Diagnosis
Based on the provided scenario, one appropriate diagnosis for this patient is Post-Traumatic Stress Disorder (PTSD), particularly given her history of a serious car accident that has led to significant anxiety and lifestyle changes.
DSM-5 Criteria for PTSD
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the criteria for diagnosing PTSD include:
1. Exposure to a traumatic event: Direct exposure to a traumatic event, witnessing the event, learning that the event occurred to a close family member or friend, or experiencing repeated or extreme exposure to aversive details of the traumatic incident.
2. Intrusive symptoms: The presence of one or more intrusive symptoms associated with the traumatic event, such as:
– Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
– Recurrent distressing dreams related to the event.
– Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event were recurring.
– Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
– Marked physiological reactions to reminders of the traumatic event.
3. Avoidance: Persistent avoidance of stimuli associated with the traumatic event, as evidenced by one or both of the following:
– Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
– Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about the traumatic event.
4. Negative alterations in cognitions and mood: Negative alterations in cognitions and mood associated with the traumatic event, as evidenced by two or more of the following:
– Inability to remember an important aspect of the traumatic event.
– Persistent and exaggerated negative beliefs or expectations about oneself or others.
– Persistent distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame themselves or others.
– Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
– Markedly diminished interest or participation in significant activities.
– Feelings of detachment or estrangement from others.
– Persistent inability to experience positive emotions.
5. Alterations in arousal and reactivity: Alterations in arousal and reactivity associated with the traumatic event, as evidenced by two or more of the following:
– Irritable behavior and angry outbursts.
– Reckless or self-destructive behavior.
– Hypervigilance.
– Exaggerated startle response.
– Problems with concentration.
– Sleep disturbance.
6. Duration: The duration of these symptoms is more than one month.
7. Functional significance: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
8. Exclusion: The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Evidence Supporting PTSD Diagnosis
In this case, several elements in the scenario support a diagnosis of PTSD:
– Exposure to a Traumatic Event: The patient has a history of a serious car accident.
– Intrusive Symptoms: Although not explicitly mentioned, her intense anxiety and fear may suggest she experiences intrusive thoughts related to the accident.
– Avoidance Behavior: The patient avoids driving and needs someone else to drive her to stores, indicating avoidance of reminders of the trauma.
– Negative Alterations in Cognition/Mood: The patient’s anxiety is severe enough to affect her job and social life significantly.
Differential Diagnoses
Two possible differential diagnoses for this patient could include:
1. Acute Stress Disorder (ASD): Similar to PTSD but occurs within three days to one month following a traumatic event.
2. Specific Phobia: A marked fear or anxiety about a specific object or situation (in this case, driving).
Questions for Differential Diagnosis
To help determine if the patient meets criteria for one of the differential diagnoses (e.g., Specific Phobia), I would ask:
1. Can you describe your feelings when you think about driving? This question aims to assess whether her anxiety is specifically linked to driving (characteristic of a phobia) rather than broader PTSD symptoms.
2. Have you experienced these symptoms since the accident, or did they develop later? This question helps clarify whether her symptoms align more closely with ASD (which develops shortly after a trauma) versus PTSD.
3. Are there specific situations related to driving that you can tolerate without intense fear? This question assesses whether there are any exceptions to her avoidance behavior and helps gauge whether her fear meets the criteria for a specific phobia.
