Providing Diagnoses

Original discussion board. There are three possible diagnoses in this scenario.  Can you identify them?  Discuss. Nadine was a 15-year-old girl whose mother brought her for a psychiatric evaluation to help her with long-standing shyness. Although Nadine was initially reluctant to say much about herself, she said she felt constantly tense. She was generally unable to speak in any situation outside of her home or school classes. She refused to leave her house alone for fear of being forced to interact with someone. She was especially anxious around other teenagers, but she also became “too nervous” to speak to adult neighbors she had known for years. She said it felt impossible to walk into a restaurant and order from “a stranger at the counter” for fear of being humiliated. Nadine also felt she constantly was on her guard, needing to avoid the possibility of getting attacked. She was the most confident when she was alone in her room. From seventh grade to ninth grade, Nadine’s peers turned on her. The bullying was daily and included intense name-calling (for example – “stupid,” “ugly,” “crazy”) and physical threats. One girl (the ringleader) had been Nadine’s good friend in elementary school, but hit her and gave her a black eye. Nadine did not fight back. She refused to tell her parents what happened but cried herself to sleep at night. Nadine transferred to a specialty arts high school for ninth grade. Even though the bullying ended, she could not make friends. Nadine felt even more unable to venture into new places. She felt increasingly self-conscious that she could not do as much on her own. Nadine was even scared to read a book by herself in a local, public park. She had nightmares about the bullies in her old school. She spent whole weekends “trapped” in her home. respond classmate 1: From what we’ve been told about Nadine, she is suffering from paranoia, anxiety, and Post Traumatic Stress Disorder (PTSD). Nadine is experiencing paranoia because she is afraid to speak to strangers to order food or just about anyone outside of her own home. She believes that she may get attacked or ridiculed. This leads to the anxiety of always watching over her shoulder and being fearful of others around her. She is suffering from PTSD because she was tormented for years by whom she thought were her friends. Now, she can’t read a book in public, has a lack of confidence, and endures nightmares consistently to the point where she’s not even free in her own home. respond classmate 2: If I had to choose three diagnoses to diagnosis Nadine with the first one that I would choose is 313.23 which is selective mutism. Selective mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in select social settings, such as school. These children are able to speak communicate in a setting where they are comfortable, secure, and relaxed. In the scenario, it stated that Nadine was unable to speak in any situation outside of her home and school classes. The second diagnosis that I will diagnose Nadine with is 300.23 which is Social Anxiety Disorder (social phobia). According to DSM-5 book, this disorder sometimes emerges out of a childhood history of social inhibition or shyness in U.S. and European studies. The onset of social anxiety disorder may follow a stressful or humiliating experience (e.g., being bullied, vomiting during a public speech), or it may be insidious, developing slowly. The last and final diagnosis is 300.22- Agoraphobia. In the scenario, it stated that Nadine was scared to read a book by herself in a local, public park.  This diagnostic criterion is a fear or anxiety about two or more of the following five situations, using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd and being outside of the home alone. These are the three possible diagnoses that I would diagnose Nadine with for her current symptoms. In my opinion, Selective Mutism diagnose would be my first choice.