Reference no: EM133350027

Clinical Case Study: David

David is a 20-year-old man who presents to your practice with difficulties interacting with others and making friends. He avoids social situations with people he does not know (or not know well) as much as possible. He reported having commenced an online degree to avoid having to interact with other students at uni. However, he has just found out that he has a group presentation for one of his units and reports that on making this discovery, he became "incredibly panicky", reporting racing heart, sweating, trembling, and felt like he couldn't breathe. He states that when he is in social situations, he notices that his hands always shake and he sweats a lot, and he's extremely worried about people noticing this and thinking that he is "weird or lame or stupid". He admits that he spends a lot of time thinking over and over again about previous social interactions and worrying about what other people think of him.

David described himself as a shy and anxious child. His mother was diagnosed with Bipolar I when he was 16 years old and she commenced medication at this time. He recalls that his upbringing prior to this was "chaotic" and "a mess". Sometimes his mother could not get out of bed for days, while other times, they would be out all day and night visiting his mother's friends. He expressed some shame about his upbringing and remembers not having many friends over. He further recalled being bullied in school. He states that he "doesn't blame the bullies", as "I've always been weird".

David recognises that he has increasingly isolated himself, though acknowledges that he has maintained two childhood friendships. He reported that he would like to be able to make new friends and join some sporting clubs and feels embarrassed that "I have these issues". In this context, he also states that he is "useless" and "why would anyone ever want to be friends with me?".

From the case study:

(i) specify the most likely diagnosis and differential diagnoses to rule out and

(ii) list factors relevant to a biopsychosocial approach to understanding David's
a) experience/symptoms,
b) aetiology/vulnerability and
c) treatment/intervention.