T Nation

Diagnosis Differential


I jave a diagnosis Differential due on Thursday. Pretty confident I have the answer here...here is the client and my diagnosis. How does it look?

Symptoms/Client History

Erica is a 27 year old woman who has panic attacks that are triggered when she is in various locations that provoke memories of very painful experiences of abuse that occurred when she was a child. What diagnosis(es), if any, should Erica receive?

My Diagnosis

Erica, because she has panic attacks when in various locations could definitely have an Anxiety Disorder. Panic attacks are a sign of an Anxiety Disorder.

Specifically, since her panic attacks bring back painful memories of being abused when she was a child could determine that Erica has PTSD or Posttramatic Stress Disorder. She was exposed to abuse and when she is these certain locations her body remembers what happens and puts her into a hyperawarness mode that the same thing might occur here again. She also recalled certain painful memories and has increased arsoual in these locations because she is able to recall these memories which singals a Panic attack which can point to PTSD.

Erica could also have a Specifc Phobia of the locations where the traumatic events occured. Certainaly she attemtps to avoid these locations, but when she does not her body reacts with a panic attack in those ceratin locations. The panic attacks that occur only occur when she is in the various locations of where she was abused as a child.


With the informatioen that is given to you, it is most likely going to be PTSD (that is if these symptoms are present for longer than a month).

I don't know what the aim of the course is. But going by it's name, I'm going to assume that the diagnostic process of falsifying the differential diagnosises is key. Therefor I think you should let your teacher see that there are other diagnosises to be considered (like a simple panic disorder), but that these are less likely to be the case (because these panic attacks seem to be triggered by specific locations linked to a specific memory, which is not so much the case with a panic disorder). In other words, you seem to have the good answer, but why do you think that other diagnosises are wrong?

You could also look into dissociative disorders (allthough these are less likely).


Wit the traumatic history of Erica I realized that something deeper had to be the cause. Panic attacks with or without agoraphobia have nothing to do with the past experiences, they are random. Specific Phobia does fit, but it leaves out the actual trauma that took place and focuses on the "eventual"trauma that might occur. PTSD is the only of the Disorders that wraps up the past and places it as a cause of attacks.

this class is just cut and dry diagnostics the first part of a prerquisite for my clinical internship (Shadowing) I'm hoping to get next spring


Ya, PTSD is the #1

But, panic disorder, generalized anxiety disorder, social phobia, specific phobia could also be part of your DDx.

Also, less likely, disease such a pheochromocytoma, hyperthyroidism and epilepsy would be worth questionning. Same with asthma and supraventricular paroxystic tachycardia.


I'm looking at PTSD with Specific Phobia

it just seems redundant to add the Specific Phobia in with the PTSD...but a thorough diagnosis is the aim here.

The client has a clean health record

So PTSD with SP it is

thanks alot


adjusts glasses and straightens lapels of labcoat

Very good, gentleman, I concur.

Carry on.


One of the criteria of PTSD (according to the DSM) is avoiding stimuli that in one or the other way could provoke memories abaut the actual trauma. So saying phobia in addition to PTSD is redundant. PTSD covers this already.


Agreed. Unless there's more info about the case than the OP presented, there is no evidence for a specific phobia to be diagnosed here.




I was thinking that originally, but I added the SP to ensure the most thorough answer possible....It really wouldnt matter, as I am going to suggest behavioral means of therapy rather than biochemical for now (no chance of drug sides)

I'm going to suggest a mix of Modeling and Flooding to treat the PTSD as opposed to SSRI's or anti-depressanrs


Spooky, we need to meet in my office. An evaluation of your methods is in order. Bring your labcoat and be prepared to stay overnight.


It could be lupus...



Right on - both methods are efficacious. You could make the argument that a stepped approach like Prolonged Exposure would be preferable to Flooding, but that's definitely nit-picking.


I think she was bit by a vampire and is having flash backs!


This is my final answer 100 perecent correct

This client has panic attacks that are triggered by unusual cues that do not fit the typical cues associated with a diagnosis of Agoraphobia Without History of Panic disorder, Specific Phobia, or Social Phobia. Agoraphobia is anxiety about being in a situation from which escape would be difficult or help would not be readily available if the client experienced panic-like symptoms.

This client's panic attacks are produced by the memories of previous abuse, not the inability to obtain help. The anxiety associated with Specific Phobia is usually triggered by exposure to or anticipation of exposure to a feared object or a situation. In this client's case, any location that stimulates the memories will produce the panic attacks.

Social Phobia requires that the client fear exposure to unfamiliar people or scrutiny by others because he or she may act in a way that is humiliating or embarrassing. None of these cues are applicable to the client's panic attacks. A final possibility is that the client's panic attacks are a symptom of Posttraumatic Stress Disorder. Panic attacks are not specifically defined as a part of this disorder, however, they can fulfill the criteria for "intense psychological distress" at exposure to external cues that symbolize an aspect of the trauma.




ya know, the stepped desensitization would be more subtle than flooding. that approach might be more beneficial to someone with PSTD, thanks for that catch


I've been known to turn a nightmare into a wet dream


as treatment?


yes. and a 2wk script for NO products.