Introduction
Husna is 28 years old female. She is a housewife and has two children.
She has good relations with her husband. She is educated and lives with her children
and husband.
She came with the problems of persistent worry, guilt, sleep disturbances, fear of
family judgment,
and existential anxiety (fear of death, moral reflection).
Identification Data
Name: Husna
Age: 28 years old
Sex: Female
Religion: Islam
Education: Master in Physics
Occupation: Housewife
Marital Status: Married
No. of Siblings: 6
Birth Order: 1st
Family System: Joint
Residence: Multan
Informant: No
Presenting Complaints
Duration of Symptoms: The symptoms are persistent for almost 1 year.
Complaints According to Client:
- Persistent anxiety, worries, and sleep disturbance.
- Emotional dysregulation and interpersonal difficulties.
- Excessive worry over minor issues.
- Guilt following emotional outbursts.
- Uncontrollable anger during arguments.
History of Present Illness
The client is presenting with persistent anxiety, emotional dysregulation, and
interpersonal difficulties. She reports excessive worry over minor issues, sleep
disturbances, and guilt
following emotional outbursts. Though conflict avoidant, she experiences
uncontrollable anger during arguments.
She desires emotional connection with her family but avoids initiating conversation
due to fear of judgment and
decision-making by others. Existential anxiety is triggered by news of death, leading
to intense self-reflection
and fear of afterlife. She also expresses concern over her future sister-in-law’s
behavior and its potential
impact on her brother’s marital life.
Past Psychiatric History
She had no other psychiatric issue than this, lasting from almost 1 year.
Substance Use History
She did not have any history of substance use including drugs or alcohol throughout
her lifespan.
Past Medical History
She did not have any medical history except minor breathing issues.
Personal History (Childhood and Adolescence)
The client reports being raised in a family environment characterized by
emotional distance and parental conflict. Her father was described as aggressive,
and frequent disputes between
her parents created a tense atmosphere. These conflicts had a significant emotional
impact on her, contributing
to insecurity and emotional sensitivity from a young age. She recalls wanting to
express herself but refrained
due to fear of being judged. This resulted in emotional suppression and
overthinking.
Educational and Occupational History
The client has completed a Master’s degree in Physics, demonstrating strong
academic
achievement and intellectual capability. Despite her education, she is currently a
housewife and does not hold
formal employment outside the home. Her decision to focus on household
responsibilities may be influenced by
personal choice or family circumstances.
Social and Interpersonal Functioning
The client experiences emotional withdrawal and difficulty expressing herself
within
her family due to fear of judgment and past exposure to parental conflict and
aggression. She desires closer
family connections but perceives emotional distance and silence during distress.
Anxiety about her brother’s
marriage further impacts her interpersonal comfort. Overall, her social interactions
are limited and affected by
her emotional struggles.
Personality Traits
The client shows emotional sensitivity and tends to avoid conflict. She frequently
ruminates on her
worries and struggles to express her true feelings openly. At times, she masks her
distress with a smile, which
may hide underlying anxiety. She is cautious in her interactions with family
members due to fear of being judged
or misunderstood.
Family History
The client reports a family background marked by parental conflict and emotional
tension. Her father is
described as aggressive, and frequent disputes between her parents created a
stressful home environment. These
conflicts had a significant emotional impact on the client during her upbringing.
Psychological Assessment
- Informal Assessment
- Formal Assessment
Behavioral Observation
During the interview, the client appeared cooperative and engaged. She maintained
eye contact
intermittently and had a calm but somewhat guarded demeanor. She displayed a
constant smile throughout the
session, even while discussing distressing topics, suggesting possible emotional
masking.
Mental Status Examination - General Appearance
The client was neatly dressed and appeared comfortable during the interview.
She had a calm attitude and smiled consistently, even when talking about upsetting
topics, which may indicate
she was trying to hide her true feelings. She made eye contact at times but was
sometimes a bit reserved.
There were no unusual movements or restlessness observed.
Speech
Her speech was natural and easy to understand. She spoke clearly and stayed on
topic throughout the
conversation. The speed, volume, and tone of her voice were normal. There were no
signs of rushed talking or
unusually slow responses.
Mood and Affect
Subjective Mood: The client reports feeling anxious and worried, particularly about
the future and
existential concerns related to death and her deeds.
Objective Mood: Despite her report of anxiety, the client appeared calm and
maintained a constant smile
throughout the interview. No visible signs of sadness, distress, or other mood shifts
were observed.
Perception
Hallucinations: The client denied experiencing any hallucinations (auditory, visual,
or other sensory).
Illusions: No illusions or misinterpretations of real stimuli were reported or
observed.
Sensorium
The client was fully alert and oriented to time, place, and person throughout the
interview.
There were no signs of confusion, disorientation, or altered consciousness.
Orientation to Time, Place, and Person
She had accurate orientation to time. She had good orientation to place
(Seyal Medical Centre). She had good orientation to person (e.g., answered
grandmother's name correctly).
Memory
Immediate Memory: Intact, able to repeat simple numbers and phrases.
Recent Memory: Mild disturbances during emotionally intense situations, otherwise
intact.
Remote Memory: Able to recall personal historical information such as date of birth,
educational background,
and past life events.
Calculation
The client was asked to perform basic arithmetic operations. She was able to
complete them correctly,
indicating intact numerical ability and attention. (e.g., 100 - 25 = 75).
Fund of Knowledge
She had good general knowledge. For example, she correctly answered:
Q: Who was the first founder of Pakistan? A: Quaid-e-Azam.
Insight
The client demonstrates partial insight. She is aware that her emotional responses,
excessive worry,
and fear of death are affecting her daily life. However, her understanding of
psychological nature and depth
of issues appears limited.
Judgment
Social and practical judgment appear to be fair. The client is able to make
appropriate decisions in
everyday life but may struggle when emotions are heightened. Her ability to
anticipate consequences during
emotional distress (e.g., anger outbursts) seems compromised. For example, she
expressed regret after
arguments but was unable to control her actions in the moment.