Diagnostic clarity: Re-evaluating a clinical case for social anxiety disorder diagnosis in comorbid presentations
DOI:
https://doi.org/10.64074/pspwa225Keywords:
Social anxiety disorder , Generalised anxiety disorder , Diagnostic clarity , Comorbid anxietyAbstract
Diagnostic clarity plays a vital role in the effective treatment and recovery of individuals with anxiety disorders. Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) frequently co-occur, yet SAD often remains undiagnosed in individuals who are primarily identified with GAD. This oversight can exacerbate the symptoms of both disorders, thus complicating treatment and hindering recovery. This paper explores the impact of missed comorbid diagnoses through a case study of "Rex", an individual initially diagnosed with GAD. Using a qualitative method, this paper draws on personal narratives to examine Rex’s experiences. Findings reveal that Rex’s symptoms align closely with the diagnostic criteria for SAD as outlined in the DSM-5-TR, despite the absence of a formal SAD diagnosis. The analysis highlights how the unrecognised presence of SAD contributed to persistent social avoidance, and the heightening of the symptoms of both disorders, causing functional impairment and poorer treatment outcomes. This paper highlights the importance of comprehensive diagnostic assessments in anxiety disorders, particularly when symptoms of GAD and SAD overlap. It advocates for the implementation of treatment strategies that target social fears in SAD. Furthermore, it was recommended that periodical reassessments become an integral part of care plans to be sure that no evolving or missed symptoms are left uncaptured. By emphasising the significance of diagnostic precision and personalised care, this paper contributes to a more nuanced understanding of anxiety comorbidity and its implications for mental health practice.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing: USA.
Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health services system in the 1990s. Psychososial Rehabilitation Journal, 5(1), 61-65.
Brady, K. T., Haynes, L. F., Hartwell, K. J., & Killeen, T. K. (2013). Substance use disorders and anxiety: a treatment challenge for social workers. Social work in public health, 28(3-4), 407-423.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. Pharmacy and Therapeutics, 38(1), 30.
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184-189.
Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric rehabilitation journal, 19(3), 91.
Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial rehabilitation journal, 11(4), 11.
Fonzo, G. A., Ramsawh, H. J., Flagan, T. M., Sullivan, S. G., Letamendi, A., Simmons, A. N., ... & Stein, M. B. (2015). Common and disorder-specific neural responses to emotional faces in generalised anxiety, social anxiety and panic disorders. The British Journal of Psychiatry, 206(3), 206-215.
Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in context, 8, 212573.
Leichsenring, F., & Leweke, F. (2017). Social anxiety disorder. New England Journal of Medicine, 376(23), 2255-2264.
Llewellyn-Beardsley, J., Rennick-Egglestone, S., Callard, F., Crawford, P., Farkas, M., Hui, A., ... & Slade, M. (2019). Characteristics of mental health recovery narratives: systematic review and narrative synthesis. PloS one, 14(3), e0214678.
McHugh, R. K. (2015). Treatment of co-occurring anxiety disorders and substance use disorders. Harvard review of psychiatry, 23(2), 99-111.
Mennin, D. S., Heimberg, R. G., & Jack, M. S. (2000). Comorbid generalized anxiety disorder in primary social phobia: symptom severity, functional impairment, and treatment response. Journal of Anxiety disorders, 14(4), 325-343.
Nutt, D., Argyropoulos, S., Hood, S., & Potokar, J. (2006). Generalized anxiety disorder: A comorbid disease. European neuropsychopharmacology, 16, S109-S118.
Robertson, S., Carpenter, D., Donovan-Hall, M., & Bartlett, R. (2020). Using lived experience to develop a personal narrative workshop programme in order to aid mental health recovery. Journal of Mental Health, 29(4), 483-491.
Rowa, K., Waechter, S., Hood, H. K., & Antony, M. M. (2017). Generalized anxiety disorder. Psychopathology: History, Diagnosis, and Empirical Foundations, Third Edition, 149-186.
Smith, J. P., & Book, S. W. (2008). Anxiety and substance use disorders: A review. The Psychiatric Times, 25(10), 19.
Stein, D. J. (2001). Comorbidity in generalized anxiety disorder: impact and implications. Journal of Clinical Psychiatry, 62, 29-36.
Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068.
Zbozinek, T. D., Rose, R. D., Wolitzky‐Taylor, K. B., Sherbourne, C., Sullivan, G., Stein, M. B., ... & Craske, M. G. (2012). Diagnostic overlap of generalized anxiety disorder and major depressive disorder in a primary care sample. Depression and anxiety, 29(12), 1065-1071.
