Case 1 Marie Sue Marie Sue 53 year old female has long standing anxiety dating back to childhood She always feels shy and self conscious around others and never feels she knows what to say or how to act She has ever dated and reports few friendships over her life She works as a computer programmer in the Bay Area so that I don t have to see people face to face She has passed up advancement opportunities at work as these would have placed her in a more interactive role with other people She often feels physically tense nervous nauseas and flushed even during casual conversations After these situations she will often replay these events in her head in an extremely self critical manner She spends most of her time alone and lacks social skills She avoids almost all social situations The client does not report any history of substance use or notable medical conditions 1 What disorders are you considering for Marie Sue Some disorders that I am considering for Marie Sue are SAD GAD Social Phobia and Specific phobia 2 Which disorder is the most fitting diagnosis for Marie Sue I think that the most fitting diagnosis for Marie Sue would be Social Anxiety Disorder SAD She is embarrassed to be out in public and speak to others due to her low self esteem and fear of showing her anxiety level Also she might not get married because she has never dated anyone and is avoiding to do so 3 What is one cultural factor that may be influencing Marie Sue s presentation diagnosis She tries the avoidance approach to social contacts or interaction with other people She prefers to spend time alone rather than facing people or social situations She has not dated anyone and is most likely not going to get married She even gives up any career advancement in order to avoid dealing with people and situations