1   Fears and Phobias A significant change to the DSM-5 is the separation of diagnoses formerly grouped together in the DSM-IV. Anxiety disorders no longer include obsessive-compulsive disorders, which are now their own classification (obsessive-compulsive and related disorders). Also separated from anxiety disorders are posttraumatic stress disorder and acute stress disorder, which are now included in the classification of trauma- and stressor-related disorders. Anxiety Disorders There are few changes to the diagnoses in this classification that directly impact individuals under the age of 18. In fact, the primary change has been the re-grouping of disorders to more accurately reflect associations in diagnostic criteria. This revised classification includes separation anxiety disorder, selective mutism (formerly included in disorders usually first diagnosed in infancy, childhood, or adolescence in the DSM-IV), specific phobia, social anxiety disorder (formerly social phobia), panic disorder, agoraphobia, generalized anxiety disorder, anxiety due to another medical condition, other specified anxiety disorder, and unspecified anxiety disorder. The diagnosis anxiety disorder not otherwise specified has been removed, and two new diagnoses added: other specified anxiety disorder and unspecified anxiety disorder. Both of these diagnoses represent significant clinical distress or impairment based on anxiety disorder diagnostic criteria, but do not meet full criteria for a specific diagnosis. Clinicians should use other specified anxiety disorder and add the specific reason for the more general diagnosis (e.g., short duration of symptoms or cultural association). The latter diagnosis—unspecified anxiety disorder—is used when clinicians cannot (or choose not to) identify reasons for an inability to make a more specific diagnosis, yet clearly observe multiple criteria from the anxiety disorders classification. Below is a summary of additional changes to the diagnoses in this classification that may impact individuals under the age of 18. Social Anxiety Disorder (Social Phobia) The preferred diagnostic descriptor is now social anxiety disorder, reflecting a more specific association with symptomology. Wording of criteria has been altered to be more clear and applicable across social situations and age ranges. For children, anxiety must occur in peer settings (i.e., not exclusively with adults); the requirement that the child must exhibit a capacity for age-appropriate social interaction with familiar people has been removed. Also, consistency across ages has been supported by the requirement of duration to be at least six months (for all ages) and by the deletion of the need for individuals over 18 to recognize the fear is unreasonable. Separation Anxiety Disorder This disorder—formerly included in disorders usually first diagnosed in infancy, childhood, or adolescence—has been moved to the anxi.

1. 1
Fears and Phobias
A significant change to the DSM-5 is the separation of
diagnoses formerly grouped together in
the DSM-IV. Anxiety disorders no longer include obsessive-
compulsive disorders, which are
now their own classification (obsessive-compulsive and related
disorders). Also separated from
anxiety disorders are posttraumatic stress disorder and acute
stress disorder, which are now
included in the classification of trauma- and stressor-related
disorders.
Anxiety Disorders
There are few changes to the diagnoses in this classification
that directly impact individuals
under the age of 18. In fact, the primary change has been the re-
grouping of disorders to more
accurately reflect associations in diagnostic criteria. This
revised classification includes
separation anxiety disorder, selective mutism (formerly
included in disorders usually first
diagnosed in infancy, childhood, or adolescence in the DSM-
IV), specific phobia, social anxiety

2. disorder (formerly social phobia), panic disorder, agoraphobia,
generalized anxiety disorder,
anxiety due to another medical condition, other specified
anxiety disorder, and unspecified
anxiety disorder.
The diagnosis anxiety disorder not otherwise specified has been
removed, and two new
diagnoses added: other specified anxiety disorder and
unspecified anxiety disorder. Both of these
diagnoses represent significant clinical distress or impairment
based on anxiety disorder
diagnostic criteria, but do not meet full criteria for a specific
diagnosis. Clinicians should use
other specified anxiety disorder and add the specific reason for
the more general diagnosis (e.g.,
short duration of symptoms or cultural association). The latter
diagnosis—unspecified anxiety
disorder—is used when clinicians cannot (or choose not to)
identify reasons for an inability to
make a more specific diagnosis, yet clearly observe multiple
criteria from the anxiety disorders
classification.
Below is a summary of additional changes to the diagnoses in
this classification that may impact
individuals under the age of 18.
Social Anxiety Disorder (Social Phobia)
The preferred diagnostic descriptor is now social anxiety
disorder, reflecting a more specific
association with symptomology. Wording of criteria has been
altered to be more clear and
applicable across social situations and age ranges. For children,
anxiety must occur in peer
settings (i.e., not exclusively with adults); the requirement that

