¶ … Andrea M. is a 21-year-old female in her fourth year of college with aspirations to become a civil rights attorney. She was first recommended to seek treatment when she experienced her first panic attack three years ago. At the time, a friend advised her to seek counseling. However, Andrea never did seek counseling at that time. Andrea has since been avoiding certain types of social situations, has gravitated towards jobs with as little social contact as possible, and fears that her anxiety may be impacting her performance in school and her ability to find viable work as an intern this summer. She loves "diving into my work" and becoming absorbed in her academics, but when it comes to attending classes, Andrea feels stressed and has been missing more classes than she has ever before. After not showing up to classes for two weeks, and an incident involving alcohol poisoning during that same time period, her family intervened and called the mental health center.
Presenting Concerns
The level of distress Andrea feels is high, as she has been experiencing more frequent and severe panic attacks lately. She has never fainted, but she has "been in tears" on more than one occasion. Andrea has walked out of social situations, and feels humiliated "often." She attributes the additional stress to her workload at school, and to the change in the nature of her classes. Andrea has been experiencing panic attacks with greater intensity and frequency over the past several months, although she has suffered from them off and on for ten years. She claims, "I never knew anything was wrong until now." Andrea often takes two hours to get ready for class, claiming that she tries "everything in my closet" before she feels she is ready to be presentable in public. Being late for class has also been a problem for her, but because her grades and work are among the best in her class, her professors have never complained.
Background of Problem
When Andrea was ten years old, she remembers starting to feel excessively self-conscious in school. It was right after she got her first period, and she remembers being paranoid all day that everyone in school knew. She ran to the bathroom between every class and was certain she had blood on her clothes. During this same time, Andrea became more withdrawn than she had before. She had always been on the quiet side, but by the time she was twelve, Andrea had few friends and rarely attended parties. Her parents believed she was simply a studious girl and left her alone. Throughout high school, incidences of what she now recognizes as panic attacks started to occur with relative frequency. Increased heart rate, a sense of impending doom, changes in her breathing, sweating, and occasionally, shaking were some of the symptoms. These symptoms would arise immediately prior to impending engagements, during social events, and during conflict or confrontation scenarios. When Andrea first started college, she delved into her studies but still experienced the symptoms of anxiety so avoided social engagements. She does not belong to any clubs, and her only friends live in her hallway in the dormitory. Andrea admits that although she completes all her work on time and has good grades, she rarely participates in class. She mentions how grateful she is that professors don't "call on you" or "single you out" like they did when she was in high school. In the past, Andrea remembers hiding in the bathroom and even hiding under the table in school to avoid being called on. However, in her senior year Andrea had to make up for the lack of credits in debate classes. She had avoided taking debate because of the intense teamwork the class represented. Andrea has also remain distant from the academic societies in the legal field, in spite of the strong encouragement of her academic advisors to do so.
Developmental, Family, Social, and Work History
Andrea's parents divorced when she was eight years old. She has two step siblings. Besides work-study programs to pay off her financial aid loans, Andrea has never had a steady job. In high school, Andrea was a good athlete. She wanted to play basketball, but gravitated instead toward track and field because it did not require the rigors of teamwork. Andrea remembers in elementary school, playing softball and always wanting to remain in the outfield so that "I never had to field a ball." She since avoided team sports because she thought she did not like them, but now admits it is because she does not like teamwork in general. "I have always liked working independently, but until now did not realize how extreme my aversion to teamwork had become. Now I freak out when there is a team...
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