Differential Diagnosis
- Single most likely diagnosis
- A) Agoraphobia: This is the most likely diagnosis because the patient has become increasingly withdrawn and fearful of being in public places, especially when there are many people around, following a panic attack. Her refusal to attend social events or go shopping alone is consistent with agoraphobic avoidance behaviors.
- Other Likely diagnoses
- E) Social anxiety disorder (social phobia): Although the patient's primary fear seems to be related to being in public places, her symptoms could also be interpreted as a fear of social or performance situations in which she is exposed to possible scrutiny by others. However, the key factor here is the fear of being in public places, which leans more towards agoraphobia.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Major depressive disorder: While the patient's mood is described as neutral and she has a full range of affect, which does not strongly suggest depression, it's crucial to consider depression in any patient with significant social withdrawal. Depression can sometimes manifest with anxiety symptoms, and missing this diagnosis could have serious consequences.
- Rare diagnoses
- B) Antisocial personality disorder: This diagnosis is unlikely because the patient's behavior is driven by fear rather than a disregard for others' rights or feelings. Antisocial personality disorder involves a pattern of disregard for others' rights, lack of empathy, and impulsivity, which is not indicated in the scenario provided.
- D) Schizoid personality disorder: This is also unlikely as the patient's withdrawal seems to be based on fear rather than a genuine lack of interest in social relationships. Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression, which doesn't fit well with the patient's history of gradual withdrawal following an anxiety attack.
- F) Specific phobia: While specific phobias involve fear of specific objects or situations, the patient's fear seems more related to the context (being in public places with many people) rather than a specific object or situation, making this diagnosis less likely.