I need help with a diagnosing a case study using the DSM5. I need a primary diagnosis, and secondary's, and rationale as to why the diagnosis was given. Any thoughts or ideas would be appreciated.
Here is the case study...
Jim was a nice looking man in his mid-30's. He could trace his shyness to boyhood and his social anxiety to his teenage years. He had married a girl he knew well from high school and had almost no other dating history. He and his wife, Lesley, had three children, two girls and a boy. At our first meeting, Jim was very shy and averted his eyes from me, but he did shake hands, respond, and smile a genuine smile. A few minutes into our session and Jim was noticeably more relaxed. "I've suffered with this anxiety for as long as I can remember", he said. "Even in school, I was backward and didn't know what to say. After I got married, my wife started taking over all of the daily, family responsibilities and I was more than glad to let her."
If there was an appointment to be made, Lesley made it. If there was a parent-teacher conference to go to, Lesley went to it. If Jim had something coming up, Lesley would make all the social arrangements. Even when the family ordered takeout food, it was Lesley who made the call. Jim was simply too afraid and shy.
Indeed, because of his wife, Jim was able to avoid almost all social responsibility - except at his job. It was his job and its responsibilities that brought Jim into treatment.
Years earlier, Jim had worked at a small, locally-owned record and tape store, where he knew the owner and felt a part of the family. The business was slow and manageable and he never found himself on display in front of lines of people. Several years previously, however, the owner had sold his business to a national record chain, and Jim found himself a lower mid-range manager in a national corporation, a position he did not enjoy.
"When I have to call people up to tell them that their order is in," he said, "I know my voice is going to be weak and break, and I will be unable to get my words out. I'll stumble around and choke up....then I'll blurt out the rest of my message so fast I'm afraid they won't understand me. Sometimes I have to repeat myself and that is excruciatingly embarrassing........"
Jim felt great humiliation and embarrassment about this afterwards: he couldn't even make a telephone call to a stranger without getting extremely anxious and giving himself away. That was pretty bad!
For years, he has beaten himself up over these issues. What was wrong with him? Why was he so timid and scared? No one else seemed to be like he was. He simply must be crazy! After a day full of this pressure, anxiety and negative thinking, Jim would leave work feeling fatigued, tired, and defeated. Jim reports that he recalls feeling this fatigue and hopelessness as far back as high school. He reports that for as long as he can remember he has felt "down." In fact, he cannot remember the last time he did not feel "down and hopeless." He reports that he thinks these issues have affected his ability to concentrate and held him back first in school and now on his job.
Meanwhile, his wife, being naturally sociable and vocal, continually enabled Jim not to have to deal with any social situations. In restaurants, his wife always ordered. At home, she answered the telephone and made all the calls out. He would tell her things that needed to be done and she would do them. Jim and Leslie enjoyed a good relationship and their family life was the one bright spot in Jim's life.
He had no friends of his own, except for the couples his wife knew from her work. At times when he felt he simply had to go to these social events, Jim was very ill-at-ease, never knew what to say, and felt the silences that occurred in conversation were his fault for being so backward. He knew he made everyone else uncomfortable and ill-at-ease.
Of course, the worst part of all was the anticipatory anxiety Jim felt ahead of time - when he knew he had to perform, do something in public, or even make phone calls from work. The more time he had to worry and stew about these situations, the more anxious, fearful and uncomfortable he felt.
Case Study- Jim
Using DSM 5 non-axial format
Diagnosis: 300.23 Social Anxiety Disorder
Notation: (this is area for psycho-social factors)
Disability Severity: severe as it impedes his marital life and professional life
Medical Conditions: none
Criteria A: Significant anxiety in more than one social setting- in restaurants , ordering food, making telephone calls- stumbles over his words, social ...
269-word dicussion of an expert`s diagnostic impression of Jim's social anxiety.