Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Diagnosis I – Hanging Files

Diagnosis and Diagnostic Decisions

Diagnosis & Diagnostic Process

Think of psychological diagnosis, like physical diagnosis, as a classification system that looks like a filing cabinet with numerous drawers and hanging files within each.

For the next four weeks, I will talk about three drawers in that filing cabinet; the first being a drawer marked Anxiety Disorders.” I will also discuss the atypical cases that lurk in each hanging file.

The reason for grouping disorders is that this leads to precision in diagnosis and ultimately/ideally in precise care. An erroneous diagnosis leads to nonproductive and even counterproductive care.

Anxiety Disorders that we see among injured workers include Panic Disorder, Phobias, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder as well as Acute and Posttraumatic Stress Disorders.

As with any group of disorders, the Anxiety Disorders have features in common; for example, several of the Anxiety Disorders include panic attacks (sweating, trembling, palpitations, shortness of breath, nausea, chest pain, dizziness, feelings of unreality and/or feelings of detachment, fear of dying, numbness or tingling and chills or hot flashes.

In treating injured workers, it is important to keep in mind three things:

a. Were the anxiety symptoms present prior to injury?

b. Are the anxiety symptoms related to specific situations or generalized to all situations?

c. Are we seeing a disorder or the patient’s attempt to control his/her own symptoms?

d. What is occurring that does not permit the patient to improve and/or arguably makes the Disorder worse?

Are we treating a Social Phobia, a Specific (environmental) Phobia, an Obsessive-Compulsive Disorder or is it truly Posttraumatic Stress Disorder? If the diagnosis is not precise, the treatment will be misdirected and the patient will languish in care without improvement. Additionally, if care is extended beyond that necessary to address the Disorder, the patient, with little to occupy his/her time, will see psychological care as equivalent to a social relationship and use the care to fill the vacuum of time.

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