Professional Documents
Culture Documents
Case Report
Case Report
Case Report
Anxiety disorders are the most pervasive class of mental disorders, with a 12-month
prevalence in the community of about 18%. People with social anxiety disorder have fear and
avoid the scrutiny of others. The concern in such situations is that the individual will say or do
pronounced that the individual shuns most interpersonal encounters, or endures such situations
only with intense discomfort. Once largely neglected by the medical community, social anxiety
disorder came to the attention of the general medical community a decade ago, and is now
garnering increased attention and recognition as a widespread, impairing, but treatable condition
Individuals with social anxiety disorder are typically shy when meeting new people,
quiet in groups, and withdrawn in unfamiliar social settings. When they interact with others, they
might or might not show overt evidence of discomfort (e.g., blushing, not making eye contact),
but invariably experience intense emotional or physical symptoms, or both (e.g., fear, heart
racing, sweating, trembling, trouble concentrating). They crave the company of others, but shun
social situations for fear of being found out as unlikable, stupid, or boring (Stein, 1996).
Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers;
in some situations, this can lead to such individuals being mistakenly labelled as snobs. People
with social anxiety disorder are typified by low self-esteem and high self-criticism, and as
detailed below, often have depressive symptoms. Believed to account for about half of cases in
the community, and most individuals seeking treatment for social anxiety disorder,
generalizedsocial anxiety disorder is also the most disabling form of the disorder. Although
people with generalized social anxiety disorder can fear and avoid specific performance
situations such as public speaking, their social fears and avoidance extend far beyond that
Setting:
Demographic Details:
Name: MA
Age: 20 years
Gender: Female
Qualification: F.A
Socioeconomic Status: High
Religion: Islam
Number of siblings 6
Subject’s birth order 6th
Father Alive/Dead Alive
Mother Alive/Dead Alive
Father’s age and profession 55 and Doctor
Mother’s age and profession 50 and doctor
Dependent/Independent Dependent
Marital status Unmarried
Family Structure Nuclear
Head of Family Father
Earning Members 3
Residence Islamabad
Source of Referral:
Presenting complaints:
Miss MA was cheerfully getting a charge out of her life, but the issue raised when she
was rejected by her adore. Concurring to client, she needed to wed with him; she is of see that
she didn’t merit all that mess in her life. As per client’s depiction he criticized on her (client)
looks and physical appearance, which makes the client down hearted and after that she never met
her college companions as well. This was one of major reason for client’s this condition.
Family History:
The client belongs to a high socio economic class. Both the client’s parents were doctors
and earning proficient. The client had 5 sisters who were all doctors by profession and 4 of them
married to doctors as well. The client is unmarried and lives in a nuclear family. Client is
youngest in her siblings, and being overprotective by her parents. The client is very emotionally
attached with her mother but conflict arise a few months back when client faced such problem in
her life. There was one case of depression in the maternal side of the client’s family. There were
no genetic or inheritance based medical problems in the client’s family.
Personal History:
Miss MA was born without any inherited problem and had a normal birth without any
pre and post-delivery complications. She had enjoyed entire millstones at appropriate ages and
never suffered from any kind of physical, emotional and mental trauma throughout her
childhood. Her childhood was a never-ending source of pleasurable excitement. She is FA pass
with distinctions in various subjects and an overall gold medal. She is very hard working and
wishes to achieve big goals in life but is hopeless due to her conditions and limitations. She had
good relationships with her teachers and other class mates throughout her school and college life.
She was involved with a guy, when she was going through her collage period. She wanted to
marry with that guy, but the things didn’t work according to plan. She was badly criticized by
him in front of her friends. After that incident Miss MA never moved on. The client feels down
hearted and complaints of restrictions imposed on her by her father.
Pre-morbid Personality:
The client was hard working and had big ambitions. The client has a natural talent
for arts and drawing. She was an extrovert throughout her life except past few months. She is
youngest of all siblings and was loved by everyone in family so the life was very happy and
satisfying for her.
The client was making very less eye contact. She talked at an ordinary rate, with brief
intervals. Her volume was low. She was agreeable and replied each address clearly. She had a
good orientation of time.
