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DSM5 Clinical Case#3 (Written by: Loes Jongerden, and M

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DSM5 Clinical Case#3

(Written by: Loes Jongerden, and M.A.Susan Bögels, Ph.D.)

Logan was a 12-year-old boy who was referred to mental health care for long-standing anxiety about losing his parents and relatively recent fears about getting a severe disease.

Although his parents described a long history of anxiety, Logan’s acute problem began 5 weeks prior to the consultation, when he watched a television show about rare and fatal diseases. Afterward, he became scared that he might have a hidden disease. His parents reported three “panic attacks” in the prior month, marked by anxiety, dizziness, sweats, and shortness of breath. About that same time, Logan began to complain of frequent headaches and stomachaches. Logan’s own theory was that his bodily aches were caused by his fears about being ill and about his parents going away, but the pain was still uncomfortable. He insisted he was not scared about having more panic attacks but was petri ed about being left sick and alone. These illness fears developed several times a week, usually when Logan was in bed, when he “felt something” in his body, or when he heard about diseases.

Logan had begun to suffer from anxieties as a young child. Kindergarten was notable for intense separation dif culties. He was brie      y bullied in third grade, which led to his rst panic attacks and worsening anxiety. According to his parents, “there always seemed to be a new anxiety.” These included fear of the toilet, the dark, sleeping alone, being alone, and being pestered.

Logan’s most persistent fear revolved around his parents’ safety. He was generally ne when both were at work or at home, but when they were in transit, or anywhere else, he was generally afraid that they would die in an accident. When the parents were late from work or when they tried to go out together or on an errand without him, Logan became frantic, calling and texting incessantly. Logan was predominantly concerned about his mother’s safety, and she had gradually reduced her solo activities to a minimum. As she said, it felt like “he would like to follow me into the toilet.” Logan was less demanding toward his father, who said, “When we comfort him all the time or stay at home, he’ll never become independent.” He indicated that he believed his wife had been too soft and overprotective.

Logan and his family underwent several months of psychotherapy when Logan was age 10. The father said therapy helped his wife become less overprotective, and Logan’s anxiety seemed to improve. She agreed with this assessment, although she said she was not sure what she was supposed to do when her son was panicking whenever she tried to leave the house or whenever he worried about getting a disease.

Logan’s developmental history was otherwise unremarkable. His grades were generally good. His teachers agreed that he was quiet but had several friends and collaborated well with other children. He was quick, however, to negatively interpret the intentions of other children. For example, he tended to be very sensitive to any indication that he was being picked on.

Logan’s family history was pertinent for panic disorder, agoraphobia, and social anxiety disorder (social phobia) in the mother. The maternal grandmother was described as “at least as” anxious as Logan’s mother. The father denied psychiatric illness in his family.

On examination, Logan was a friendly, articulate boy who was cooperative and goal directed. He was generally in a “good mood” but cried when talking about his fears of dying and getting sick. He denied suicidality and hopelessness but indicated he was desperate to get over his problems before starting high school. His cognition was good. His insight and judgment appeared intact except as related to his anxiety issues.