Piglet: Generalized Anxiety Disorder

Client: Piglet

Background Information: Piglet is a young male pig from the Winnie the Pooh Series by A. A. Milne.  Piglet is not currently employed and resides in the Hundred Acre Wood.  Piglet lives alone in a home that, according to Piglet, once belonged to his grandfather, "Trespassers William".  His housing is stable and the house is well cared for.  Piglet does not have any physical health problems.  Piglet's goal is to become brave and be not so timid. 

Description of Problem: Piglet is very timid and displays frequent and severe characteristics of anxiety and nervousness.  Piglet stresses and worries that any situation can go wrong and dwells on what he will need to do if everything does go wrong.  For example, in conversation with his best friend Pooh Bear, Piglet asked, "Supposing a tree fell down, Pooh, when we were underneath it?".  Piglet is afraid of the dark and the wind.  He also has an unrealistic fear of heffalumps and woozles.  Some of Piglet's other worries include, being abandoned and his small size.  Piglet frequently gets flustered during conversations and stutters when he talks. 

Diagnosis: 300.02 Generalized Anxiety Disorder

A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities.  

Piglet meets the duration criteria as he has had excessive anxiety and worry (apprehensive expectation) for his whole life.  

B.  The person finds it difficult to control the worry.

Piglet is unable to control his worries and feel like he constantly lives under the weight of his anxieties.  Piglet frequently discusses his fears with his friends and he wishes that he was brave. 

C.  The anxiety and worry are associated with three (or more) of the following six symptoms.

1. Restlessness or feeling keyed up or on edge
Piglet frequently shows signs of restlessness and being on edge as he is frequently startled.   Piglet becomes agitated and anxious when he leaves his house because he believes something will always go wrong.  In stressful situations, Piglet's anxiety levels tend to elevate and worsen.

2. Being easily fatigued 

3. Difficulty concentrating or mind going blank
Piglet has difficulty concentrating when listening to others speak.  Piglet's thoughts often race and jump from one bad scenario to another with little control over the anxious thoughts. 

4. Irritability

5. Muscle tension
When Piglet is anxious or afraid he displays symptoms of autonomic hyper-arousal, such as rapid heart beat and shortness of breath, accompanied by muscle tension.  

6. Sleep disturbances (difficulty falling or staying asleep, or restless unsatisfying sleep)
Piglet has difficulty falling asleep as he is afraid of the dark and will frequently hide under the covers when he is anxious.  Piglet frequently has nightmares and restless sleep where he wakes up feeling tired. 

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder.
Piglet's anxiety and worry are not a result of panic disorder, social phobia, obsessive-compulsive disorder, separation anxiety disorder, anorexia nervosa, somatization disorder, hypocondriasis, or related to PTSD.  

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  
Piglet's anxiety causes him clinically significant distress.  Piglet's anxiety and worry are debilitating and distressing for Piglet because he spends a significant amount of time dwelling on and preparing for worst case scenarios.  Piglet's anxiety impairs his social functioning.  For example, Piglet's fear of the wind prevents him from leaving his house to see his friends.  

F. The disturbance is not due to the direct psychological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.
Piglet does not use drugs and is not on any medications.  Piglet does not have any medical conditions.

Strengths: A strength of Piglet's is that despite his overwhelming anxiety he often pushes through his fears to rescue his friends.  Piglet shows considerable resilience.  Piglet has a great support network of friends who live in the same neighborhood, especially his best friend Pooh Bear.  Another strength of Piglet's is that he is open to talking with his friends about his fears and anxieties.  Piglet frequently uses positive self talk to encourage himself to face his fears and to calm himself down when anxious.

Treatment Plan: Cognitive Behavioral Therapy (CBT) is an evidence-based approach that is effective for treating generalized anxiety disorder.  Piglet  has shown previous success with cognitive techniques.   For example, Piglet asked "Supposing a tree fell down, Pooh, when we were underneath it?".  Pooh carefully thought and then replied, "Supposing it didn't" and Piglet was comforted by this.  CBT could help Piglet learn to monitor his anxiety symptoms and to recognize his negative thought patterns.  Through cognitive restructuring, Piglet could learn to challenge and replace the negative thoughts that contribute to his anxiety.  Piglet could benefit from learning relaxation techniques and breathing exercises to reduce tension and help him learn how to relax during stressful situations. 