Assessment:
The client was assessed through following psychological tests:
House: The house speaks to sense of belonging, nurturance and steadiness of a person, the figure
drawn by the client reveal signs of anxious behavior shown through shading in house, small
house, and shaded roof, whereas little entryway demonstrates a sign of socially insufficient
behavior. Drawing figure at right side of page demonstrates that individual is not social, while
Tree: The tree drawn appears the mental age of 30 a long time. Shaded tree beat portrays her
stresses approximately future. Overwhelming lines appear her anxiety, though no leaves on tree
show that client is feeling fruitless/barren. Shaded roots illustrate inconveniences in past.
Person: Individual is more coordinate representation of self. Large eyes and head extension
appears signs of anxious behavior. Erasures moreover demonstrate signs of anxiety, whereas
mouth emphasis shows depression. Long neck, minor shoulders and little trunk illustrate
sentiments of inferiority. Shaded hands are a sign of anxiety, whereas overlooked legs appear a
sign of debilitation.
Rotter’s Incomplete Sentence Test (RISB):The subject score on RISB was 146, which
is high above the cut off score i.e. 135, which depict that subject might have maladjustment
towards her environment. Client was not well adjusted, have social problems. Concern about
possible future failure indicate that she have high level of anxiety which is responsible for her
hopefulness and peace. Her parental, contempt and family members are seen as supportive and
helpful. She want social approval, individual identity and loneliness. She want happy gathering
BGT (Bender Gestalt Test):The patient completed all the images which were shown to
her. The patient took time of 14 minutes to complete the test. The patient attempt only 2 errors in
SPM (Standard Progressive Matrices):The clients score on SPM was 25 and her
percentile was 95th which shows that her reasoning ability and ability of intellectual functioning
Diagnosis:
Theoretical Orientation: One of the main theories about social anxiety asserts that social
underestimating the positive aspects. Individuals with social anxiety tend to overestimate the
threat of social interactions, the likelihood of negative outcomes, and the consequences of
negative outcomes. Individuals with social anxiety also tend to underestimate their ability to
Another theory about social anxiety is that patterns of thoughts and beliefs play an important role
in social anxiety, and targeting these thoughts and beliefs can be a helpful way to treat it. These
– Over estimate the level of threat in social situations. (For example, “This person is going to be
judging me.”)
– Under estimate their ability to handle social situations. (For example, “I’m going to say
something stupid.”)
– Expect negative outcomes from interactions in social environments. (For example, “He is
– Over estimate the consequences of these negative outcomes. (For example, “He’s probably
going to tell everyone at the office how stupid I am, and then I’ll probably be fired.”)
Because of these beliefs and expectations, social interactions are often avoided. Focus of
attention during social interactions when individuals with social anxiety are in social
interactions, they tend to focus more on how they are being perceived by other people (for
example, “My handshake was too weak. She’s going to think I have no confidence….”), rather
-This focus on one’s own performance can be very distracting, and can get in the way of having
-This attention can also lead one to only pay attention to the negative aspects of how they are
-Because of this focus, individuals with social anxiety tend to remember past interactions as
This pattern can lead to more avoidance of social interactions (Huppert et al, 2003).
Number of sessions:
First session was conducted with the client at Rawal hospital and initial intake was done in
which client shared her problems. Consent was taken from the client and was ensured that all the
information will be kept confidential. In introductory session basic history was taken from the
Client reported that she was 20 years old and resident of Islamabad. Her birth order
was last among siblings and she was unmarried. She lived in nuclear family system and her
Client reported that she was cheerfully getting a charge out of her life, but the issue raised when
she was rejected by her adore. Concurring to client, she needed to wed with him. She is of see
that she didn’t merit all that mess in her life. As per client’s depiction he criticized on her (client)
looks and physical appearance, which makes the client down hearted and after that she never met
her college companions as well. This was one of major reason for client’s this condition.
The client was hard working and had big ambitions. The client has a natural talent for
arts and drawing. She was an extrovert throughout her life except past few months. She is
youngest of all siblings and was loved by everyone in family so the life was very happy and
satisfying for her.
