Quiz time again!

A social worker is working with a 21 year-old transgender college student who has reported several panic attacks since starting university. The client has reported no known triggers and is doing well academically, however stating that it’s often accompanied by severe stomach cramps or indigestion. What should the social worker do FIRST?

A. Refer the client to the college’s LGBT center in order to address gender identity concerns that may be impacting anxiety.
B. Refer client to a psychiatrist to address anxiety with a regimen of medication.
C. Begin cognitive behavioral therapy to identify negative thoughts.
D. Explore with client follow-up with PCP to rule out gastro-intestinal diagnoses.

While the question mentions the client identifies as transgender, we can rule out A, since we don’t want to assume this is the client’s primary concern. Remember, you want to be where the client’s at, and without extra needed information, we can’t assume client’s adjustment.

B and C might be appropriate, but not until we get the whole clinical picture. Since there is evidence suggesting that clients with gastro-intestinal disorders (for example, irritable bowel syndrome, Crohn’s) often suffer from worsened anxiety symptoms, we want to make sure that this is ruled out as a concern aggravating client’s symptoms. This also aligns with the concept of ruling out medical concerns first.

While the anxiety could be triggered by additional stressors, medical concerns give us a more holistic picture of the client in their immediate environment and circumstances.

Takeaway Tip: Ruling out the medical takes priority in the person in environment perspective, and knowing about our client’s medical struggles can inform even better interventions and interdisciplinary collaboration.

Resources and References

IBS and anxiety:

https://adaa.org/understanding-anxiety/related-illnesses/irritable-bowel-syndrome-ibs

Interdisciplinary care:

http://newsroom.ucla.edu/stories/social-workers-and-medical-students:-the-ideal-team