Winnie the Pooh Series by A. A. Milne

Winnie the Pooh Series by A. A. Milne

Winnie the Pooh Series by A. A. Milne

Winnie the Pooh Series by A. A. Milne

The Power of a Single Smile

There is construction on a road near my home and I pass through it everyday on my way to work in my tiny blue car.  The road is a side street with connecting apartment complexes so they cannot not shut it down completely.  One elderly man's job is to hold up a sign that says "slow" and then turn it around to say "stop" if a bulldozer or other large truck needs to cross from one side of the road to the other.  I took notice of him because he always has a huge smile on his face as he waves or nods to the passing cars.  The thing that made me notice him was how joyful he was and that he wanted to share his joy with others. 

One day he waved to me and I smiled and waved back.  I started waving to him each time I saw him.  And one morning as he waved back at tipped his construction helmet down in a gentlemanly manner. I giggled and waved back.  Maybe he was starting to remember me? 

 This had been going on for a few weeks.  It puts me in a good mood as I am  stuck in traffic behind other cars waiting to drive through the construction area.  

This morning as I approached the corner that my elderly friend usually stands on holding up his red "slow" sign I noticed he held a second sign made out of cardboard that said " good morning little blue car!".  I couldn't believe it!   He made me a sign.

I wish I could have taken a picture or thanked him more than just waving and smiling one of my brightest smiles back, but I had to drive past with the flow of traffic. 

This situation made me think about just how important connections with our fellow humans are and the impact we can have on each other.  One of the core principles of social work is understanding the value and importance of human relationships.  Kindness and a smile can really go a long way. 

Review of DSM Textbook Tabs and Tips!

So I decided to purchase the DSM Textbook Tabs in order to help me quickly find specific disorders.  Here is my honest review and feedback.  I will also include some helpful tips in case you also buy these DSM IV-TR tabs.

I purchased the DSM Textbook Tabs from Amazon.com.  The price was $9.95 for the tabs and $3.99 for standard shipping + tax.  I received them five days after purchasing them.  I figured $15 was a good investment to help me feel more organized and simplify the almost 1000 page DSM IV-TR.

The tabs come on 4 separate sheets which act as a guide to place the tabs in the right place.  The instructions say to fold the perforated top edge of the sheet and hold this over the top of the book.  Also, make sure you push the left side of the sheet all the way into the spine.  You take off the tab and line it up with the correct color next to it.  Make sure you are on the right page number!  I got too enthusiastic at first and forgot to switch to the next page number, but I was able to take the tab off and put it on the right page without tearing the book. 




One issue I ran into was the sticky part of the tab sometimes ripped off if  I peeled the tab too fast or from an angle.  I found that the best way to peel off the tab was to pull it straight back to the left .  Once I started pulling the tabs off this way none of them ripped.  I also recommend holding down the top perforated edge to make sure you are placing the tabs in the right place.  Without holding the sheet down the sheet does not stay in place.    




The most challenge part was putting on the tabs at the end of the book with sheet number four.  I could no longer just lay the book on the floor to put the tabs on because the perforated top edge was hitting the floor and not staying aligned.  In order to fix this problem I held the back of the book up and also held the sheet in place when placing the tabs on the page.  This made it much easier!




Overall, it took me about 30 minutes to put all the tabs on, but I was being extra careful.  I love the colors and the way the different disorders are organized.  I am really glad I decided to buy the tabs and I'm sure they will come in handy!  As an added bonus, putting the tabs on was a good review of all the disorders!

 

The website for the DSM Textbook Tabs system is www.dsmtextbooktabs.com ( I think the website is currently under construction). 

*** I am not affiliated with this company.  Everything mentioned are my honest thoughts and opinions!

Treating Yourself

Life can get a bit crazy with work, school, family, and working toward achieving your dreams.  Sometimes we can get so wrapped up in the craziness of life that we forget to think about ourselves.  When I am stressed sometimes treating myself to something small like a new dress can make a world of difference.

