Craya is a 37-year-old Latina cisgender woman who is married to her wife of

10 years. Craya reports being happy in her relationship, and she and her wife share one child,

age 6. Craya was born and raised in the Twin Cities, and lives about 10 minutes from her family

home. She states that she has a "close and loving" relationship with her parents and two

siblings. Craya works as a website designer, and she has her BS in computer science.

Craya reports to Clinic X with complaints about "anxiety problems." As is standard for

Clinic X, she is given a battery of questionnaires and standardized interviews, including the C-

SSRS. She also undergoes a more flexible intake interview with a psychologist.

At the intake interview, she tells her psychologist that she has "always been a little

intense" and that she's been anxious most of her life. In the last three years, since the onset of

COVID-19, she has felt her experiences of anxiety worsen. She has begun to fixate on the

possibility of falling ill or contaminating her family. No one in her family has specific risk factors

for serious COVID, and Craya and her family have all been fully-vaccinated. Yet she has

repeated thoughts about being contaminated with COVID or another horrible illness. When she

has the thought that she is contaminated with an illness, she begins to worry that she will get

her family sick, and that her whole family will die of whatever illness she thinks she has.

Because this thought causes an unpleasant spike in anxiety, Craya has begun to repeatedly

google early signs of illness whenever the thought comes up. She spends several hours per day

googling signs of illness. Although she usually feels much less anxious immediately after

googling, an unpleasant about illness thought always comes back. She reports that the time

she spends googling takes away from work, requiring her to work nights and weekends to keep

up with her projects. This also means she has less time to spend with her family, and she has

stopped seeing friends altogether.

Craya tries not to have these thoughts. She avoids the news, and she tries not to walk

by the pharmacy on her way home from work because the pharmacy always prompts thoughts

of testing for an illness. However, the thought about being contaminated invariably comes

back. Every time this thought arises, she gets the urge to google early signs of illness and check

if she has any symptoms. Craya has begun to feel quite down about this thought and behavioral

pattern. She doubts herself, experiences feelings of being sad or depressed, and noted that she

is "more quick to anger" than before.

Although Craya's friend and family circle all were concerned about COVID-19 pre-

vaccination, she reports that she seems to be the only person holding onto this intrusive and

upsetting thought of being contaminated. She told her psychologist that "everyone else seems

to have gone back to normal. The problem is, I don't know how to stop worrying about being

Contaminated."

1. Which DSM-5 disorder is it most likely Craya has, based on the presented facts of the case? Elaborate

2. Are there any differential diagnoses you'd want to consider before diagnosing Craya with the answer to question 1. In other words, are there other disorders you think it might be? Or other comorbid disorders that she might

have? Elaborate

3. What is the yearly and lifetime prevalence for the disorder that Craya most likely has? What is the prevalence information related to various demographic groups (e.g., are men more likely than women to have it? Is there a

racial bias in diagnosis)?

4. What is the typical age of onset for this disorder? How about its course?

5. Consider C-SSRS, one of the measures given to Craya? Why might her psychologist have given it to her?

6. How might Craya's answers on the C-SSRS impact course of intake interview and treatment? Focus on the role of risk assessment and management, based on response to C-SSRS.

7. What is the role of googling in this case, and how does it relate to the thought of being contaminated?

8. What treatments suggested are evidence-supported for this disorder?

9. Although exact causes of mental health concerns may vary from person-to-person, what do the textbook and the lectures suggest might be some possible causes of Craya's difficulties (e.g., specific biological and environmental mechanisms)? List at least three possible contributing factors, and explain your reasoning and your source of information

10. What is required for all mental health concerns to reach the level of diagnosis? Do you have evidence that Craya meets each of the three required elements? Explain your answer for each of the three building blocks of

mental health diagnosis. (2 points