A 16-year-old girl is brought to the office by her mother due to nonspecific stomachaches and pains. She has no other medical history. The patient has missed more than 10 days of school due to the symptoms since the academic year started 6 months ago. The mother says that her daughter has always been anxious with a "sensitive stomach," but the symptoms have worsened since the patient's best friend moved away a month ago. She has a few other friends but prefers to stay home and does not participate in after-school activities. The mother says, "She worried for weeks about going to a party. On the night of the party she had an anxiety attack and started hyperventilating. She ended up not going to the party at all." The patient says she is "just very shy" and is afraid of being embarrassed or "looking stupid" around others. Physical examination shows no abnormalities. During the interview, the patient makes little eye contact and gives brief answers to questions. Which of the following is the most likely diagnosis?

Question

A 16-year-old girl is brought to the office by her mother due to nonspecific stomachaches and pains.  She has no other medical history.  The patient has missed more than 10 days of school due to the symptoms since the academic year started 6 months ago.  The mother says that her daughter has always been anxious with a "sensitive stomach," but the symptoms have worsened since the patient's best friend moved away a month ago.  She has a few other friends but prefers to stay home and does not participate in after-school activities.  The mother says, "She worried for weeks about going to a party.  On the night of the party she had an anxiety attack and started hyperventilating.  She ended up not going to the party at all."  The patient says she is "just very shy" and is afraid of being embarrassed or "looking stupid" around others.  Physical examination shows no abnormalities.  During the interview, the patient makes little eye contact and gives brief answers to questions.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_3645_d44c_9249_ff4de911e32d_MD0001_00 This patient's intense social anxiety, in which she fears embarrassment and scrutiny by others, is characteristic of social anxiety disorder (social phobia). It is a common psychiatric disorder with typical onset in adolescence that can result in significant impairment in functioning and quality of life. Social interactions with peers and meeting new people cause significant distress. Anticipatory anxiety weeks before a social event and avoidance (not going to parties, school refusal) are common. Patients with social anxiety disorder frequently appear ill at ease during the interview, avoid eye contact, give overly brief responses, and may exhibit physical manifestations of anxiety (eg, blushing, sweating, trembling, tachycardia). The specifier "performance-only" is given to patients who have symptoms only in performance situations (eg, speaking or performing in public). (Choice A) This patient's social anxiety predates the stressor of her friend moving away. Stressors often exacerbate symptoms of other disorders. Adjustment disorder is not diagnosed when symptoms meet criteria for another disorder. (Choice B) Individuals with agoraphobia avoid public situations (eg, movie theaters) as escape might be difficult or help might not be available if they are incapacitated or have panic like symptoms. Although individuals with social anxiety disorder may avoid leaving the house, this is primarily due to fear of embarrassment and scrutiny by others. (Choice C) This patient's anxiety is restricted to social situations, whereas generalized anxiety is characterized by multiple worries. (Choice D) Shyness is a common nonpathological personality trait. However, this patient's severe and pervasive anxiety is out of proportion to the actual threat posed by social situations. It is causing significant distress and functional impairment in both academic and social contexts. (Choice E) Patients with social anxiety disorder may have panic attacks related to social situations. In panic disorder, however, attacks are unexpected and there is no clear trigger. (Choice G) Patients with anxiety disorders often present with somatic symptoms. This patient's stomachaches are a physical manifestation of her anxiety. She does not exhibit the excessive preoccupation with physical symptoms that characterizes somatic symptom disorder. Educational objective: Social anxiety disorder involves excessive fear of scrutiny or embarrassment in social or performance situations, resulting in significant distress and functional impairment. __________ References: Social anxiety disorder in adolescence: how developmental cognitive neuroscience findings may shape understanding and interventions for psychopathology. (http://www.ncbi.nlm.nih.gov/pubmed/25818181) Social anxiety disorder in DSM-5. (http://www.ncbi.nlm.nih.gov/pubmed/24395386)

A 16-Year-Old Girl Is Brought to the Office by Her