A 21-year-old woman comes to the office at her mother's request because she is irritable and depressed. The patient was sexually attacked in the parking lot of her job two months ago. Since then, she has felt that "the world is not a secure place," and she prefers to stay at home rather than return to work. She will "zone out" in the midst of the day and hear her assailant's voice, "as if I am standing there in the parking lot." At times, she feels as if she is outside her body and cannot recollect the specifics of what happened, and she adds, "I feel like I am going insane." The patient has become withdrawn and either avoids her friends or becomes "snappy" when they visit her. She has lost interest in her hobbies of writing poetry and exercising. There is a family history of major depression in the patient's mother and schizoaffective disorder in her maternal grandmother. Which of the following is the most likely diagnosis?

Question

A 21-year-old woman comes to the office at her mother's request because she is irritable and depressed. The patient was sexually attacked in the parking lot of her job two months ago. Since then, she has felt that "the world is not a secure place," and she prefers to stay at home rather than return to work. She will "zone out" in the midst of the day and hear her assailant's voice, "as if I am standing there in the parking lot." At times, she feels as if she is outside her body and cannot recollect the specifics of what happened, and she adds, "I feel like I am going insane." The patient has become withdrawn and either avoids her friends or becomes "snappy" when they visit her.  She has lost interest in her hobbies of writing poetry and exercising.  There is a family history of major depression in the patient's mother and schizoaffective disorder in her maternal grandmother.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Following a distressing experience, this patient's 2-month history of intrusive flashbacks, avoidance, dissociative symptoms (amnesia, depersonalization), and emotional detachment is indicative of post-traumatic stress disorder (PTSD). Patients suffering with PTSD have dreams and/or flashbacks that continually experience a terrible, life-threatening incident (in which the patient feels as if the traumatic event is actually recurring). Individuals will frequently avoid people, places, and activities that remind them of the traumatic occurrence, resulting in sleep disruption, hypervigilance, poor mood, and irritability. A month of persistent symptoms is required for PTSD.

A 21-Year-Old Woman Comes to the Office at Her Mother's