Panic disorder with agoraphobia case study

CASE STDY

Module/Week 2 Case Study Assignment

Case 1: Panic Disorder

Case Studies in Abnormal Psychology

Gorenstein & Comer, 2015

DSM Application (10 points): List the DSM criteria for Panic Disorder. Next to each criterion, detail the specific symptoms that match.

Dx checklist:

Panic Disorder

1. Unforeseen panic attacks occur repeatedly.

2. One or more of the attacks precedes either of the following symptoms:

a. At least a month of continual concern about having additional attacks.

b. At least one month of dysfunctional behavior changes associated with the attacks (for example, avoiding new expiriences).

Matching Symptoms

1. Unforeseen panic attacks occur repeatedly.

a. Joe had an unforeseen attack while on a plane, while on a routine trip to the store, and also had an increasing amount of attacks in bed during the middle of the night.

2. One or more of the attacks precedes either of the following symptoms:

a. At least a month of continual concern about having additional attacks.

i. The case study describes Joe as having attacks over a course of a few weeks not to include the initial week. Joe first had an attack while on an airplane and then a few days later, suffered an attack in bed at 2 am. Over time, Joe had come to fear the possibility of new attacks and had described this apprehensiveness to his doctor who suggested a psychologist visit.

b. At least one month of dysfunctional behavior changes associated with the attacks (for example, avoiding new expiriences).

i. Joe began to remain in his home, avoiding trips to the store for fear of an another panic attack. At times, he did leave his home with the componay of his wife, however his symptoms only lessened rather than disappeared.

Assessment Questions (6 @ 5 points each):

#1: In the case of “Joe,” what event precipitated his panic attack?

“With a panic attack, there is no external triggering event” (Gorenstrin & Comer, 2015, p. 8). In Joe’s case, he was sitting on an airplane while he panicked, he awoke in the middle of the night and had then had an attack, and then finally had attacks if he left his home to go to the store or for a walk. But none of these things have anything in common and do not suggest causality.

#2: Why is Joe’s case different from most panic attacks?

Joe’s case is different in that panic disorder usually begins between late adolescence and the mid-30’s.

#4: Why do individuals first suspect a general medical condition?

People first suspect a medical condition when they have a panic attack because they experience many physical symptoms like a racing heartbeat, dizziness, becoming short of breath, choking sensations, perspiration, and trembling among other physical symptoms. In Joe’s case, his wife thought he was having a heart attack.

#5: Why was Dr. Geller convinced that panic disorders are “best explained by a combination of biological and cognitive factors?”

Dr. Geller believes that panic disorder is caused by biological factors as well as cognitive factors because a panic attack brings about responses in which a person reacts both physiologically and cognitively. They may experience physical symptoms like discomfort in the chest, dizziness, perspiration, and increased heart rate. Some of these symptoms are types of physiological arousal that mirror the fight or flight response however, a person suffering a panic attack is not reacting to real danger, yet the body continues to behave that way anyway. From the physiological aspects of panic attacks come the cognitive factors. The person who is having an attack percievces these physical symptoms to be of real danger and begins to interpret them as such, thus producing more physical symptoms and possibly even more dread or fear.

#7: How did Joe’s avoidance of going outside alone contribute to his panic disorder?

Joe had a panic attack while walking outside to go to the store one day. That panic attack drove him home. In order to prevent having another attack while on the street, Joe avoided leaving the home. Behaviorally speaking, Joe stopped doing X so that Y would not occur again. This concept is known as negative reinforment where a behavior is strengthened by avoiding a negitve outcome. Joe’s avoidance behavior was reinforced because he no longer panicked while walking to the store. But, in doing this anxiety about being outside can develop. This sort of anticipatory anxiety increases the likelihood of another panic attack whether outside or not.

#8: What was the outcome for Joe?

Joe receieved several thereapy sessions with a psychologist who administered CBT and psychoeducation. Other techniques such as exposure tretments and relaxation training were employed as well. For example, Joe practiced muscle relaxation and breathing control. Eventually he was asked to practice these techniques while engaging in activities that preceded previous panic attacks. Over time, his symptoms progressively lessened until he was not having any symptoms or attacks which led him to a state of body and mind control, once again.

Bible Application Question (10 points, 50 word minimum): Discuss this case and disorder from a biblical perspective using at least 1 Scripture reference (direct quotes do not count towards length requirement).

Which comes first? The thoughts or the behavior? According to the case study, Joe had a happy childhood, yet his family did suffer financial problems and Joe had unresolved issues regarding his resulting lack of education. Joe was also a Soldier and an infantryman at that, which implies that he may have saw some combat action and could very well have some lingering psychological issues there. All of these life factors could have contributed to maladaptive thinking which may have produced neuronal changes in the brain over time. This fits with the documented normal age range for the onset of panic disorder.

As cited in Comer (2016), research by Henn (2013) and Bremner and Charney (2010) state that the brain circuit and nuerotransmitters thought to be involved with panic attacks may not function appropriately. One thought toward causality is heredity. Personally, I wonder if maladaptive thoughts have a larger role than the text suggests. Biblically, thoughts and emotion play a huge role in determining health.

Thoughts govern behavior. What can be seen is the most salient component of behavior however, physiology (to include psychophysiology) is behavior as well. Thoughts are crucial to maintaining psychological health. For example, a panic attack leads to fear and other maladaptive thoughts. The Bible may not address panic attacks by name, but it does describe one in Psalm 55:4–8 (NIV) “my heart is in anguish within me; the terrors of death have fallen on me. Fear and trembling have beset me; horror has overwhelmed me. I said, ‘Oh, that I had the wings of a dove! I would fly away and be at rest. I would flee far away and stay in the desert’”.

Fear is the overruling emotion during a panic attack, but it can be the overruling emotion throughout a person’s daily life as well. All this negativity presents further complications in the mind and body. Matthew 6:33 reminds us to seek God and His kingdom first. Phillipians 4:19 says that God will meet all our needs. Matthew 10:28 pleads with us to be rid of fear of such temporal matters and to fear the Lord instead. God reminds us over and over that fear has no room in the heart of a child of God. When that child insists on focusing on these cognitive distortions, his spiritual and psychological health diminish and this is where we see problems like panic disorders. Thoughts should be focused on God, His promises (in this case), and who we are in Christ. 1 John 4:18 tells us that “there is no fear in love. But perfect love drives out fear”. With a focus on Christ, panic attacks have no place in the life of a believer.

References

Comer, R. J. (2016). Fundamentals of abnormal psychology. New York: Worth /Macmillan Learning.

Gorenstein, E. E., & Comer, R. J. (2015). Case studies in abnormal psychology. New York, NY: Worth , a Macmillan Higher EducationCompany.