Chief complaint of intense anxiety and fear of driving a car

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A female patient presents to your office with a chief complaint of intense anxiety and fear of driving a car after a history of a serious car accident. Her anxiety is becoming more disruptive and is now affecting all elements of her life. She wont go to the store unless someone else drives her, she quit her job, and she stopped seeing friends. Use textbooks as references and consider the following questions as you post your response: What is one diagnosis that might be appropriate for this patient? What are the DSM 5 criteria for the diagnosis? What evidence in the scenario supports the criteria for that diagnosis? What are two differential diagnoses?

 

Sample Solution

The patient’s symptoms suggest a possible diagnosis of Post-Traumatic Stress Disorder (PTSD).

DSM-5 Criteria for PTSD:

  1. Exposure to actual or threatened death, serious injury, or sexual violence.
  2. Presence of intrusive symptoms, such as flashbacks, nightmares, or distressing memories.
  3. Avoidance behavior, such as avoiding places or situations that remind the individual of the traumatic event.
  4. Negative mood alterations, such as persistent feelings of sadness, anger, or guilt.
  5. Hyperarousal symptoms, such as difficulty sleeping, irritability, or being easily startled.

Evidence Supporting the Diagnosis:

  • Exposure to a traumatic event: The patient’s history of a serious car accident meets the criterion for exposure to a traumatic event.
  • Intrusive symptoms: The patient’s intense anxiety and fear of driving could be considered intrusive symptoms, as they are related to the traumatic event.
  • Avoidance behavior: The patient’s avoidance of driving, stores, and social activities indicates significant avoidance behavior.
  • Negative mood alterations: The patient’s anxiety and distress suggest negative mood alterations.
  • Hyperarousal symptoms: While not explicitly stated, the patient’s anxiety and fear could be indicative of hyperarousal symptoms.

Differential Diagnoses:

  • Panic Disorder: The patient’s symptoms of anxiety and avoidance could also be consistent with panic disorder. However, the specific focus on driving and the clear link to the car accident suggest PTSD as a more likely diagnosis.
  • Specific Phobia: A specific phobia of driving could also be considered. However, the severity of the patient’s symptoms and the impact on her daily life suggest a more generalized anxiety disorder like PTSD.

It is important to conduct a thorough assessment to confirm the diagnosis and rule out other possibilities. The patient may benefit from psychotherapy, medication, or a combination of both treatments to manage her symptoms and improve her quality of life.

 

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