Your client reports occasional "freak outs" during which she experiences:
4. Shortness of breath
5. Choking feelings
6. Chest pain
11. Feelings of unreality
12. Fear of going crazy
13. Fear of dying
What's she experiencing? That's a panic attack. What's the diagnosis? It's very likely panic disorder. This imaginary client is symptoms in every one of the thirteen categories of symptoms that make up a panic attack. (She only needed to have four to meet initial criteria for a panic disorder diagnosis.) It's as if she entered your office to help you prepare for the ASWB exam. Thanks, client!
In order to fully meet panic disorder criteria, a panic attack needs to be follow by a month or more of either 1) persistent worry about additional panic attacks or 2) significant maladaptive change in behavior related to the attacks (avoidance bx, that is). Also, as with every last diagnosis, panic disorder can only be diagnosed if it's not better explained by substance use or a medical condition. So watch out for an exam question like this:
A client reports a series of panic attacks during which he experiences an accelerated heart rate, shaking, a sensation of being smothered, and heat sensations. He worries "all the time" about future panic attacks and has stopped dating for fear of a panic attack occurring in the middle of a date. What should the social worker do FIRST to help this client?
Before looking at the answers, think of what yours would be. That's generally a good approach to studying, unless you're pressed for time (e.g., in timed mode on a practice exam). What answers might you expect to see as A-D? Maybe these:
A) Diagnose the client with panic disorder
B) Provide psychoeducation about panic attacks
C) Refer client for a medical evaluation
D) Introduce cognitive behavioral techniques for reducing panic.
What do you say? We're in a diagnostic blog post, so the diagnostic answer is tempting. But it's premature to diagnose the client. First things first: rule out an underlying medical condition that may be causing the client's panic-attacky symptoms (the client's symptoms are just about all the ones left of the DSM list of thirteen above) . The client saying he's having panic attacks doesn't mean that's necessarily what's really going on. He should get a clean bill of health, then receive the diagnosis, then the psychoed and CBT. This simple order of operations--rule outs first!--will help get you through many a social work exam item.
Before moving on to helpful links, there's one more thing to note for the diagnosis: Culture-specific symptoms are sometimes seen. The DSM-5 lists tinnitus, headaches, and "uncontrollable screaming or crying" among them. They count too.
Okay, now some helpful links:
For more exam prep re panic disorder and lots more, try SWTP's full-length practice tests. Sign up to get started!
[Post by Will Baum, LCSW]
April 7, 2016