Diagnose Carlos. Use the DSM, and use AEB. Discuss and debate. Make a case using a list format so it is easy to see how to align the criteria with Carlos's signs and symptoms. What is a differential diagnosis and what might a differential be for Carlos? The diagnosis will be found in the DSM-5 under Anxiety Disorders.

Carlos is a 54-year-old divorced father of two adult daughters. His history of mental health services is limited to couples counseling that he attended with his wife before they divorced 10 years ago. Carlos has an MS in computer software and is an IT consultant who can work remotely. Carlos reports that about a year ago he was at work one afternoon when he began to feel tense and anxious for no reason. He says he became short of breath, began to feel faint, and that his mind began to race. These symptoms only lasted a few minutes and then went away; however, he says he had a few more experiences just like this one over the next few weeks and months (each one "coming out of nowhere"). These symptoms began to grow worse, beginning about four months ago. Carlos says he woke up one night with the feeling that he was choking or being strangled, and he could not catch his breath. He said he also felt very frightened, and thought he was going to die. He drove himself to the emergency room, thinking he was having a heart attack. He was sent home after it was determined that his heart was fine, and then two days later he had another attack while driving to work. This episode was so severe that Carlos had to pull over to the side of the road, and again he says he felt frightened, was short of breath, was sweating, and he felt nauseous and sick to his stomach. He says this attack was totally unexpected, and that after 20 minutes or so it gradually went away, and he went on to work. Since the event in the car, the 'episodes' have become fairly regular, although Carlos can't tell when the next one is going to happen. In the past month, for example, he has had at least two severe episodes per week, occurring at various times (some at night, others during the day, etc.). Carlos also says the episodes appear to be increasing in intensity as time progresses. For example, he says, "When they first started, they scared me, but I could handle them pretty well. Now, they're out of control. I honestly thought I was going to die when I had the last one a couple of days ago - I couldn't breathe, I was feeling crazy, and my mind was running 100 miles an hour. hour. Now, all I do is worry about the next one."

As a result of these episodes, Carlos reports he has changed his lifestyle a great deal. For example, he says that for the past three weeks he has essentially been home bound, not wanting to leave his house for fear of another episode happening. He is working exclusively from home and keeps making excuses not to go into the office. He left home recently to visit his doctor for an evaluation, however Carlos shares that while waiting in the doctor's office he found himself becoming nervous and fearful because of how crowded the office was, he became more fearful as he wondered how he would escape or get to his car if he were to have another episode. Carlos said, "I feel like I would have an attack and not be able to get out, I would be frozen in place and not even be able to tell someone I needed help. It would be so embarrassing." Carlos says that this nervousness about public and crowded spaces was never a problem for him until he started having these 'episodes.' The fear is even worse when it is a place with a lot of closed doors - which is how the doctor's waiting room is set-up. Carlos relates that he has been ordering more and more things from home so that he does not have to go shopping or do other errands because it just feels too terrifying. Carlos did one shopping errand when his daughter visited, but he was embarrassed to need the help. While Carlos is able to work from home, he used to go to the office once or twice a week and he has not done that for weeks now. Carlos shares that he is very shaken, sad, and embarrassed by what is happening as he has been unable to go to his Wednesday night card game because it's usually in the basement of one of his friend's home. He knows he will feel too trapped. Carlos says, "I've been going to that card game almost every Wednesday for 10 years. I miss it so much, but I just can't. I don't know how much longer I can keep giving the guys excuses."

A diagnosis of panic disorder was considered but eliminated as Carlos does not meet all the criteria.

A - (recurrent unexpected attacks - 4 or more) AEB Carlos describes panic attacks and meet

A1 - (palpitations) - NO - does describe feeling like having a heart attack - but symptom is better applied elsewhere).

A2 - (sweating) - AEB Carlos reported that he had to pull over during an episode and was "sweating"

A3 - (trembling) - n/a

A4 - (SOB) - AEB -Carlos reports stated that during at least two episodes that he felt "short of breath."

A5 - (choking) - AEB - Carlos reported that he woke up from an attack feeling like he was "choking or being strangled."

A6 - (chest pain) AEB - Carlos drove to the hospital because he felt like he was having a "heart attack."

A7 - (nausea) - AEB - AEB Carlos reported that he had to pull over during an episode and was "nauseous."

A8 - (faint) - AEB Carlos reported that during an initial episode he felt "faint."

A9 - (chills) - NO

A10 - (numbness) - NO

A11 - (derealization) -

A12 (fear of losing control) - NO

A13 - (fear of dying) - AEB - Carlos stated 'I thought I was going to die."

B - (at least one month or more)

B1 - (persistent worry about consequences) - AEB - for the past month, since the episode in the car

B2 - maladaptive changes