22-Year-Old Female Presenting with Intrusive Thoughts and Anxiety Symptoms

Case at a Glance

A 22-year-old female presents with persistent intrusive thoughts, visual disturbances, perfectionist tendencies, and chronic anxiety significantly impacting her occupational and social functioning.

Patient's Story

The patient reports experiencing recurrent intrusive thoughts that occur daily, particularly when encountering specific triggers such as seeing a razor in the shower, which immediately prompts thoughts of self-harm behaviors like shaving off her eyebrows. She describes these intrusive thoughts as being accompanied by disturbing visual imagery, including what she describes as 'scary images with demonic vibes' and visions of loved ones dying. The patient experiences significant distress in occupational settings when things are not arranged to her standards, describing a burning sensation in her head and urges to pull her hair when items like napkins are not perfectly aligned. She reports that her mind is 'constantly racing' and that she never feels calm, even during sleep when her dreams are filled with anxiety. These symptoms have led to increased social isolation as she feels constantly in 'survival mode' and unable to maintain friendships.

Initial Assessment

Patient appears distressed when discussing symptoms. Reports chronic sleep disturbances with anxiety-filled dreams. Demonstrates insight into her condition, acknowledging that her perfectionist standards are unreasonable but feeling unable to control her reactions in triggering moments. Social withdrawal is evident, with patient choosing isolation over social interaction due to feeling overwhelmed.

The Diagnostic Journey

Patient acknowledges need for professional help but reports consistently postponing medical appointments. When asked about barriers to seeking treatment, patient indicates avoidance behaviors that may be contributing to delayed care-seeking. Further exploration of past experiences with healthcare and specific obstacles to treatment initiation would be beneficial.

Final Diagnosis

Pending comprehensive psychiatric evaluation. Differential diagnoses to consider include Obsessive-Compulsive Disorder (OCD), Generalized Anxiety Disorder, and possible comorbid conditions affecting perfectionism and intrusive thought patterns.

Treatment Plan

Immediate referral to primary care physician for initial evaluation and psychiatric referral. Recommend comprehensive psychiatric assessment to evaluate for OCD and anxiety disorders. Cognitive Behavioral Therapy (CBT) with exposure and response prevention techniques may be indicated. Pharmacological intervention may be considered pending psychiatric evaluation. Patient education regarding intrusive thoughts and reassurance about treatability of symptoms.

Outcome and Follow-up

Patient education provided regarding available treatment options including direct scheduling with psychiatrist or counselor depending on insurance coverage. Emphasis placed on addressing barriers to treatment initiation and developing concrete steps for accessing care. Follow-up needed to ensure patient engagement with recommended interventions and monitor symptom progression.