Examples Of Reason For Referral

Reason for Referral

The major precipitating reason the client, Carol has come into treatment is that she has been experiencing extreme anxiety and worry to the point it has affected her life. Carol was once very successful and confident but she is now full of anxiety and cannot function in her daily life the way she used to. A little over a year ago, Carol was involved in a serious car accident involving a four-car pile-up. She ended up requiring several operations, spent over a month in hospital recovering from her surgeries, and was off another four months to recover physically and emotionally from the accident. Unfortunately, Carol never seemed to recover fully. She has had problems both in her personal and professional life, and recently
When she does drive, she describes feeling her heart racing, sweating, shaking, and is worried and terrified that she would get into another accident. She decided to try taking public transit in an attempt to eliminate all the anxiety and fear of getting in her car, but while she no longer had to worry about driving, she found she still worried about everything else. She is afraid to go out and run basic errands, and she is concerned over her finances even though she earns a good income. The thought of social activities became a chore because she worried about everything from getting a table, finding something on the menu she liked and, of course, the thought of driving anywhere was frightening.

I am considering two possibilities for a diagnosis. The first would be Post-traumatic Stress Disorder (PTSD) and the second, Generalized Anxiety Disorder (GAD).

For PTSD, I identified the following criteria to meet the diagnosis as stipulated in the DSM- 5:
A. Exposed to a traumatic event from which she was seriously injured,
B. Physiological reaction to external cues associated with the event, (driving she experiences sweating, shaking, heart racing)
C. Avoidance of stimuli associated with the event (deciding not to drive anymore),
D. Negative cognitions and mood after event. Must have at least two identified, which were
4. negative emotional state (constant fear/worry/heightened
Carol described herself as a shy and quite child and noted that her parents had high expectations for her and her younger sister, such as maintaining good grades, being neat and tidy. Her mother stayed home to raise the girls and her father was a business executive who was hard working and a perfectionist. He had hoped the girls would follow his example and carol conformed to his expectation. Carol did note that she suffered from separation anxiety entering kindergarten, but overcame this and he did well in school both academically and socially, going on to university, graduate school and becoming a well-established finance manager. Her personality type describes a person who may be reactive, sensitive, and easily excitable in the presence of stress. Her cognitive patterns show that she is very meticulous and controlled, and has high expectations of herself. The accident would have affected her perceived sense of control over her environment, affecting her thoughts, beliefs, and perceptions about her abilities to control her environment, possibly playing a key role in developing the