Student

Diagnosis:

DSM-IV Axis I 309.81 Post Traumatic Stress Disorder

309.21 Separation Anxiety Disorder R/O

Axis II No Diagnosis

Axis III No Diagnosis

Axis IV Grandmother passed away last month

Axis V GAF = 71 (current)

Signs and Symptoms of PTSD and Separation Anxiety Disorder

According to The DSM-IV (2000) Post Traumatic Stress Disorder (PTSD) develops following exposure to an extreme traumatic stressor involving direct personal experience, witnessing, or learning of an unexpected or violent death, serious harm, injury, or threat of death or injury of a close family member or other close associate. "The person's response to the event involves intense fear, helplessness, or horror (DSM-IV, 2000, p. 463)." The traumatic event can be relived in numerous ways. Some examples include, recurrent troubling dreams, flashbacks, "intense psychological distress, or physiological reactivity at exposure to cues that symbolize or resemble an aspect of the traumatic event (DSM-IV, 2000, p. 468)." "There is a persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (DSM-IV, 2000, p. 463)." The individual makes purposeful attempts to evade "thoughts, feelings, or conversations about the traumatic event (DSM-IV, 2000, p. 464)." Persons with PTSD often experience increased anxiety or arousal. Symptoms include sleep difficulties, hyper vigilance, exaggerated startled response, irritability, outbursts of anger, or difficulty concentrating or completing tasks (DSM,-IV, 2000, p. 464).

Children may experience PTSD slightly different than adults. Their response is usually classified by disorganized or agitated behavior. According to Robert Erk (2004) symptoms of children and adolescents experiencing PTSD include, intellectual impairment, language and communication difficulties, withdrawal, negative self perceptions, depression, fear, shame, guilt, conduct disorders, hyperactivity, enuresis and encopresis, somatization, sleep difficulties/disturbances, and regressive and repetitive play.

According to the DSM-IV (2000), signs and symptoms of Separation Anxiety Disorder include, a child experiencing an increased amount of distress when they are apart from their attachment figure. These children often have the fear of "being lost and never being united with their parents." They may display "clingy" and "shadowing" behaviors. Independent travel is often uncomfortable, and all measures to avoid doing so may be taken by the child. Children may be hesitant to participate in social settings, i.e. going to school, camp, or hanging out with friends. Bedtime can be especially difficult for these children. Many of these children experience nightmares in which the content is a depiction of the child's worries. These children often end up sleeping in their parents room (or the significant attachment figure), or right outside of the room if access is denied. Children may also complain of physical ailments, i.e. headaches, stomachaches, vomiting, and nausea.

Anna is an eight year old girl, whose teachers have reported that she is acting spacey, she's forgetting things, and is being distracted. Anna has been fidgeting and talking to her peers, and is also getting out of her seat at inappropriate times. Anna's previous two teachers had no recollection of Anna being a behavior problem. They stated that she had been a good student, and was quite popular. Anna's mother and father reported different types of behavior at home. They stated that Anna has been irritable and jumpy and has been protesting when father has dropped her off at school, saying that she hates school, is worried that no one will pick her up from school, and that she has a headache and a tummy ache. The family also reported that recently Anna has awakened at night, two or three times per week and climbed into bed with her parents, complaining of bad dreams. In regards to Anna's family background, she has no siblings, and she belongs to a large extended family where all four grandparents were alive until her maternal grandmother passed away last month.

In reading the above background information on Anna there is direct correlation between the recent loss of her grandmother, and her current exhibited behaviors. In short, Anna is suffering from PTSD due to the death of her grandmother. As a result the disturbance has caused considerable intellectual impairment. Anna's reported behaviors of spaciness, forgetfulness, distractibility, irritability, jumpiness, and sleep difficulties, are all symptoms of increased arousal. Anna's sudden hate for school can be symptomatic of a numbing of general responsiveness, including a "markedly diminished interest of participation in significant activities (DSM-IV, 2000, p. 468)." Anna's physical symptoms (headache, stomachaches) are symptomatic of PTSD found mostly in children. While Anna's fidgeting, talking to her peers, and getting out of her seat at inappropriate times, are all symptoms of Attention Deficit Hyperactivity Disorder; she does not meet enough of the criteria to be diagnosed as such. These behaviors are better accounted for with a PTSD diagnosis, which according to Robert Erk hyperactive behaviors are common in traumatized children. Lastly, it has been noted in the DSM-IV (2000) that symptoms of PTSD usually begin within the first three months following the traumatic event. The assumed traumatic event in Anna's life happened one month ago. Her exhibited behaviors became noticeable both at school and at home within that time frame.

As a result of the above information Anna's behaviors are not better accounted for under any other anxiety disorder. For example, Anna does exhibit some symptoms of Generalized Anxiety Disorder such as anxiety and worry, restlessness or feeling keyed up, sleep disturbance, difficulty concentrating, irritability etc, yet these symptoms have not been present for a period of at least six months. In addition to Generalized Anxiety Disorder, Anna also exhibits symptoms of Adjustment disorder with anxiety. This disorder results from a response to "an identifiable stressor or stressors that result in the development of clinically significant emotional or behavioral symptoms (DSM-IV, 2000, p. 680)." The Anxiety subtype is used when "the predominant symptoms such as nervousness, worry, or jitteriness, or in children, fears of separation from major attachment figure are displayed