Case Studies

phobia

Hannah, age 55, was in a major car accident 20 years ago during a cross country trip. Ever since, she has been unable to drive on major highways. Although she does drive, she goes to great lengths to travel only on back roads and scenic routes. She is able to go where she wants but it often takes her much longer to get there than it should.

obsessive-compulsive disorder

A 26 year old man is very concerned about cleanliness and hygiene. He spends a significant amount of time each day washing his hands or showering, especially after touch a toilet seat, doorknob, or any other item he thinks may be dirty or contaminated. The patient explains that he is concerned about becoming infected or sick from touching these objects. He periodically acknowledges that the washing is excessive but explains that he becomes very anxious when he tries to avoid washing and eventually feels compelled to wash even more to make up for the omission.

phobia

A 27-year-old, athletic young man has an intense fear of needles. He tries to rationalize his fear by explaining that he is just being cautious and protecting himself from acquired immunodeficiency disease syndrome (AIDS). He realizes that his fear is irrational but is unable to control it. The patient has fainted twice in the past when his blood was drawn during a physical examination. He becomes extremely anxious at the sight of a needle and worries for days before an appointment with his physician or dentist.

obsessive-compulsive disorder

Bert is 40 years old and works on an assembly line in a brush factory. He is terribly afraid of being contaminated by germs. He avoids shaking hands with others. He won't eat in the cafeteria. He has trouble leaving the bathroom because he isn't sure he has washed his hands well enough.

bipolar disorder

You see Jill (age 24) in the emergency room of a hospital where her parents have brought her for evaluation. They are worried because she is giving away all of her possessions and says she is planning to move to Seattle so she can "save the world." Her parents say that she has hardly been sleeping at all, but she seems very energetic. They say she has appeared to be "in a frenzy" lately. When you interview Jill you notice that she speaks very rapidly. It is hard to get her to be quiet long enough for you to ask questions. She seems agitated, and has difficulty sitting still.

depressive disorder

Morris has been referred to you for psychotherapy following a suicide attempt. When you interview him he is very teary. He speaks slowly and looks down at the ground as he speaks. He reports difficulty in falling asleep and staying asleep for the past month. Morris states that he hasn't had much of an appetite and has lost 15 pounds. He reports that things he used to like just don't seem enjoyable anymore, and he thinks that life is not worth living. Morris doesn't expect things to improve in the future, which is why he tried to kill himself.

generalized anxiety disorder

Amy, age 38, is a worrier. She is restless, irritable and has difficulty concentrating. She worries that she worries so much and isn't always sure what it is that she is worried about. She can't let her husband or children leave the house without making them call her regularly to reassure her that they are ok. Her husband is growing weary of her fretting. Her children can't understand what all the fuss is about. Their impatience with her only makes her worry more.

social anxiety disorder

A 28-year-old woman is a rising junior executive in her investment company. Her increasing duties require her to make periodic formal presentations to the senior management of the company. However, she becomes intensely anxious at the thought of speaking in public. When she is forced to give a presentation she begins to feel anxious days in advance of the talk and the anxiety increases as the time for the talk approaches. She is concerned that her anxiety will become noticeable during the talk or that she will do something to embarrass herself.

panic disorder

A 35-year-old clothing salesman was showing a particularly fussy customer a suit 2 months ago and suddenly began to sweat profusely. His heart started to pound, he felt dizzy, and became fearful that he was about to die. The customer didn't notice his condition and continued to question him about the suit in minute detail. The patient, feeling faint, abruptly left the customer and went to lie down in the back of the store. The customer became insulted, complained to the manager, and left. When the manager found the patient he was slumped in a chair in the back room trembling. Approximately 10 minutes later the patient's symptoms began to subside. He saw his physician the next day who found no evidence of any medical problems. Two weeks later, he had another similar unexpected attack. Since that time he has worried continuously about having another attack. His friends and colleagues have noticed that he is no longer as spontaneous and outgoing as he had been in the past.

schizophrenia

Raul believes that the mayor of Chicago, Rahm Emanuel, is trying to kill him. Every time Raul sees a Chicago police officer, he runs away in the opposite direction even though he is not breaking any laws and has no warrants out for his arrest. He also believes that Barack Obama wants him dead, and he carefully examines every airplane that he sees in the sky to make sure it isn't Air Force One. When President Obama does come to Chicago, Raul stays in hiding. Black limousines and men in black suits also scare Raul because he associates them with Rahm Emanuel and President Obama. Raul comes across as "crazy" when he is out in public. He is constantly muttering to himself about random topics that don't make any sense whatsoever. He might be talking about sex one second and then pizza or the Vietnam War the next second. His grammar is fine, but the words just don't add up to anything coherent or meaningful; it's pure gibberish. Those who know Raul say that he is pleasant to be around, despite his unusual behavior. They do say, however, that he isn't very "emotional." In fact, he comes across as very deadpan, despite the outlandishness and intensity of his symptoms. He rarely smiles or frowns; his facial expression appears frozen in a neutral position, and his eyes are expressionless. When he looks people in the eye, he does not show the changes in facial musculature that are typically associated with interpersonal communication. This makes him very difficult to read. Despite his lack of expression, on very rare occasions he has told people that he is actually quite miserable and in a lot of emotional pain—he just doesn't show it. Moreover, there have been times when he has felt quite happy, such as when he had a brief romantic relationship in the shelter one winter. But again, he never expressed this happiness verbally or through facial expressions.