Case History – Training Record

Chief complaints:

The client reports the following complaints for the past 2 years: Excessive and persistent worry about daily activities Restlessness and feeling "on edge" Palpitations and shortness of breath Difficulty concentrating Disturbed sleep Fear of losing control in public situations

Presenting concerns:

Ms. Khushi was apparently well two years ago when she began experiencing frequent and uncontrollable worry related to academic performance and future career prospects. Initially, the anxiety was situation-specific, particularly before examinations and presentations. Over time, the worry became generalized and extended to health, family safety, finances, and routine daily matters. She reports physical symptoms such as increased heart rate, sweating, trembling, muscle tension, gastrointestinal discomfort, and fatigue. Cognitive symptoms include excessive rumination, fear of negative evaluation, and catastrophizing. Emotional symptoms include irritability and persistent apprehension. The anxiety has led to avoidance of social gatherings, reduced academic productivity, and

Client verbatim statement:

For the past two years, I’ve been constantly worried about my studies, future, health, family, money, and even small daily things, and I can’t control these worries.” “I usually feel restless and on edge, with a racing heart, shortness of breath, sweating, trembling, muscle tension, and stomach discomfort.” “My mind keeps overthinking and catastrophizing, which makes it very hard for me to concentrate and stay productive in my academic work.” “I avoid social situations because I’m scared I might lose control or embarrass myself in public, and this has affected my relationships.” “I have trouble sleepingbecause my thoughts race at night, and even after sleeping, I wake up feeling tired and unrefreshed.”

A – Affect / Emotion

Constricted but appropriate

B – Behaviour

Cooperative, midly restless

C – Cognition

Oriented to time place and cognition

D – Daily functioning

Manages personal self-care and daily activities independently. Academic and work performance is affected due to poor concentration and excessive worry. Avoids social situations, leading to reduced social interaction. Sleep disturbance causes fatigue and reduced daytime efficiency.

Onset details

It was insidious, beginning approximately two years ago. Initially, anxiety was situational, occurring primarily in academic contexts such as examinations and presentations. Over time, the symptoms gradually increased in frequency, intensity, and scope, becoming persistent and generalized across multiple life domains.

Course details

The course has been non-episodic, with no history of acute panic attacks, psychosis, mania, or substance-related exacerbation.

Predisposing factors

Anxious temperament since childhood Perfectionistic personality traits Family history of anxiety symptoms Achievement-oriented family environment

Precipitating factors

Increased academic pressure during graduate studies Performance-related stress (exams, presentations)

Perpetuating factors

Chronic worry and cognitive distortions (catastrophizing, fear of failure) Avoidance of social and evaluative situations Poor sleep quality and fatigue Limited social support and reduced coping outlets

Protective factors

Good insight and motivation for help Supportive family background No substance use or major medical comorbidity Intact reality testing and functioning

Present maintaining factors

Persistent cognitive distortions such as excessive worry, rumination, and catastrophizing Avoidance of social and performance situations, reinforcing anxiety Disturbed sleep leading to fatigue and reduced emotional regulation Ongoing academic and career-related stressors Limited use of adaptive coping strategies and lack of prior psychotherapy

Family history

Father: 55 years, employed, history of chronic stress Mother: 52 years, homemaker, history of anxiety symptoms (undiagnosed) Sibling: Younger brother, healthy No known family history of psychotic disorders or substance dependence Family environment described as supportive but achievement-oriented, with high expectations regarding academic success.

Personal history

Birth and Developmental History Full-term normal delivery No prenatal, perinatal, or postnatal complications Developmental milestones achieved on time Childhood History Described as a shy, sensitive, and conscientious child Good academic performance Tendency toward perfectionism No history of abuse or neglect

Educational history

Consistently above-average academic performance Experiences significant performance anxiety Difficulty coping with competitive academic environments

Vocational / occupational history

Currently working part-time alongside studies Reports difficulty managing workload due to anxiety and fatigue

Sexual and marital history

Unmarried No current romantic relationship No reported sexual difficulties

Forensic history

(not filled)

Suicidal / self-harm / substance use history

(not filled)

Living conditions

(not filled)

Premorbid personality

She is described as introverted, responsible, perfectionistic, and emotionally sensitive. She tends to be self-critical, seeks reassurance, and has a low tolerance for uncertainty.