Susan is nineteen years old and attends an appointment, accompanied by her mother, to request a sick note for university. Susan presents as a shy girl, avoiding eye contact and speaking as little as possible. Her mother explains that Susan has recently begun studies at the local university but although she was excited at the prospect, she has found the transition very stressful. As the weeks have gone on she has become more and more anxious and now cannot sleep and is unable to attend any classes. Susan’s mother explains that Susan has always found change of any sort very difficult. She doesn’t mix with her peers and whilst this did not seem a problem at her small local school where teachers helped her engage with group activities, university life has presented her with social demands that have provoked total withdrawal. Although Susan has followed her usual routine of catching the bus to university, she has not attended any classes for 3 weeks and instead reads alone in the library.