worry at sunsetWe're coming near the end of anxiety disorders to include in these blog questions. If you've been following along from the start, you may be able to get this one by process of elimination. What's left?

Instead of putting the name of the disorder in the title and listing out criteria up top, let's leave some mystery here--especially helpful for folks who find the blog before question-only social media post. (If you're not already following SWTP on Facebook, do!)

A question about this anxiety disorder might look something like this:

A client who has sought help for persistent depressive disorder has recently been experiencing episodes of severe anxiety for the first time in her life. She reports "awful" periods of increased heart rate, "terrified" sweating, and shortness of breath, among other symptoms. "It all comes out of nowhere," she says. The client says her sadness has lessened recently, which she credits in part to "the Wellbutrin kicking in." She hypothesizes that either the depression was masking her anxiety or that revisiting childhood memories in therapy has been having an unwanted negative effect. What is the BEST way to diagnose the client's anxiety symptoms according to DSM-5?

A) Unspecified Anxiety Disorder

B) Substance/Medication-Induced Anxiety Disorder

C) Panic Disorder

D) Persistent Depressive Disorder with Anxious Distress

What do you say?

First of all, the client is nicely psychologically minded. Those are good, psychodynamic hypotheses! But they're not in the answer choices.

Let's narrow down. Persistent depressive disorder with anxious distress? Maybe. But take a look at the "with anxious distress" specifier in the DSM. These are the symptoms:

1. Feeling keyed up or tense

2. Feeling unusually restless

3. Difficulty concentrating because of worry

4. Fear that something awful may happen

5. Feeling that the individual might lose control of himself or herself

Two of these are required "during a majority of days" to tack the specifier onto MDD or persistent depressive disorder. But what the client in the question describes isn't these. It isn't anxious distress, it sounds more like panic. We move on.

Unspecified anxiety disorder is used when the full criteria for another diagnosis aren't met. Also not the case.

So what about panic disorder? Panic is what the client appears to be experiencing. However--and this is a big however--there's something that's very likely triggering the recent panic attacks, the recent start of Wellbutrin. Wellbutrin can exacerbate anxiety symptoms for some. Lots of medications can do that (as, of course, can alcohol and many narcotics). But whether or not you knew that about this medication, you might've noted the mention of the medication in the stem of the item. As a general rule, there's little to nothing included in a question that doesn't hint in some way at the correct answer. The prescription may have helped the client escape dysthymia, but it seems to have brought on panic symptoms. While there's too little information here to make the diagnosis definitive, the best of these answer choices--the one to rule out first--is B) Substance/Medication-Induced Anxiety Disorder.

Make sense? Great!

For reading about the diagnosis try:

For some specifics re Wellbutrin and anxiety:

And for more practice questions about anxiety disorders and a wide range of other material, try our free practice test and sign up for SWTP.

May 17, 2016
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