3. the child must exhibit a capacity
for age-appropriate social interaction with familiar people has
been removed. Also, consistency
across ages has been supported by the requirement of duration
to be at least six months (for all
ages) and by the deletion of the need for individuals over 18 to
recognize the fear is
unreasonable.
Separation Anxiety Disorder
This disorder—formerly included in disorders usually first
diagnosed in infancy, childhood, or
adolescence—has been moved to the anxiety disorders
classification and criteria descriptions
changed somewhat to reflect the core anxiety associated with
the disorder. The requirement for
2
onset has been removed (formerly under 18 years), being
replaced by terminology reflecting
“developmentally inappropriate” language. This change
supports the recognition of the
disorder’s existence in both children and adults, although
duration prior to diagnosis does vary—
at least 4 weeks in children and at least 6 months in adults.
Selective Mutism
This disorder—formerly included in disorders usually first
diagnosed in infancy, childhood, or
adolescence—has been moved to the anxiety disorders to
highlight the anxiety often associated

4. with the disorder. The core criteria remain unchanged.
Obsessive-Compulsive and Related Disorders
This classification—new to the DSM-5—recognizes the
similarities in presentation and
diagnostic criteria of disorders characterized by obsessions
and/or compulsions. The former
refers to thoughts that are persistent and intrusive, while the
latter denotes behaviors an
individual feels compelled to perform. This classification
includes obsessive-compulsive
disorder, body dysmorphic disorder (formerly included in
somatoform disorders in the DSM-IV),
hoarding disorder, trichotillomania (hair-pulling disorder;
formerly included in impulse control
disorders not elsewhere classified), excoriation (skin-picking)
disorder, substance/medication-
induced obsessive-compulsive and related disorder, obsessive-
compulsive and related disorder
due to another medical condition, other specified obsessive-
compulsive and related disorder, and
unspecified obsessive-compulsive and related disorder.
Several new specifiers have been added to diagnoses in this
group, including those pertaining to
degree of insight regarding diagnosis-related behaviors. This
change underscores the potential
for beliefs and perceptions related to the disorder to be void of
insight and/or delusional, while
differentiating between these characteristics and a potential
diagnosis in the schizophrenia
spectrum and other psychotic disorders.
As noted with the anxiety disorders, two new diagnoses have

5. been added that reflect non-
specific, yet classification-bound characteristics: other specified
obsessive-compulsive and
related disorder and unspecified obsessive-compulsive and
related disorder. Both of these
diagnoses represent significant clinical distress or impairment
based on obsessive-compulsive
and related disorder criteria, but do not meet full criteria for a
specific diagnosis within this
classification. Clinicians should use other specified obsessive-
compulsive and related disorder
with the specific reason for the more general diagnosis (e.g.,
body-dysmorphic-like disorder with
actual flaws or culturally associated behaviors). The latter
diagnosis—unspecified obsessive-
compulsive and related disorder—is used when clinicians
cannot (or choose not to) identify
reasons for inability to make a more specific diagnosis, yet
clearly observe multiple criteria from
the obsessive-compulsive and related disorder criteria
classification.
Below is a summary of significant changes to existing diagnoses
and brief descriptions of new
diagnoses.
Body Dysmorphic Disorder
3
This diagnosis has been moved to this new classification and
several criteria altered, including

