Essay Prompts

You are working as a therapist at a college counseling center and have been referred a new student. When you meet with him, he describes that he has been experiencing a lot of anxiety and fear for his health. He described he has been having to leave his classes several times from fear that he is going to vomit. Sometimes he is flooded with images of him vomiting uncontrollably in front of everyone, and this experience makes him so terrified that he has to leave for the bathroom. When in the bathroom, he recounts how he then washes his face and hands for a few minutes, and his fear subsides. He recalls that he has always had a fear of vomiting since he was a little kid from when he came down with food poisoning, but lately, he has been more and more concerned with vomiting and staying healthy.

Your client says that he sometimes experienced this occasionally as an adolescent, but since he has come to college, the fear is much more frequent. He regularly avoids any kind of situation where he thinks he may get sick or may cause him to vomit. He describes how he avoids shaking hands with people, only eats food that he prepares that is ‘calming’ for his digestion, and washes his hands and face at least a dozen times a day in order to stay healthy. If he doesn’t do so, he describes feeling an overwhelming wave of panic that can prevent him from focusing or doing important life and school tasks. What single diagnosis do you think is most likely? What level of severity do you think it is? Why? What other information do you need to be more confident in this diagnosis? What other diagnoses would you want to rule out before settling on the most likely diagnosis?

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