Clinical case review
Review the complete Psychology case, its five progressive clues, the diagnosis, and the clinical reasoning behind the answer.
Want to test yourself first? Play the original case before reading the clues and explanation below.
WhatsTheDx publishes a new Psychology case every day. Five clues, one diagnosis, and no account needed to play.
Play today's Psychology caseThese are the case findings in their original reveal order, moving from the broader presentation to the most discriminating evidence.
Clue 1
A 29-year-old woman is referred to a community psychologist by her primary care doctor. Twelve days ago she was working an evening shift as a pharmacy technician when an armed man held the store at gunpoint for several minutes before fleeing. She has not returned to work since, and when she enters the office she quietly asks to sit in the chair that faces the door.
Clue 2
Since that night she has had nightmares of the robbery and intrusive flashes of the gun that surge whenever a shop door chimes. She is hypervigilant and startles at sudden noises, sleeps only two to three hours, and now takes a long detour to avoid the street where the pharmacy sits. She had no psychiatric history and was working full-time and coping well until the incident.
Clue 3
On assessment her most striking feature is dissociation: she describes the world around her as unreal and dreamlike, briefly spaces out mid-sentence during the interview, and cannot recall a portion of the robbery itself despite having been present and physically unharmed throughout.
Clue 4
Using a structured clinical interview for trauma-related symptoms, she endorses 11 of the 14 possible symptoms, spanning intrusion, negative mood, dissociation, avoidance, and heightened arousal, comfortably above the diagnostic threshold, with clinically significant impairment in her work and social functioning.
Clue 5
Her symptoms first appeared on the third day after this single life-threatening event; today is day 12, and the complete picture has been continuously present since. Nothing predated the robbery, and it has now been well under one month since it occurred.
Diagnosis
This woman was exposed to a discrete life-threatening event and, since day three, has shown the full DSM-5 stress-syndrome picture: intrusion (nightmares, flashbacks), arousal (hypervigilance, startle, insomnia), avoidance, negative mood, and prominent dissociation (derealization, dissociative amnesia for part of the event), endorsing 11 of the 14 symptoms with marked impairment. The single decisive discriminator is timing: symptoms have lasted less than one month (onset day 3, now day 12), which places it in the 3-day-to-1-month window rather than posttraumatic stress disorder, whose defining feature is symptom persistence beyond one month. It is not adjustment disorder because the stressor is overtly life-threatening and she far exceeds the required symptom threshold, and the trauma-cued, non-spontaneous nature of her arousal separates it from panic disorder.
The explanation and decisive case findings were checked against the source below.
Open the clinical referenceFor education and entertainment only. This fictional case is not medical advice and does not replace supervised clinical training, diagnosis, or treatment.