During 2nd session, after greetings detail history was taken from the patient. The client
belongs to a high socio economic class. Both the client’s parents were doctors and earning
proficient. The client had 5 sisters who were all doctors by profession and 4 of them married to
doctors as well. The client is unmarried and lives in a nuclear family. Client is youngest in her
siblings, and being overprotective by her parents. The client is very emotionally attached with
her mother but conflict arise a few months back when client faced such problem in her life.
There was one case of depression in the maternal side of the client’s family. There were no
genetic or inheritance based medical problems in the client’s family.
She was born without any inherited problem and had a normal birth without any pre
and post-delivery complications. She had enjoyed entire millstones at appropriate ages and never
suffered from any kind of physical, emotional and mental trauma throughout her childhood. Her
childhood was a never-ending source of pleasurable excitement. She is FA pass with distinctions
in various subjects and an overall gold medal. She is very hard working and wishes to achieve
big goals in life but is hopeless due to her conditions and limitations. She had good relationships
with her teachers and other class mates throughout her school and college life. She was involved
with a guy, when she was going through her college period. She wanted to marry with that guy,
but the things didn’t work according to plan. She was badly criticized by him in front of her
friends. After that incident Miss MA never moved on. The client feels down hearted and
complaints of restrictions imposed on her by her father.
During 3rd session, different psychological tests were administered based on identifying
problems. Behavioral observations were also done during test administration. Client was asked to
draw house, tree and person for HTP interpretation and after that Rotter Incomplete Blank Test
In 4th session different TAT cards were shown to the clients and instructions were given
to write a story about each picture on the cards. After that Bender Gestalt Test and Standard
In 5th session, therapeutic suggestions were given to the client. Cognitive behavioral therapy
was used with the patient. Therapy addresses negative patterns and distortions in the way we
Patient was guided that not the external events but our thoughts affect the way we feel. In other
words, it’s not the situation that determines how you feel, but your perception of the situation.
Therapist explained the therapy through example of party invitation. Patient was asked to
imagine that you have just been invited to a big party. Consider three different ways of thinking
about the invitation, and how those thoughts would affect your emotions.
Thought #1: The party sounds like a lot of fun. I love to be going out and meeting new people.
Emotions: Happy, excited
Thought #2:Parties aren’t enjoyable. It’s good to stay at home and watch a movie.
Emotions: Neutral
Thought #3:I never know what to say or do at parties. I’ll make a fool of myself if I go.
Emotions: Anxious, sad
In this example, same event can lead to completely different emotions in different
people. It all depends on our individual expectations, attitudes, and beliefs. We have to identify
and correct the negative thoughts and beliefs. If you change the way you think, you can change
In 6th session, further therapeutic techniques were applied. Exposure therapy was used with the
patient. Client was asked to imagine the anxious situation during the session and she was
encouraged to practice flooding in real life. Initially, client hesitated to imagine the most anxious
situation but therapist instructed her to relax and feel calm and then therapy was started again.
Last session was of termination when client and therapist both felt that goal has achieved.
psychotherapy.
Prognosis:
The prognosis seems favorable as there are more chances to get better as her family is supportive
towards her. She is also willing to get better and want counseling so she can get out of her
problems.
Termination:
After achieving psychotherapeutic goals set up by the client and therapist in the start,
psychotherapy was terminated. During 7th session, progression of the therapy was checked and
client told the therapist that she is relieving from problematic behaviors. She told that she has
learned to overcome her problems. Her signs and symptoms are getting low in frequency.
References
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, et al. (2007) Use of mental
health services for anxiety, mood, and substance disorders in 17 countries in the WHO world
Hidalgo RB, Tupler LA, Davidson JRT (2007) An effect-size analysis of pharmacologic
Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., &Castonguay, L. G. (2013).
Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on
nature, etiology, mechanisms, and treatment. Annual review of clinical psychology, 9, 275-297.
Swain, J., Hancock, K., Hainsworth, C., & Bowman, J. (2013). Acceptance and commitment
therapy in the treatment of anxiety: a systematic review. Clinical psychology review, 33(8), 965-
978.