptomsduringthepast7days. Please
respondtoeachitembymarking(orx)oneboxperrow.
Clinician
Use
In the past SEVEN (7) DAYS.... Item
Never Rarely Sometime
s
Often Always Score
1. I felt worthless.  1  2  3  4  5 3
2. I felt that I had nothing to look forward to.  1  2  3  4  5 1
3. I felt helpless.  1  2  3  4  5 1
4. I felt sad.  1  2  3  4  5 1
5. I felt like a failure.  1  2  3  4  5 1
6. I felt depressed.  1  2  3  4  5 2
7. I felt unhappy.  1  2  3  4  5 1
8. I felt hopeless.  1  2  3  4  5 1
Total/Partial Raw Score: 11
Prorated Total Raw Score:
T-Score: 48.2

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WHODAS 2.0
World Health Organization Disability Assessment Schedule 2.0
36-item version, self-administered
PatientName: Tony Jenkins Age: 26 Sex: MaleFemale Date:
Thisquestionnaireasksaboutdifficultiesduetohealth/mentalhealthconditions.Healthconditionsincludediseasesorillnesses,
otherhealthproblemsthatmaybeshortorlonglasting,injuries,mentaloremotionalproblems,andproblemswithalcoholor
drugs.Thinkbackoverthepast30daysandanswerthesequestionsthinkingabouthowmuchdifficultyyouhaddoingthefollowing
activities.Foreachquestion,pleasecircleonlyoneresponse.
Clinician Use Only
Numeric scores assigned to each of the items: 1 2 3 4 5
em
e
n
e
ge
n
e
In the last 30 days, how much difficulty did you have in:
Raw It
Sc o
r
Raw
Doma
i Scor
Avera
Domai
Scor
Understanding and communicating
D1.1 Concentrating on doing something for ten
minutes? None Mild Moderate Severe Extreme or
cannot do
D1.2 Remembering to do important things? None Mild Moderate Severe Extremeor
cannotdo
D1.3 Analyzingandfindingsolutionstoproblemsin
day-to-day life? None Mild Moderate Severe Extreme or
cannot do 6 1
D1.4 Learninganewtask,forexample,learninghow
to get to a new place? None Mild Moderate Severe Extreme or
cannot do
30 5
D1.5 Generally understanding what people say? None Mild Moderate Severe Extremeor
cannotdo
D1.6 Starting and maintaining a conversation? None Mild Moderate Severe Extremeor
cannotdo
Getting around
D2.1 Standingforlongperiods,suchas30minutes? None Mild Moderate Severe Extremeor
cannotdo
D2.2 Standing up from sitting down? None Mild Moderate Severe Extremeor
cannotdo
D2.3 Moving around inside your home? None Mild Moderate Severe Extremeor
cannotdo 5 25 1 5
D2.4 Getting out of your home? None Mild Moderate Severe Extremeor
cannotdo
D2.5 Walkingalongdistance,suchasakilometer(or
equivalent)? None Mild Moderate Severe Extreme or
cannot do
Self-care
D3.1 Washing your whole body? None Mild Moderate Severe Extremeor
cannotdo
D3.2 Getting dressed? None Mild Moderate Severe Extremeor
cannotdo 4 0.8
D3.3 Eating? None Mild Moderate Severe Extremeor
cannotdo
20 5
D3.4 Staying by yourself for a few days? None Mild Moderate Severe Extremeor
cannotdo
Getting along with people
D4.1 Dealing with people you do not know? None Mild Moderate Severe Extremeor
cannotdo
D4.2 Maintaining a friendship? None Mild Moderate Severe Extremeor
cannotdo
D4.3 Getting along with people who are close to
you? None Mild Moderate Severe Extreme or
cannot do
15
25
3
5

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D4.4 Making new friends? None Mild Moderate Severe Extremeor
cannotdo
D4.5 Sexual activities? None Mild Moderate Severe Extremeor
cannotdo

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Clinicia
n Use
Only
Numeric scores assigned to each of the items: 1 2 3 4 5
Raw
ItemR aw
Dom ai
Average
Dom ain
In the last 30 days, how much difficulty did you have in:
Life activities—Household
D5
.1
Taking care of your household responsibilities? No
ne
Mil
d
Mode
rate
Sev
ere
Extre
meor
canno
tdo 4
2
0
0.8
5D5
.2
Doing most important household tasks well? No
ne
Mil
d
Mode
rate
Sev
ere
Extre
meor
canno
tdo
D5
.3
Getting all of the household work done that
you needed to do? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D5
.4
Gettingyourhouseholdworkdoneasquicklyas
needed? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
Life activities—School/Work
Ifyouwork(paid,non-paid,self-employed)orgotoschool,completequestionsD5.5–
D5.8,below.
Otherwise, skip to D6.1.
Because of your health condition, in the past 30 days, how much difficulty did you have
in:
D5
.5
Your day-to-day work/school? No
ne
Mil
d
Mode
rate
Sev
ere
Extre
meor
canno
tdo 6
2
0
1.2
5D5
.6
Doing your most important work/school tasks
well? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D5
.7
Getting all of the work done that you need to
do? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D5
.8
Gettingyourworkdoneasquicklyasneeded? No
ne
Mil
d
Mode
rate
Sev
ere
Extre
meor
canno
tdo
Participation in society
In the past 30 days:
D6
.1
Howmuchofaproblemdidyouhaveinjoiningincommunityact
ivities(forexample,festivities,
religious,orotheractivities)inthesamewayas
anyone else can?
No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
16
4
2
5
D6
.2
Howmuchofaproblemdidyouhavebecause
ofbarriersorhindrancesaroundyou? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D6
.3
Howmuchofaproblemdidyouhavelivingwithdignitybec
auseoftheattitudesand
actions of others?
No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno

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Name:
Student ID:
Unit #:
t do 0
D6
.4
Howmuchtimedidyouspendonyourhealth
condition or its consequences? No
ne
So
me
Mode
rate
A
Lot
Extrem
e or
canno
t do
D6
.5
Howmuchhaveyoubeenemotionallyaffected
by your health condition? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D6
.6
Howmuchhasyourhealthbeenadrainonthe
financial resources of you or your family? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D6
.7
How much of a problem did your family have
because of your health problems? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
D6
.8
Howmuchofaproblemdidyouhaveindoing
thingsby yourself for relaxation or pleasure? No
ne
Mil
d
Mode
rate
Sev
ere
Extrem
e or
canno
t do
General Disability Score (Total):
56
1
8
0
11.
2
5