Differential Diagnosis for Leah's Condition
The following differential diagnoses are considered based on Leah's symptoms and history:
- Single Most Likely Diagnosis
- Post-Traumatic Stress Disorder (PTSD): This diagnosis is the most likely due to Leah's exposure to a traumatic event, her symptoms of flashbacks, nightmares, avoidance of reminders of the event, and hypervigilance. Her behavior changes, such as withdrawal, irritability, and difficulty concentrating, also support this diagnosis.
- Other Likely Diagnoses
- Anxiety Disorder: Leah's excessive fear, anxiety, and avoidance behaviors, particularly in relation to the school and the sniper's house, suggest an anxiety disorder. Her fear of being alone, fear of new situations, and clinginess also support this diagnosis.
- Depressive Disorder: Leah's symptoms of tearfulness, irritability, loss of interest in activities, and changes in sleep patterns and appetite suggest a depressive disorder. Her withdrawal from friends and decreased interest in schoolwork also support this diagnosis.
- Adjustment Disorder: Leah's symptoms of emotional distress, behavioral changes, and difficulty adjusting to the traumatic event could be indicative of an adjustment disorder. However, the severity and duration of her symptoms may be more consistent with PTSD.
- Do Not Miss Diagnoses
- Traumatic Brain Injury: Although there is no direct evidence of a head injury, the possibility of a traumatic brain injury should be considered, especially given Leah's report of her head hurting during the incident. A brain injury could contribute to her cognitive and behavioral symptoms.
- Dissociative Disorder: Leah's symptoms of dissociation, such as her report of feeling like she was in a "different world" during the incident, could suggest a dissociative disorder. However, this diagnosis would require further evaluation and is less likely given the overall clinical presentation.
- Rare Diagnoses
- Acute Stress Disorder: Although Leah's symptoms are consistent with acute stress disorder, this diagnosis is less likely given the duration of her symptoms (over 2 months). Acute stress disorder typically lasts for a shorter period.
- Conversion Disorder: Leah's symptoms of physical complaints, such as minor infections and fatigue, could suggest a conversion disorder. However, this diagnosis is less likely given the overall clinical presentation and the presence of more prominent symptoms of PTSD and anxiety.
Justification for Each Diagnosis
Each diagnosis is considered based on Leah's symptoms, history, and behavioral changes. The most likely diagnosis, PTSD, is supported by her exposure to a traumatic event, symptoms of flashbacks, nightmares, avoidance, and hypervigilance. Other likely diagnoses, such as anxiety disorder and depressive disorder, are considered due to her excessive fear, anxiety, and depressive symptoms. Do not miss diagnoses, such as traumatic brain injury and dissociative disorder, are considered to rule out potential underlying conditions that could contribute to her symptoms. Rare diagnoses, such as acute stress disorder and conversion disorder, are less likely but are considered to ensure a comprehensive differential diagnosis.