6. specifications for repetitive behavior and preoccupied thoughts.
In addition, a specifier of “with
muscle dysmorphia” has been added, which denotes a persistent
belief that the individual’s body
is insufficiently developed in size and/or musculature. The
inclusion of the “absent
insight/delusional beliefs” specifier when applicable eliminates
the potential for a second
diagnosis of delusional disorder, somatic type that was possible
under DSM-IV diagnostic
criteria.
Hoarding Disorder
New to the DSM-5, this diagnosis is marked by significant
difficulty discarding or otherwise
parting with possessions. The stress associated with discarding
items causes an accrual of items
that eventually impedes normal functioning in a living area.
Hoarding characteristics may first
appear in early to mid adolescence, and have neurobiological
correlates. Individuals with this
diagnosis often have a comorbid mood or anxiety disorder as
well. It is of note that hoarding can
be a symptom of obsessive-compulsive disorder; however,
research shows that hoarding can also
exist in the absence of obsessive-compulsive disorder and has,
therefore, been identified as a
separate diagnosis.
Trichotillomania (Hair-Pulling Disorder)
The diagnostic criteria for this disorder have changed slightly in
the DSM-5, reflecting specific
language more closely associated with obsessive-compulsive
disorders (moving away from its
previous association with impulse control). Also, hair-pulling
disorder has been added

7. parenthetically for clarity.
Excoriation (Skin-Picking) Disorder
This disorder is new to the DSM-5 and is characterized
primarily by recurring skin picking
resulting in lesions and/or scarring. Attempts to decrease or
stop picking and significant distress
attributable to the skin picking are also diagnostic criteria. The
most common onset for the
disorder is during adolescence, and often begins with a
dermatological condition. It is also
commonly comorbid with obsessive-compulsive disorder,
trichotillomania, and depressive
disorder.
Substance/Medication-Induced Obsessive-Compulsive and
Related Disorder
This new diagnosis is defined by a combination of repetitive
behaviors characteristic of
obsessive-compulsive disorders—including obsessions,
compulsions, skin picking, or hair
pulling—that began during or immediately following substance
intoxication or exposure to
medication.
Obsessive-Compulsive and Related Disorder Due to Another
Medical Condition
This new diagnosis is defined by a combination of repetitive
behaviors characteristic of
obsessive-compulsive disorders—including obsessions,
compulsions, skin picking, or hair
pulling—that are a direct result of another medical condition.
Other specified obsessive-compulsive and related disorder, and
unspecified obsessive-
compulsive and related disorder.

8. 4
Reference:
• American Psychiatric Association. (2013). Highlights of
changes from DSM-IV-TR to
DSM-5. Retrieved from:
http://www.dsm5.org/Documents/changes%20from%20dsm-iv-
tr%20to%20dsm-5.pdf
© 2013 Laureate Education, Inc.
Case Write Up
Use the following structure for your report write-up.
State the Conclusion First
ne sentence (e.g., I
recommend that we/they do A.)
with data (e.g., …the decision should be taken because a, b,
and c...)

9. were
considered
each is measured
support each with evidence
support each with evidence
option
and long-
term
future given the statement
Suggestions for How to Read the Case
Study the
Situation
- risk.
case.
most important criteria.

10. Develop
Hypotheses
options
it
constituents
Proof and Action
case.
idence, quantitative
wherever possible.
–
state what will be done and when.
Evaluate
Alternatives
downside to the option you recommend.

11. option.
Submission Instructions
Go to Assignments to submit your completed case analysis.
Refer to the Course Schedule for
the specific date this assignment is due.
Criteria:
Weighting
Format of paper APA style
10%
Originality of ideas and research
10%
Use of literature (Citations and References)
10%
Clarity and logic of paper
10%
Grammar and Language
10%
Length of paper
10%
Introduction/Executive Summary and Background
20%
Action Plan
20%
Total
100%
Case Analysis Grading Criteria

