ANNIE CASE
Case summary :
Annie is a 36-year-old Caucasian American who lives with her husband of 14 years. As a
teenager she began experiencing occasional panic attacks, which became more severe and
frequent in her senior year of college. She describes these attacks as a sudden need to escape,
accompanied by dry mouth, heart palpitations, weakness in her arms, and racing thoughts.
She also fears losing control or going crazy. Her first significant panic attack occurred while
she was studying at the college library. She felt severe anxiety and a sudden urge to leave.
After that, she noticed that these attacks became more frequent, and she became very afraid
of having another panic attack.For the past several years, Annie has avoided situations that
may provoke anxiety or panic-like physical sensations. For example, she avoids crowds at
con- certs, sporting events, and shopping malls. In these places, she is concerned about what
she will do if she has feelings of panic, and the potential embarrassment that her panic might
cause. She also avoids situations where it would be embarrassing if she started to have severe
anxiety (e.g., a social event with strangers, or formal gatherings). She relies on her husband to
accompany her to stores or places where she feels uncomfortable. She is extremely anxious
whenever she is separated from her husband; she is afraid that if she becomes anxious and he
is not around, she will not be able to handle it. For instance, once she was at a friend's house
and began to feel weak, as if she might pass out. Anxious that she might faint, she
immediately called her husband to pick her up. Her anxiety has put a significant amount of
strain on their relationship, because he is unable to be out late with friends or leave town for
business. Her husband is supportive, but Annie worries about the impact that her panic is
having on their relationship.Annie has also experienced several nocturnal panic attacks that
have awoken her in the middle of the night. Her heart beats rapidly and she feels shaky, with
intense anxiety. Fear of this happening makes nighttime anxiety-provoking for her; she has
difficulty falling asleep, and also wakes up several hours earlier than she would like, because
she cannot get back to sleep after her husband has left for work.In addition to acute anxiety,
Annie experiences generalized worry about many areas of her life. She worries excessively
about family members, her job, finances, and making decisions about her future. She also has
intense fears about nose- bleeds. She worries that if she had a nosebleed with a large amount
of blood, she might start to feel faint. If she has a nosebleed or sees someone with a
, nosebleed,she begins to feel anxious and may have a panic attack.Annie is particularly
sensitive to many physical sensations and environmental cues because of their association
with anxiety. She is sensitive to bright lights, which make her feel dizzy. She is keenly aware
of any physical sensations that do not have an obvious cause. If she begins to feel flushed or
shaky.During her daily routine, this sensation might lead to a panic attack. She also has a
long history of significant premenstrual exacerbation of her anxiety due to associated
physical sensations, such as bloating. She dreads getting her period, because she expects that
she will experience more anxiety and panic.Annie is sensitive to environmental cues, such as
time of day, and experiences increased anxiety in the morning, which she attributes to her
tendency to feel groggy at that time of day as well as her anxiety about her husband leaving
for the day.Annie has taken Zoloft for many years and also uses Xanax on rare occasions. She
does not like Xanax because it makes her feel "out of it" and she worries about becoming
addicted. However, she keeps it on hand for occasional use,and feels comforted that she has
that option if she feels that her anxiety is out of control.Annie has no significant medical
history. Her mother and sister experienced it . clinical depression and also tend to worry, but
there is no other known family.History of anxiety or panic. Annie grew up in a rural area, and
she describes her childhood as "very sheltered." Her parents were very protective and she was
quite dependent on them growing up. She married her high school boyfriend. Now, sheAnnie
has no significant medical history. Her mother and sister experience clinical depression and
also tend to worry, but there is no other known family history of anxiety or panic. Annie grew
up in a rural area, and she describes her childhood as "very sheltered." Her parents were very
protective and she was quite dependent on them growing up. She married her high school
boyfriend. Now, she doubts her ability to function independently and second-guesses herself
often. Primarily, she doubts her ability to handle her anxiety on her own, particularly without
her husband present.
Although Annie did not report any significant depressed mood or loss of interest, she did
report feeling down and discouraged following panic attacks. She also feels frustrated with
herself for letting her anxiety get out of control.Annie has attended counseling on several
previous occasions for a few ses- sions each time, but did not find talking about her anxiety
helpful. Presently, she feels that she has reached the point at which she wants to move
forward in her life without having to rely on others to deal with her anxiety and panic.
