Case 2

Demographic Data
Name: Ak

Address: Shawa

Gender: Female

Education: 9th standard

Occupation: N/A

Date Of Birth: 7 May 2003

Age: 21

Siblings: 1 male and 1 female

Birth Order: 2nd

Marital Status: Single

Religion: Islam

Language: Pashto

Family Structure: Nuclear

Date: 21-10-2023

Mode Of Referral:
The client was referred by his brother.

Presenting Complaints:
On asking the patient about his complaints, client also reported having disturbance sleeping at
night and reported continuous nightmares of losing her brother. Client also reported complains
of severe headache, nausea as well as appetite loss due to which she suffered severe weight
loss.

Symptoms:

Fear
Headaches

Nausea

Hopelessness

Stomaches

Nightmares

Appetite loss

History Of Present Illness:

The client reported that she had been experiencing these symptoms after the transfer of her
brother the last year. Client stated that she was very closely attached to her brother. She was
having persistent worry about losing her brother. Client would become worried and anxious
when her brother became late from the office or when he had having mild illness. Client used to
call him again and again to confirm that he is ok. At first all these were normal but after the
transfer of her brother the symptoms became severe. She had an intense fear of losing her
brother. Client had a fear that something bad will happen to him. Gradually she lost her interest
in her studies and social gatherings. She used to stay mostly in her home.

Past Psychiatric History:

N/A

Past Medical History:

N/A

Family History:
N/A

Social and Economical History:

Client belongs to a middle-class family.

Forensic History:
N/A

Informal Assessment:
MSE ( Mental Status Examination)

General Appearance:
Neat and clean

Motor Behavior:
Speech:

Normal volume

Mood:

Sad and low

Orientation:

Well Oriented

Short term memory:

Normal

Long term memory:

Normal

Pre - Morbid Personality:

Before illness the client was normal.

Formal Assessment:
Test Administration:

Severity Measure For Separation Anxiety Disorder:

The client scored 35 indicating greater severity of Separation Anxiety Disorder.

Beck Anxiety Inventory Scale:

On BAI client scored 15 indicating mild anxiety symptoms.

Tentative Diagnosis:
According to DSM5 309.21 (F93.0) patient have Separation Anxiety Disorder.

Therapeutic Recommendation:

Cognitive Behavioral Therapy:

Cognitive behavioral therapy (CBT) focuses on helping children with SAD reduce feelings of
anxiety through practices of exposure to anxiety-inducing situations and
active metacognition to reduce anxious thoughts. CBT has three phases: education, application
and relapse prevention. In the education phase, the individual is informed about the different
effects, anxiety can have physically and more importantly mentally. By understanding and being
able to recognize their reactions, it will help to manage and eventually reduce their overall
response.

A study investigated the content of thoughts in anxious children who suffered from separation
anxiety as well as from social phobia or generalized anxiety. The results suggested that
cognitive therapy for children suffering from separation anxiety (along with social phobia and
generalized anxiety) should be aimed at identifying negative cognition of one's own behavior in
the threat of anxiety-evoking situations and to modify these thoughts to promote self-esteem
and ability to properly cope with the given situation.

Session 1:

In first session relevant history was taken from the client and mental Status was examined .The
main focus was establishing a good Rapo with the patient so that she could feel easy and speak
comfortable. But in this session the Rapo is not too much developed .The client wears press and
clean dress.Have Clean shoes and combed hair. The talking style of the client was good , well
oriented towards time place. The session last about 40 minutes.

Session 2:
The aim of this session was to further strengthened the bond between the client and therapist.
Case history was taken and further detailed demographics of the client were asked in a friendly
way. Detailed data regarding the client’s presenting complaints.This paved the way to get
insight of the client’s problem and to develop plan regarding the intervention process to be
carried out during the process.

Session 3:
This session aimed at the pre assessment of the client both through observation and through
use of standardized tests. Observation of the client was recorded through behavioral, in the
form of fear, anxious thoughts and behaviors, feelings of hopelessness. The Formal assessment
was carried out through Severity Measure for Separation Anxiety Disorder and Beck Anxiety
Inventory Scale. On Beck Anxiety Inventory Scale the client scored 15 indicating mild anxiety
symptoms and on Severity Measure for Separation Anxiety Disorder she scored 35.

Sessions to be continued