12. Child and Adolescent Counseling Cases

13. Fears and Phobias
Week 3, Case 1
Zach is a 7-year-old white male who is deathly afraid of going
to the dentist. His parents report having tried “everything.”
Unfortunately, after a few initial visits, Zach began refusing to
go to the dentist after his fifth birthday. This problem
compounds itself as Zach has now developed poor dental habits
(he avoids brushing his teeth at home because it reminds him of
the dentist), and they have been unable to get him to open his
mouth for prolonged time periods at the dentist. Nevertheless,
Zach’s dentist has gotten a few peeks into Zach’s mouth and
believes Zach likely has several cavities.
Week 3, Case 2
Darrell is a 12-year-old African-American male. He was
referred for counseling by his parents. He does not want to
come to counseling and reports that he has a “stupid problem.”
Based on reports from his parents and from Darrell, Darrell is
extremely afraid of dogs. He lives a short distance from middle
school and, therefore, he walks there every school day.
Unfortunately, Darrell has come to have difficulty walking past
several houses that keep dogs in their yards. Even though the
dogs are fenced and do not appear especially aggressive, Darrell
will freeze and refuse to walk past these houses. He has tried
switching sides of the street and routes to his school, but to no
avail. This has left him and his parents and his friends
perplexed and frustrated. Darrell is ashamed of this problem and
of having to come to counseling. He has asked his parents to
call the other families to have them keep their dogs inside, but
does not really want to deal with the problem on any other
level.
Week 3, Case 3

14. Maria is an 18-year-old Latina female. She has been referred for
counseling by her parents and her high school counselor.
However, Maria is very willing to attend counseling because she
is in great distress. During one of her classes at school, Maria
was required to give a speech and the ensuing difficulties were
distressing for everyone involved. Despite the fact that she is
nearly a straight A-student, Maria insisted from the beginning
that she could not and would not give a speech in class.
Although she acknowledges that “it’s crazy” that she is so
afraid of the speaking assignment, Maria is convinced that she
will be unable to complete the assignment without humiliating
herself in front of the class. Even the thought of standing in
front of the class and giving a speech produces physiological
signs of anxiety and pleas for help in avoiding the speech
assignment.
Treatment Plan Guidelines
7m
As you work with treatment planning concepts for individual
cases, please use the following guidelines.
I. Identify a list of problems reported to you by the client and/or
caregiver(s).
II. As you are able, identify the primary psychiatric diagnoses
you believe may be present and may need to be addressed
(Note: In each problem-based chapter of the Erk text, DSM-IV-
TR diagnostic criteria for specific problems are listed. Please
also refer to the DSM-5 diagnostic update documents
provided.).
III. Based on these problems, describe the counseling goals in
the most measurable way possible (e.g., How will you and the
client be able to recognize that the problem has reduced or the
goal has been partially or completely been met?).

15. IV. Identify the level of care needed to address the presenting
problem(s). This could include:
a. Inpatient
b. Residential treatment
c. Partial hospitalization
d. Intensive outpatient counseling
e. Outpatient counseling
V. Based on counseling research and evidence, select a
treatment modality—individual counseling, group counseling,
family counseling, or a combination of these. (Note: In the Erk
text, there is a section in each problem-based chapter on
evidence-based treatments or treatment outcomes that you can
use to help guide your recommendations for treatment).
VI. Identify and describe how you will tailor the treatment to
the client’s unique individual and cultural background.
Exemplary
Proficient
Progressing
Emerging
Element (1): Responsiveness: Did the student respond to the
main question of the week?
9 points (28%)
Posts exceed requirements of the Discussion instructions (e.g.,
respond to the question being asked; go beyond what is required