DATA AVAILABLE :
Case summary :
Annie is a 36-year-old Caucasian American who lives with her husband of 14 years. As a
teenager she began experiencing occasional panic attacks, which became more severe and
frequent in her senior year of college. She describes these attacks as a sudden need to escape,
accompanied by dry mouth, heart palpitations, weakness in her arms, and racing thoughts.
She also fears losing control or going crazy. Her first significant panic attack occurred while
she was studying at the college library. She felt severe anxiety and a sudden urge to leave.
After that, she noticed that these attacks became more frequent, and she became very afraid
of having another panic attack.For the past several years, Annie has avoided situations that
may provoke anxiety or panic-like physical sensations. For example, she avoids crowds at
con- certs, sporting events, and shopping malls. In these places, she is concerned about what
she will do if she has feelings of panic, and the potential embarrassment that her panic might
cause. She also avoids situations where it would be embarrassing if she started to have severe
anxiety (e.g., a social event with strangers, or formal gatherings). She relies on her husband to
accompany her to stores or places where she feels uncomfortable. She is extremely anxious
whenever she is separated from her husband; she is afraid that if she becomes anxious and he
is not around, she will not be able to handle it. For instance, once she was at a friend's house
and began to feel weak, as if she might pass out. Anxious that she might faint, she
immediately called her husband to pick her up. Her anxiety has put a significant amount of
strain on their relationship, because he is unable to be out late with friends or leave town for
business. Her husband is supportive, but Annie worries about the impact that her panic is
having on their relationship.Annie has also experienced several nocturnal panic attacks that
have awoken her in the middle of the night. Her heart beats rapidly and she feels shaky, with
intense anxiety. Fear of this happening makes nighttime anxiety-provoking for her; she has
difficulty falling asleep, and also wakes up several hours earlier than she would like, because
she cannot get back to sleep after her husband has left for work.In addition to acute anxiety,
Annie experiences generalized worry about many areas of her life. She worries excessively
about family members, her job, finances, and making decisions about her future. She also has
intense fears about nose- bleeds. She worries that if she had a nosebleed with a large amount
of blood, she might start to feel faint. If she has a nosebleed or sees someone with a
, nosebleed,she begins to feel anxious and may have a panic attack.Annie is particularly
sensitive to many physical sensations and environmental cues because of their association
with anxiety. She is sensitive to bright lights, which make her feel dizzy. She is keenly aware
of any physical sensations that do not have an obvious cause. If she begins to feel flushed or
shaky.During her daily routine, this sensation might lead to a panic attack. She also has a
long history of significant premenstrual exacerbation of her anxiety due to associated
physical sensations, such as bloating. She dreads getting her period, because she expects that
she will experience more anxiety and panic.Annie is sensitive to environmental cues, such as
time of day, and experiences increased anxiety in the morning, which she attributes to her
tendency to feel groggy at that time of day as well as her anxiety about her husband leaving
for the day.Annie has taken Zoloft for many years and also uses Xanax on rare occasions. She
does not like Xanax because it makes her feel "out of it" and she worries about becoming
addicted. However, she keeps it on hand for occasional use,and feels comforted that she has
that option if she feels that her anxiety is out of control.Annie has no significant medical
history. Her mother and sister experienced it . clinical depression and also tend to worry, but
there is no other known family.History of anxiety or panic. Annie grew up in a rural area, and
she describes her childhood as "very sheltered." Her parents were very protective and she was
quite dependent on them growing up. She married her high school boyfriend. Now, sheAnnie
has no significant medical history. Her mother and sister experience clinical depression and
also tend to worry, but there is no other known family history of anxiety or panic. Annie grew
up in a rural area, and she describes her childhood as "very sheltered." Her parents were very
protective and she was quite dependent on them growing up. She married her high school
boyfriend. Now, she doubts her ability to function independently and second-guesses herself
often. Primarily, she doubts her ability to handle her anxiety on her own, particularly without
her husband present.
Although Annie did not report any significant depressed mood or loss of interest, she did
report feeling down and discouraged following panic attacks. She also feels frustrated with
herself for letting her anxiety get out of control.Annie has attended counseling on several
previous occasions for a few ses- sions each time, but did not find talking about her anxiety
helpful. Presently, she feels that she has reached the point at which she wants to move
forward in her life without having to rely on others to deal with her anxiety and panic.
DATA AVAILABLE :
