Diagnosis: Eliza Petrova

Supporting Evidence (Initial Data)

• Parent reports intense fear of vomiting (self/others) as central issue.
• Significant avoidance behaviors: food restriction, social/school event avoidance, public restrooms.
• Frequent reassurance seeking and potential contamination fears/rituals (checking, washing).
• Triggered/exacerbated after stomach bug ~1 year ago.
• Spence Scale: Highly elevated Physical Injury Fears subscale (>99th percentile).
• High functional impairment reported across domains (FMHC, parent narrative).

Representative DSM-5-TR Criteria

• Marked fear or anxiety about a specific object or situation (vomiting).
• The phobic situation almost invariably provokes immediate fear or anxiety.
• The phobic situation is actively avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual danger posed.
• The fear, anxiety, or avoidance is persistent (onset ~1 year ago fits typical duration).
• Causes clinically significant distress or impairment in social, occupational (school), or other important areas of functioning.
• Not better explained by symptoms of another mental disorder (e.g., panic disorder, OCD, social anxiety related to scrutiny).

Rationale / Clinical Impression

Appears central, driving most symptoms and impairment. Intensity, specific trigger/focus, and avoidance patterns strongly align.

Supporting Evidence (Initial Data)

• PCP diagnosis documented.
• Parent reports constant worry ("Always" on scales).
• Spence Scale: Highly elevated Generalized Anxiety subscale (>98th percentile).
• Reported perfectionism and potential catastrophic thinking.
• Some associated somatic symptoms endorsed (nausea, restlessness, fatigue, concentration difficulty - from FMHC/MFQ).

Representative DSM-5-TR Criteria

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities.
• The individual finds it difficult to control the worry.
• Anxiety/worry associated with 3+ of: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance (child needs 1+).
• Clinically significant distress or impairment.
• Not attributable to substance/medical condition or better explained by another mental disorder (e.g., worry only about phobic situation).

Differential Considerations / Key Questions

Key Question: Is the worry truly generalized across multiple domains, or primarily focused on illness/vomiting and its consequences? Need direct child assessment to determine breadth of worry.

Rationale / Clinical Impression

PCP diagnosis and high GAD scale scores support this, but requires confirmation that worry extends significantly beyond the primary phobia.

Supporting Evidence (Initial Data)

• Spence Scale: Highly elevated Obsessive Compulsive subscale (>95th percentile).
• Reported behaviors: Excessive handwashing before eating, checking food expiration/cleanliness, frequent reassurance seeking.
• Parent notes difficulty getting "bad or silly thoughts" (vomit/contamination) out of head, possible mental rituals ("special thoughts").
• Need to do things "just right" related to food/safety.

Representative DSM-5-TR Criteria

Differential Considerations / Key Questions

Key Question: Are the repetitive behaviors/thoughts primarily functioning as safety measures to prevent the feared outcome (vomiting/illness) – more aligned with Specific Phobia – or are they aimed at neutralizing distinct, intrusive obsessional thoughts, characteristic of OCD? Assess distress if rituals are prevented. CY-BOCS recommended.

Rationale / Clinical Impression

Significant overlap with emetophobia safety behaviors. The *function* of the rituals is the key differentiator.

Supporting Evidence (Initial Data)

• Spence Scale: Highly elevated Social Phobia subscale (>90th percentile).
• Avoidance of social events with food (parties, cafeteria), group activities.
• Parent reports fear of "making a fool of herself" (specifically by vomiting) and worries what others think (if she looks ill).
• Described as shy, reserved with new people.

Representative DSM-5-TR Criteria

• Marked fear/anxiety about social situations involving possible scrutiny by others.
• Fears acting in a way or showing anxiety symptoms that will be negatively evaluated.
• Social situations almost always provoke fear/anxiety and are avoided or endured with intense distress.
• Fear/anxiety is out of proportion and persistent.
• Causes significant distress/impairment.

Differential Considerations / Key Questions

Key Question: Is the fear of negative evaluation *specifically* tied to the possibility of vomiting/showing illness symptoms in public, or is there a broader fear of social scrutiny across various situations?

Rationale / Clinical Impression

Symptoms appear closely linked to emetophobia; need to assess if social fear exists independently of the primary phobia.