A 32-year-old man presents describing an intense fear of ger…

A 32-year-old man presents describing an intense fear of germs. He continually experiences thoughts about contracting an illness by coming into contact with things in the environment, such as doorknobs or seats in public places. His intense fear of germs has resulted in repetitive hand washing. He describes brief relief after hand washing but, because his thoughts about contamination keep returning, he states that he “cannot help but wash again for hours a day.” Both of his hands are red, raw, and cracked and he had to leave his job because of his fear of sitting down in public places. He has been taking a serotonin reuptake inhibitor since age 26 without any appreciable effect, and he has not recognized that his thoughts and behaviors were irrational. He also exhibits a high level of impulsivity.

For the vignette, please give a diagnosis and bullet point t…

For the vignette, please give a diagnosis and bullet point the symptoms that made you come to the diagnosis. Elise is a 35-year-old architect. She comes to you in great distress, feeling that she is unable to work, and generally unable to function. She says that she feels tired all the time, to the point of feeling completely exhausted. She says that she cries easily, and almost every day. She is having difficulty sleeping and has lost 20 pounds in the last 2 months without trying. She says that things have been “real bad” for the last 2 months; she doesn’t enjoy doing anything and thinks frequently of suicide. However, she also says that she has never been a very happy person. She says that things rarely go right for her, and she has given up on expecting good things to happen for her.