16. [i.e., incorporates additional readings outside of the assigned
Learning Resources, and/or shares relevant professional
experiences]; are substantive, reflective, and refers to Learning
Resources demonstrating that the student has considered the
information in Learning Resources and colleague postings).
9 points
Posts are responsive to and meet the requirements of the
Discussion instructions. Posts respond to the question being
asked in a substantive, reflective way and refer to Learning
Resources demonstrating that the student has read, viewed, and
considered the Learning Resources and colleague postings.
7–8 points
Posts are somewhat responsive to the requirements of the
Discussion instructions. Posts are not substantive and rely more
on anecdotal evidence (i.e., largely comprised of student
opinion); and/or does not adequately demonstrate that the
student has read, viewed, and considered Learning Resources
and colleague postings.
4–6 points
Posts are unresponsive to the requirements of the Discussion
instructions; miss the point of the question by providing
responses that are not substantive and/or solely anecdotal (i.e.,
comprised of only student opinion); and do not demonstrate that
the student has read, viewed, and considered Learning
Resources and colleague postings.
0–3 points
Element (2): Critical Thinking, Analysis, and Synthesis: Is the
student able to make meaning of the information?
9 points (28%)
Posts demonstrate the student’s ability to apply, reflect, AND
synthesize concepts and issues presented in the weekly Learning

17. Objectives. Student has integrated and mastered the general
principles, ideas, and skills presented. Reflections include clear
and direct correlation to authentic examples or are drawn from
professional experience; insights demonstrate significant
changes in awareness, self-understanding, and knowledge.
9 points
Posts demonstrate the student’s ability to apply, reflect OR
synthesize concepts and issues presented in the weekly Learning
Objectives. The student has integrated many of the general
principles, ideas, and skills presented. Reflections include clear
and direct correlation to authentic examples or are drawn from
professional experience, share insights that demonstrate a
change in awareness, self- understanding, and knowledge.
7–8 points
Posts demonstrate minimal ability to apply, reflect, or
synthesize concepts and issues presented in the weekly Learning
Objectives. The student has not fully integrated the general
principles, ideas, and skills presented. There are little to no
salient reflections, examples, or insights/experiences provided.
4–6 points
Posts demonstrate a lack of ability to apply, reflect, or
synthesize concepts and issues presented in the weekly Learning
Objectives. The student has not integrated the general
principles, ideas, and skills presented. There are no reflections,
examples, or insights/experiences provided.
0–3 points
Element (3): Professionalism of Writing: Does the student meet
graduate level writing expectations?
5 points (16%)
Posts meet graduate-level writing expectations (e.g., are clear,

18. concise, and use appropriate language; make few errors in
spelling, grammar, and syntax; provide information about
sources when paraphrasing or referring to it; use a
preponderance of original language and directly quote only
when necessary or appropriate). Postings are courteous and
respectful when offering suggestions, constructive feedback, or
opposing viewpoints.
5 points
Posts meet most graduate-level writing expectations (e.g., are
clear; make only a few errors in spelling, grammar, and syntax;
provide adequate information about a source when paraphrasing
or referring to it; use original language wherever possible and
directly quote only when necessary and/or appropriate).
Postings are courteous and respectful when offering
suggestions, constructive feedback, or opposing viewpoints.
4 points
Posts partially meet graduate-level writing expectation (e.g.,
use language that is unclear/inappropriate; make more than
occasional errors in spelling, grammar, and syntax; provide
inadequate information about a source when paraphrasing or
referring to it; under-use original language and over-use direct
quotes). Postings are at times less than courteous and respectful
when offering suggestions, feedback, or opposing viewpoints.
2–3 points
Posts do not meet graduate-level writing expectations (e.g., use
unclear/inappropriate language; make many errors in spelling,
grammar, and syntax; do not provide information about a source
when paraphrasing or referring to it; directly quote from
original source materials or consistently paraphrase rather than
use original language; or are discourteous and disrespectful
when offering suggestions, feedback, or opposing viewpoints).
0–1 points
Element (4):
Responses to Peers: Did the student respond to peer posts and
contribute professionally?

19. 9 points (28%)
Responds to two or more peers in a manner that significantly
contributes to the Discussion.
9 points
Responds to one or more peers in a manner that significantly
contributes to the Discussion.
7–8 points
Responds to one or more peers in a manner that minimally
contributes to the Discussion.
4–6 points
Does not respond to any peer posts.
0–3 points
32 points
100%
25–28 points
78–88%
14–21 points
44–66%
0–10 points
0–31%
© 2015 Laureate Education, Inc.
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