Treating oneself doesn't even have to involve spending money or purchasing something new.  A great way to treat yourself could be to go for a walk, read a fun book, spend some time away from your desk, or stopping to look at the sunset.  Someone once told me that a sunset is a free painting available to you everyday.  That really stuck with me and when I see the sunset while I am driving home from a long day I try to remember to take even a few minutes for self care before life gets busy again.

Eeyore: Dysthymic Disorder

Client: Eeyore

Background Information: Eeyore is an older grey donkey from the Winnie the Pooh Series by A. A. Milne.  There is no documentation on Eeyore's exact age or demographic information.  Eeyore is not currently employed.  Eeyore lives in the southeast corner of the Hundred Acre Wood in "Eeyore's Gloomy Place: Rather Boggy and Sad".  His housing is stable, but in poor condition as it regularly gets knocked down.  Eeyore is in general good health, but appears slightly underweight and often loses his tail.  Eeyore's posture is frequently in a slumped position and his eyes appear downcast and droopy.

Description of Problem: Eeyore has indicated that he has felt depressed for as long as he can remember. Eeyore has reported feeling a lack of interest in the activities his friends are engaging in.  Eeyore has low self esteem and is often tired or fatigued.  Eeyore often makes self-deprecating comments about his unimportance.  For example Eeyore is frequently saying "Thanks for noticing me".  Eeyore has a relatively hopeless outlook on life.  As reported by Pooh, after Pooh said good morning to Eeyore,  Eeyore gloomily responded by saying, "Good morning Pooh Bear.  If it is a good morning, which I doubt".  Eeyore has reported feeling that his close friends do not need him.

Diagnosis: Dysthymic Disorder 300.4

A.  Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years.  

B. Presence, while depressed, of two (or more) of the following:
 1.  poor appetite or overeating
 2.  insomnia or hypersomnia
 3.  low energy or fatigue
 4.  low self-esteem
 5.  poor concentration or difficulty making deciions
 6. feelings of hopelessness

C. During the 2-year period of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
 Eeyore has reported always feeling sad or in a depressed mood.  For example, Eeyore stated that he tries to force a smile, a real smile has not existed in a long time.  Per Eeyore and observations by his friends, Eeyore has never been without symptoms for more than a 2 month period.  

D. No Major Depressive Episode has been present during the first 2 years of the disturbance i.e., the disturbance is not better accounted for by Chronic Major Depressive Disorder, Major Depressive Disorder or in Partial Remission.
 The criteria of Dysthymia are met due to the amount of time that Eeyore has experienced these depressed symptoms.

E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
Eeyore has never had a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
 
F.  The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
Eeyore shows no symptoms of chronic Psychotic Disorder such as Schizophrenia or Delusional Disorder. 

G.  The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.
Eeyore is not currently taking any medications or drugs.  

H.  The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  
Eeyore's symptoms have significantly impaired his social relationships with his peers and friends.  Eeyore shows little interest in social engagements and isolates himself for long periods of time. 

Strengths:  A strength of Eeyore's is that he continually tries to find some form of pleasure in life. Additionally, Eeyore has shown previous resiliency in past incidences when he has lost his tail or been in a conflict with his friends.  A coping mechanism of Eeyore's is to sit by himself and "cloud paint" or to be in the company of his friends.  Eeyore has a good support system in his friends who live in his neighborhood, in particular Pooh, Christopher Robin, Owl, and Piglet.

DSM IV-TR Diagnosis Exercises Disclaimer

I am currently taking a psychosocial pathology class where we are learning how to use the Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM IV-TR).  In order to help teach myself the numerous different disorder and to have a little nerdy fun I am going to try to diagnose different popular, fictional characters from cartoons, books, and movies.  This is meant to help me practice the identification and classification of mental disorders and is no way meant to insult or infringe on the right of the characters I select.  This is also not meant to be viewed as official diagnoses of any kind, but for educational purposes only.

La Petite Social Worker

I am a social work student, currently working on my Masters in Social Work. The world is a big place and I am just one social worker, but I have big dreams to make the world a more beautiful and peaceful place. A world where diversity is celebrated, where social justice is woven into the fabric of society, and where everyone’s voice is not only heard, but listened to and valued.

This blog is to help me record and process my journey as a forever student of the world.