Ka-Sean is a 25-year-old African American lesbian who lives with her partner in an apartment outside a large city. She is currently enrolled in a counseling graduate program. Ka-Sean is the youngest of three children; she has one older brother and one older sister. She has not talked with her brother for a number of years; this coincided with his verbal opposition to her moving in with her female partner. Her support system is primarily her partner, her older sister, and her father. She regularly attends a local church and has a number of friends who are spread across the country.

Ka-Sean is a 25-year-old African American lesbian who lives with her partner in an apartment outside a large city. She is currently enrolled in a counseling graduate program. Ka-Sean is the youngest of three children; she has one older brother and one older sister. She has not talked with her brother for a number of years; this coincided with his verbal opposition to her moving in with her female partner. Her support system is primarily her partner, her older sister, and her father. She regularly attends a local church and has a number of friends who are spread across the country.

Ka-Sean is a 25-year-old African American lesbian who lives with her partner in an apartment outside a large city. She is currently enrolled in a counseling graduate program. Ka-Sean is the youngest of three children; she has one older brother and one older sister. She has not talked with her brother for a number of years; this coincided with his verbal opposition to her moving in with her female partner. Her support system is primarily her partner, her older sister, and her father. She regularly attends a local church and has a number of friends who are spread across the country.

Case Conceptualization

Ka-Sean is a 25-year-old AA homosexual female with a long-established history of excessive anxiety episodes. She experiences excessive and uncontrollable worry about things within and beyond her control. Besides, she anticipates the worst to happen despite the lack of support to justify the extreme concerns. She worries about anything, including her daily activities, relationships, health, future, and schooling. The patient has a history of chronic restlessness, stomach problems, muscle tension, fatigue, and sleeping difficulties. Furthermore, she has concentration difficulties and cannot work on tasks requiring focus. She can also have excessive anxiety that leads to chest tightness, palpitations, shaking of her hands, shortness of breath, and feelings of losing control, making her immobile.

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Educational/Academic Concerns

The patient’s anxiety symptoms have contributed to educational impairment. This is evidenced by Ka-Sean procrastinating and failing to complete her assignments. Her yearning for reassurance makes her spend much time researching her assignments due to excessive worry that her topic may not be adequate. She is also reluctant to delegate tasks in group assignments which can affect her participation in group learning (DeMartini et al., 2019).

Diagnostic Impressions: ICD-10 CODE: F41.1 – Generalized Anxiety Disorder

Rationale for Diagnostic Impressions

Generalized Anxiety Disorder (GAD) manifests with excessive anxiety and worry that occurs more days than not for at least six months. The worry is about various events or activities, and a person finds it difficult to control it (Slee et al., 2021). The DSM-V criteria for GAD require the presence of anxiety/worry accompanied by at least three of the following: Restlessness, feeling on edge, or keyed up; Easy fatigue; Concentration difficulty or mind going blank; Irritability; Muscle tension; and Sleep disturbance (APA, 2013). Ka-Sean symptoms that fit the GAD criteria include excessive worry and anxiety, restlessness, sleep disturbance with difficulty falling asleep, muscle tension, fatigue, and difficulty concentrating.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of internal medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

Slee, A., Nazareth, I., Freemantle, N., & Horsfall, L. (2021). Trends in generalised anxiety disorders and symptoms in primary care: UK population-based cohort study. The British journal of psychiatry : the journal of mental science, 218(3), 158–164. https://doi.org/10.1192/bjp.2020.159

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To prepare for the Discussion:

• Review this week’s Learning Resources.
• Review the example case of Caden from the Week 6 Learning Resources.
• Review the case study of Ka-Sean found in Chapter 5 of Kress and Paylo (2019).

Case of Ka-Sean

Ka-Sean is a 25-year-old African American lesbian who lives with her partner in an apartment outside a large city. She is currently enrolled in a counseling graduate program. Ka-Sean is the youngest of three children; she has one older brother and one older sister. She has not talked with her brother for a number of years; this coincided with his verbal opposition to her moving in with her female partner. Her support system is primarily her partner, her older sister, and her father. She regularly attends a local church and has a number of friends who are spread across the country.

Ka-Sean has had longstanding excessive bouts of anxiety. She worries excessively and uncontrollably about things within and outside of her control. She often expects the worst to happen even if there is no evidence to warrant such extreme concerns. Ka-Sean finds that she can worry about almost anything, and she reports she is consumed by fears and angst about her relationships, daily activities, health, future (e.g., career, partner), and schooling. These worries are extremely time-consuming (e.g., dominating 80% of her awake time) and leave her physically and emotionally drained.

