Case Study
Patient Demographic: Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography
Presenting Problem: You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.
Other Contexts: use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends

Question: Although pornography addiction is not a DSM-5-TR diagnosis, based on what you know about the client, which of the following is the most likely reason that he engages in frequent masturbation?
(A): Loneliness
(B): Self-esteem
(C): Anxiety
(D): Obsession/compulsion

Correct Answer: Anxiety
Explanation: Masturbation can relieve this client’s aforementioned stress and tension, and therefore anxiety, through the release of hormones such as dopamine, endorphins, and others that improve mood and physical feelings. Those same “feel-good” hormones might also temporarily improve how the client feels about himself; however, self-esteem is not an issue that has been indicated at this time. Loneliness is not indicated in this client’s case either; however, an individual who feels alone might use pornography to feel a connection to other humans. The client’s behavior does seem to be compulsive, but it is not this client’s most likely reason for masturbation. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis