Mrs. Spinner is a 46 year old woman who was referred by her husband who described “attacks” of dizziness that his wife experienced that left her incapacitated. She described being overcome with dizziness and nausea 4-5 times a week, when the room would begin to “shimmer” and she had the feeling that she was “ floating” and could not maintain her balance. The attacks almost always occurred at about 4PM, after which she had to lie down until 7 or 8PM. After feeling better she would spend the rest of the night watching TV, would fall asleep on the couch and go to the bedroom at around 3AM.
The patient was evaluated medically and all tests were negative. She was in fine physical condition. When asked about her marriage she stated that her husband was abusive verbally and demanding of her and her children. She admitted that she dreaded his arrival home from work each day. When she was unable to make dinner, her husband and children would have to go out to eat. He came home, watched TV and had no conversation with his wife.
What is her diagnosis?
What are the symptoms that helped you make this diagnosis? What diagnostic criteria do they relate to?
What are two other possible diagnoses and why did you not choose them?
How would Mrs. Spinner respond to psychotherapy designed to address her “emotional” problems?
What therapeutic approach would you consider and why?
What is her prognosis?