This excessive worrying has contributed to health issues and concerns. Ka-Sean has a history of chronic restlessness, stomach issues, muscle tension, fatigue, and difficulties with sleep. She describes her sleep cycles as “battles” consisting of repetitive “tossing and turning,” as the “to-do list” rattles about in her head. Recently, she was diagnosed with a stomach ulcer after she experienced significant heartburn, an upset stomach, fatigue, and bowel changes. Another area of concern is her inability to maintain concentration. She finds that tasks with a number of sequential steps tend to be extremely exhausting and time-consuming. This may in part be due to her “overthinking” things. She considers all the ways a given task could be accomplished, does extensive internet research, evaluates all potential obstacles, and plans the best course of action. This often results in “analysis paralysis” and was one of the reasons she quit her job at a local department store. She felt exhausted and drained by the constant decisions her boss pushed her to make around areas she believed were outside of her expertise. Last year, after leaving her job, she decided to enter a graduate program in counseling.

As a student, Ka-Sean wrestles with completing assignments because of her excessive procrastination. She often finds writing papers to be unmanageable because she believes she needs to retrieve copious amounts of information on a given topic and then seeks reassurance from her classmates and professor that her topic is worthy to explore. Her classmates believe she is a perfectionist, and when they work on group assignments they perceive she is unwilling to delegate tasks.

She has some insight into the effect of her excessive worrying. Tending to overly compensate for her worrying, Ka-Sean often tries to seek reassurance and guidance from others to help support her decision-making process. Her partner, friends, and family tell her that she worries way too much; yet she is unable to control these worries, especially when, as she says, “the flooding” of questions emerge. A recent example of this was when Ka-Sean thought her partner was cheating on her because she was unavailable on a Friday night. The “flooding” began like this: What if she is cheating on me? What if she doesn’t love me? What if she never loved me? What if she has always been using me to get to someone else? What if she is dating someone I know? What if they are talking about me and having a good laugh at how stupid I am? What if they are out together right now? Is that why she is unavailable today? What would my sister say—would she judge me? What would she say about me not being able to keep my partner happy? Am I enough to keep anyone happy? How can I be a counselor if I can’t even control my own life? What have I done to deserve all of this? Why does God keep punishing me? These questions berate her, wear on her sense of self, and lead to even more worrying.

In some situations, Ka-Sean can be so filled with anxiety that she begins to experience tightness in her chest, heart palpitations, shaking of her hands, shortness of breath, and thoughts of losing control. She becomes immobile in these situations. The first time this happened (about 2 years ago), her partner took her to the emergency room because she thought she was having a heart attack. Although these situations cannot be predicted, they occur relatively infrequently (once or twice a month) and happen around others as often as when she is alone. Ka-Sean has not attempted to avoid any social situations. She is, however, hypersensitive to these types of attacks, and she persistently worries after each of these events.

A few years ago, Ka-Sean lost her mother and describes this time as a “very dark” period. She previously sought treatment after her mother’s death due to bereavement, an increased level of anxiety, and the emergence of self-injurious behaviors (e.g., cutting, burning, punching herself). She states that she no longer copes by engaging in these behaviors, but she acknowledges that her worrying reaches debilitating levels during times of extreme stress and uncertainty. During such turbulent times, she feels even less in control and has more intense fears of losing control.

Ka-Sean is intelligent, witty, and charismatic. She is a nurturer who seems to care for others, often more than she cares for herself. This is the reason she decided to go back to school and pursue a degree in a helping profession. Ka-Sean is also passionate about reading and writing. She has written two science fiction novels, yet she has not sought publishing outlets because of her fears of rejection.

Ka-Sean’s father and sister are supportive and stabilizing figures in her life. Additionally, her partner is a childhood friend who has continually and unconditionally accepted and supported her. Ka-Sean currently takes alprazolam (Xanax) as needed, which is prescribed by her primary care physician, and would like to seek mental health treatment to help her cope more effectively with her worries and fears.

Post a brief summary of Ka-Sean in the following format:

• Case Conceptualization (Note: Include specific information about client symptoms and presenting concerns.)
• Educational/Academic Concerns (Ka-Sean experienced similar challenges during her high school education. Include information on the previous impact of client symptoms and presenting concerns on the following domains: Academic, Social/Emotional/Behavioral, and Career/College Planning.)
• Diagnostic Impressions (Be sure to use the ICD-10 code, name of the disorder, and all specifiers.)
• Rationale for Diagnostic Impressions (Include the diagnostic impressions using the DSM-5 to link the client’s symptoms to the diagnostic criteria for each diagnosis that you render. If you do not render a diagnosis, you still must use the DSM-5 to explain why you chose not to render a diagnosis.)

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Rubric: