Psychopathology

While watching television one day, Karlene experienced a rush of anxiety, accompanied with a pounding heart, numbness in her fingers and toes, violent shaking and chest pains which left her gasping for air. Thinking she had just experienced a heart attack, she went to the emergency room, but all test results were negative. 5 months later she experienced another episode on her way to work. A third attack occurred 3 weeks thereafter, and soon the attacks picked up in frequency. She soon become so preoccupied with the fear of having an attack that she could not concentrate on her work.

Stacey, a widower, is the owner of a large company. One day she experienced a dizzy spell that lasted for five to ten minutes. She went to the doctor, but all test results were negative. A few months later, she experienced another episode, this time she went to the doctor’s office accompanied by her housekeeper since she was now afraid of having an episode while she was alone in public. She has now changed her daily pattern of traveling, as she is escorted to a limousine by her housekeeper, driven to work, and is escorted to her office by two of her workers. She does not go to the bathroom alone, is escorted by her secretary, and pays additional employees to accompany her to functions at all times.

Gary is a 27 year old married electrician. For the past year he has been complaining of dizziness, sweaty palms, heart palpitations and ringing in his ears. He has also experienced dry throat and a constant edgy and watchful feeling that often interfered with his ability to concentrate. He reports always feeling like something is going to go wrong, like he is going to get fired, and like his wife is going to leave him. Because of these symptoms, he has seen a neurologist, neurosurgeon, chiropractor and an ENT specialist. He was initially told that he might have an inner ear problem before being referred to a therapist. Upon meeting the therapist, Gary discusses his immense anxiety over pleasing his wife’s family ever since their three month whirlwind courtship and marriage.

Maria lost her job after working there for 15 years and now can’t afford to pay her mortgage. She’s constantly crying and doesn’t want to get out of bed. Her family calls and she doesn’t pick up and won’t leave the house or answer the door. She feels worthless and is not motivated to get a job.

Danny can’t hold a job because of his inconsistency at work. Some days he’s energetic and cheerful and other days he feels sad, worthless and doesn’t want to get out of bed. During his energetic days, Danny is able to work for days at a time with no sleep and gets a lot of work done. One down side is that Danny often submits work with significant errors due to his frantic pace and sense of urgency. When he is feeling sad, Danny can't motivate himself to go to work and often feels like there's no point working because he can never do anything right anyway.

For the past 3 years Stacy has become a shut-in. She has been in despair about her life and doesn’t see any possibilities of it getting any better. She feels down, unmotivated, and lonely most of the time for these past 3 years and feels that her mood never really gets better.

Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small video cameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveillance photos of him that were being reviewed by the CIA". After about a year Jack quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the store and even in his own home.

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.

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.

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.

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.

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.

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.

A 28-year-old white man, who has no prior history of psychiatric illness, receives a very prestigious, and unexpected, promotion at work. He feels that a colleague of his was more deserving. He becomes convinced that this colleague is envious of his promotion and that the colleague is therefore planning to sabotage him. His fears generalize to all his coworkers and he begins to avoid work because of his paranoia. After 2 weeks of this behavior, he makes a request to his boss to have the locks in his office changed, as he is certain that his coworkers are planning to steal his files in order to get him into trouble. His boss recommends that he seek medical attention. He does so, and is treated with an antipsychotic drug. His symptoms resolve within 1 week and he is able to function at work again without feeling paranoid.

Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small videocameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveilance photos of him that were being reviewed by the CIA". After about a year Jack quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the store and even in his own home.