Case Study K

Betty, a 50-year-old woman, came to this country with her parents when she was 7 years old. The family members worked as migrant farm workers until they had enough money to open a restaurant. Betty married young. She and her husband worked in the family restaurant and eventually bought it from her parents. They raised seven children, all grown and living on their own. Betty and her husband live in a mobile home close to the restaurant. She does not work in the family restaurant anymore because she worries excessively about doing a poor job. Betty no longer goes out if she can help it. She stays at home worrying about how she looks, what people think or say, the weather or road conditions, and many other things that keep her from being social.

Betty does not sleep at night and keeps her husband awake while she roams the house. She often feels on edge or restless. She keeps her clothing and belongings in perfect order while claiming she is doing a poor job of it. She does not prepare large family dinners anymore, though she still cooks the daily meals; one daughter has taken over the family dinners. This daughter has become concerned about Betty being isolated at home and worrying excessively and calls the community mental health center for an appointment for Betty.

After some convincing Betty agrees to go to the community mental health center accompanied by her husband, her children and their spouses, several grandchildren, and a few cousins. When Betty’s name is called and she is told that the nurse is ready to see her, she frowns and says: “What will I say? I don’t know what to say. I think my slip is showing. My hem isn’t straight.” Betty is extremely well groomed and dressed in spite of concerns she has been voicing about her appearance. Betty also mentions that she wants her whole family to go in to see the therapist with her. Before the interview begins, Betty’s daughter was over heard saying that Betty “worries all the time” and although she has always been known to be a worrier, the worrying has become worse over the past six or eight months.

Although Betty wants her entire family to accompany her during the interview, she is told she cannot. This is difficult for Betty, as she repeatedly seeks reassurance from her family members. The husband shares with the therapist that Betty is constantly keeping him awake at night and often will bring up the same things that worry her on a daily basis. The therapist then interviews Betty alone. They notice that Betty casts her eyes downward, speaks in a soft voice, does not smile, and seems restless as she taps her foot on the floor, drums her fingers on the table, and seems on the verge of getting out of her chair. Betty shared that she is often tired and gets tired easily even though she spends most of her time at home, is not able to concentrate and has issues getting housework done around the house. She also shares that a recent worry for her is whether or not her husband loves her anymore and whether she and her husband have enough money, and that she does not have enough energy to attend to her clothing.

There is no convincing Betty that she looks all right. Any attempt to convince her that she need not worry about something in particular leads to a different worry before coming back to the earlier worry. After examining Betty the therapist is unsure of the explanation for her fatigue and difficulty sleeping and asks her if she is currently taking any medication that may be causing side effects. Betty produces her medicine bottles and says she is currently taking only vitamins and a hormone replacement. The therapist concludes that she may be experiencing side effects of fatigue due to her hormone replacement medication and asks her to make an appointment with her primary care provider.

A month later, during a phone call with Betty, the therapist learns, with some probing, that Betty is upset with her husband for loaning all their savings to the daughter and her husband to build a new home, while they continue to live in an older mobile home. Since learning this, Betty has not been able to sleep and has kept herself isolated in her and her husband’s bedroom and has not cooked or cleaned in over two weeks. Betty worries she is not getting better and asks the therapist about taking some herbal medicines containing kava and passaflora that her sister got from a healer; her sister wants to take her to see the healer and have her do a ritual to cure the “evil eye” that was placed on Betty and made her sick. Betty’s daughter can be heard strongly disagreeing with her aunt and the therapist’s assessment, telling Betty that she is not satisfied with her progress and will be contacting another therapist or doctor for a second opinion.

ADDITIONAL THOUGHT QUESTIONS

How common is the diagnosis? Is it common for clients with this disorder to have comorbidity, and should this client be assessed for any other condition?

A lot of people worry on a daily basis. Some people focus their worry on themselves, those that they love and care for or even events that are taking place in the world, but it doesn’t necessarily meet the criteria for a disorder. At what point does someone go from worrying to experiencing worry that is diagnosable?