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(E) The patient reports that the symptoms started 4 months ago and are getting worse

(D) The patient feels that her fear is irrational and her anxiety is needlessly excessive

(C) The patient discovers that public speaking only bothers her when she drinks coffee

(B) That she had a lead role in the school play, has good grades, and plans for college

(A) The patient reports that her father makes her anxious when he drives her to school

A 17-year-old African-American female comes to your clinic because she has trouble with public speaking. She is close to graduating high school but has been hampered in class by her inability to give effective oral presentations. She has always been regarded as "shy," but recently opted to receive an F for a class presentation instead of delivering the speech. She was a healthy child, received all of her vaccinations, and did well in grade school. She rarely goes on dates, but does have several close friends with whom she spends time.

Past medical history is significant for sporadic migraine headaches, a condition she has used on numerous occasions to avoid social gatherings where unfamiliar people might be present. She has never been admitted to the hospital. She has no psychiatric history. She has never had any surgery. She is not taking any prescription medications, but does take a multivitamin daily. She is not allergic to any medications. Family history is significant for "shyness". She does not smoke, drink alcohol, or use any illicit substances. On review of systems, she does report occasional palpitations, subjective shortness of breath, and diaphoresis when confronted with public scrutiny. There was a time in high school when she panicked after being asked to take a speed test during her typing course in front of classmates. Physical examination is unremarkable. She appears to be a healthy young woman. Screening laboratory tests were normal, including glucose and thyroid function. The finding, which would be most consistent with a diagnosis of social anxiety disorder, is

Question 10 of 40

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