As referred to in appendix A, Joan is a 22 yr old woman that has been referred for emotional analysis from her doctor after showing somatic complaints. Although in the doctors’ view no evident physical basis can be found for the claims presented, Joan highlights that she’s nausea, rapid center palpitations and sweating.

An original interview discloses Joan is an up-to-date university university student and has been in a relationship with her current sweetheart (Nevin) for the past 3 years. Joan admits to using cannabis for the original purposes of earning her feel calm; however statements that lately her use acquired increased to a more frequent level.

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Specifically identifying a trigger point on her behalf complaint, Joan discussed that throughout a regular exercising routine; four days after stopping her cannabis behavior, she visited an area shop and experienced several abnormal feelings. She encountered feelings to be nauseated, sick, sweaty and a feeling of her upper body tightening. She further state governments that within minutes of the symptoms delivering, she experienced a feeling of gasping for air and a feeling of getting out of control.

Joan claims to obtain re-experienced these symptoms when she proceeded to go at night shop as soon as at school when she was required to publicly speak during school. Because of the concern with relapsing she’s neither returned back again to the shop or her college or university class. Because of this continuous dread, Joan now insists that Nevine accompany her to major public places such as library, department stores, classes and even to the consultation. Joan does not present another physical instabilities and is is apparently alert to her area and appearance. Nonetheless it must be known that she’s insisted that she be positioned near the door through the interview improvement and did show indicators of distractibility.


This essay will attempt to evaluate all possible differential diagnoses for Joan predicated on the info provided. The differentials will be examined describing why they must be considered as part of the preliminary diagnoses. While using diagnostic and statistical manual of mental disorders (DSM-IV-TR), the article will try to correlate all differential diagnoses back to the information provided.

The DSM-IV-TR is a publishing which requires a set of all possible mental health disorders that may be attributed due to specific symptoms presented. From a psychological perspective, a therapist matches up the symptoms presented to that of the disorder symptoms shown in the DSM-IV-TR. This can help therapists to develop all potentials disorders that may classify the mental position of the individual they are dealing with (First, Frances, & Pincus, 2002).

According to First, Frances and Pincus (2002), the DSM-IV-TR further classifies disorders as being part of a multiaxial size. Axis I is categorised as being specialized medical disorder including such items as anxiety attacks and generalised panic. Axis II is categorised to be personality disorders or mental retardation and include items such as borderline personality disorder and obsessive-compulsive personality disorder. Axis III is categorised as basic medical/physical conditions or disorders, and include such items as hyperthyroidism. Axis IV is categorised as psychosocial and environmental problems and include items such as communal issues or educational problems. Axis V last but not least is classified to be global examination of performing which tests your present, general health and test items such as social social interactions and/or academic performance.

All differential diagnoses can be established through the means of using subconscious assessments, questionnaires as well as speaking with members of the family and friends. The DSM-IV-TR also contains a flow graph approach called a decision tree in order to determine possible diagnoses for different disorders. Once all differential diagnoses have been considered, a provisional examination will be recognized. The appraisal of why other diagnoses have been turned down will also be discussed, combined with the implications and prognosis of the provisional examination based on relevant literature.

Identification of differential diagnoses

Plausible differentials

Social phobia. Public phobia is part of axis I and is considered to be always a form of panic. Public phobia is the fear of being able to connect to your communal surrounding. The fear is considered to be irrational and consists of the ideology that the persons activities are being scrutinised and for that reason will result in do it yourself humiliation or self humiliation (Thobaben, 2004; Valente, 2002).

According to First, Frances and Pincus (2002), in order to classify a customer as having public phobia, they must meet the following criterias; (a) show persistent concern with being in a public situation where they feel their activities will be scrutinised or bring about embarrassment; (b) being in the feared situation incites feeling of anxiety viewed through symptoms of panic attacks; (c) dread is accepted by person as being abnormal and/or unreasonable; (d) the interpersonal situations causing the fear are avoided or been subject to with anguish; (e) the avoidance or distress of the feared situation triggers significant interruption to the person normal workout; (f) worries is not anticipated to other reasons such as material use which is not better explained by another condition.

This diagnosis is considered possible for Joan since it was discovered that, Joan has a persistent fear of dropping control and hence causing humiliation to herself (requirements a); the envision of being in the stress and anxiety leading to situations produces causes symptoms such as nausea, sweating, tightening of the upper body, palpitations, gasping for breathing, dizziness, and feeling of shedding control, similar compared to that described as panic attacks(standards b). Joan accepted that her dread was too extreme from her normal level and for that reason avoided venturing out by itself for a concern with embarrassment (criteria c & d). Hence it caused a significant impact to her regime whereby she discontinued participating classes, ceased jogging and having the ability to independently go to general population places (standards e).

However a spot that maybe used to dismiss this as a provisional analysis is the fact that Joan’s system maybe be credited to her product use (cannabis). If the product use is important or not will need to be assessed. Therefore at this time this prognosis will be considered as a differential identification until other diagnoses can be further evaluated.

Substance – induced panic with anxiety attack. This axis I diagnosis state governments that symptoms which are presented and best referred to as being similar compared to that of anxiety disorders (i. e anxiety attacks), may in fact be caused due to the ingestion or withdrawal of illicit material (Psyweb. com, n. d).

According to First, Frances and Pincus (2002), in order to be diagnosed under this disorder the criteria’s to be attained include; (a) visible anxiety or anxiety attacks are apparent in the client; (b) data in the annals of your client that requirements “a” took place within a month of the client either ingesting the medication or from cessation of drug intake; (c) the disturbance is not more appropriately recognized by an panic that is non-substance induced.

Joan meets this diagnosis standards because she has symptoms which are described as being part of an anxiety attck such as nausea, sweating, tightening up of the upper body, palpitations e. t. c (standards a). Although we are not certain if the anxiety attack happened because of this of her taking cannabis, she’s stated that within four times of halting the cannabis use the symptoms of the panic attack were initiated (criteria b). However at this stage it would be considered that this examination can be dismissed because this prognosis is superseded better by the cultural phobia disorder. The interpersonal phobia disorder was able to justify more standards that directly related to Joan’s record. The symptoms presented by Joan corresponded more regarding problems associated with having the ability to socialize in the public environment and have self self-reliance. Another indicate consider is that the second time Joan experienced this anxiety attack symptom (category demonstration), it was not caused due to not smoking cannabis prior, and therefore it suggests that Joan’s condition is more regarding her social area rather than compound induced. Therefore it is safe to state that requirements “c” has not been met and therefore this medical diagnosis is rejected while sociable phobia is maintained for today’s moment.

Specific phobia (situational type). Similar to a public phobia, specific phobia can be an axix 1 phobia described as the presence of any fear response to a specific subject or situation. The concentration of worries in most cases has minimal threat or none in any way. For the client, the fear can result in feelings of powerful distress causing avoidance of the precise situation or subject (Thobaben, 2004).

According to First, Frances and Pincus (2002), the disorder for situational type is characterised by; (a) having a persistent fear to a situation that can be regarded as being increased or unreasonable anticipated to being in the real feared situation or expectancy of the specific situation; (b) the occurrence of the feared situation incites sense of anxiety shown through symptoms of anxiety attacks; (c) your client determine the fear as being abnormal and/or unreasonable; (d) the specific feared situation is avoided or came across with anguish; (e) the evasion of the precise situation triggers hindrance on track routine of the individual; (f) the phobia is not better accounted for by another mental disorder.

Joan meets these requirements because she specifically stated that she has a specific fear of losing control and therefore embarrassing herself. Predicated on the fact that she avoids public situations predicated on this specific fear, it could be said that she posses a specific phobia of the situational basis (standards a). Joan also states that when this wounderful woman has this specific concern with getting rid of control and humiliating herself, she experienced anxiety attack symptoms of nausea, sweating, tightening up of the breasts, and dizziness (standards b). She has also validated that she considers worries as being high, which pushes her to avoid the precise situation and therefore interrupt her normal regime (standards c, d, e). Similarly to the sociable phobia, at this stage a more accountable diagnosis is not established and therefore this differential analysis has been maintained with the communal phobia for the present moment (conditions f).

Panic disorder with agoraphobia. This disorder can be an axis I disorder that identifies somebody who has a consistent occurrence of panic attack like symptoms. Along with this they also have trouble of either being in a general population environment or encountering another sort of feared situation because they feel break free might be impossible if they have a panic and anxiety attack show (Andrews, 2003).

According to First, Frances and Pincus (2002), to meet the criteria for this disorder it entails meeting requirements for both anxiety attacks and agoraphobia. This is distinguished by reaching the following criteria’s. (a) fits both the following; (1) has at least four repeated and surprising symptoms of an anxiety attck (palpitations, sweating, shortness of breath, choking sensations, breasts distress, nausea, dizziness, concern with losing control, concern with dying, paresthesias, chills or hot flushes) in just a 10 minute time frame; and (2) following panic attack the individual has either (i) got constant worry about further panic attacks, (ii) concerns of the episodes consequences, (iii) modification in behaviour as a result of attack.

Another criterion to meet includes (b) the presence of agoraphobia. This is classified as meeting the following; (1) concern of being in a feared situation because they feel break free might be impossible if indeed they have another anxiety attack; (2) potential situations where in fact the anxiety attack may took place are avoided; (3) the avoidance is not better accounted for by another mental disorder. The ultimate two criteria’s include (c) the panic attacks are not anticipated to substance abuse and (d) the anxiety attacks are not better accounted for by another disorder (First, Frances & Pincus, 2002; Psyweb. com, n. d).

Provisional diagnosis

This medical diagnosis of panic disorder with agoraphobia (DSM IV TR code 300. 21) has been proven as being the provisional prognosis for Joan’s circumstances. Joan fits all these conditions because it has already been ascertained that she’s anxiety attack symptoms and this she has acquired a month of be concerned about recurring problems and its implications (criteria a). She has also showed signals of agoraphobia because she insists sitting down close to the door and avoids situations where she may lose control and so embarrassing herself (conditions b). It was already concluded that the panic attack was not mostly due to material use but due to situational factors (standards c), and that no other disorder can be ascertained that better explains Joan’s symptoms (standards d).

Additionally the differential diagnoses of sociable phobia and specific phobia can be dismissed because anxiety attacks with agoraphobia has accounted for both these differentials. Specifically this provisional prognosis has met certain requirements of communal phobia’s fear of having the ability to interact with her public surrounding scheduled to her panic attack. It has also met certain requirements of the precise phobia’s concern with losing control and disturbing personal in response to a specific subject or situation.