A/N: I do not own twilight

Sorry this chapter took forever to write even though it's pretty short. Had a lot going on, but I will try update more often now.

Like I promised before, here is another "Special Chapter" of BtB.

Chapter 14

Dr. Liam POV

Illinois Department of Human Services

Outpatient Case Management Monthly Psychiatric Report

Date: September 2, 2009 Mental Health Care Provider: Avery, Liam William PhD., MD

Patient Name: Cullen, Edward Anthony PhD. Occupation: Neuropsychologist/Educator

Date of Birth: June 20, 1977 Age: 32 Sex: Male Residence: Chicago, Illinois

Case Number: 00214672611 Case Manager: Kate A. Garrett

Diagnosis: Post Traumatic Stress Disorder (DSM-IV-tr Axis I) including moderate to severe panic attacks and mild to moderate depression.

Frequency of Sessions: Once a Week Pharmaceutical Treatments: Alprozolam (Xanax); Clonazepan (Klonopin)

Over the course o the last year the patient, Edward, had been showing signs of improvement with his overall diagnosis. Symptoms of depression have shifted to a more mild diagnosis over time. Although he still suffers from some nights of insomnia, fatigue, and inappropriate guilt from his ordeal, the patient's weight has increased due to now maintaining a regular eating pattern after meeting with a nutritionist, his psychomotor agitation is no longer as noticeable and recurrent thoughts of death have all but diminished. Since beginning our sessions five years ago, his involvements with social engagements and obligations have still caused anxiety, but he and I have noted that his panic attacks have been decreasing in their frequency. There is still disinterest in a majority of activities, but not as much as when patient was first entered into therapy. There have been changes in the patients' social relationships that have improved his overall state of mind. One major social attachment that has proven to be beneficial with his transition into a comfortable routine has been with his co-workers at the university, a couple that he had mentored while they received their Master's degree. Outside of his family, they have been the only source of continued support for him. However, with the absence of his closest friends for the last two months due to their recent elopement, his interactions have decreased, yet he had actively made the decision to not seclude himself in their absence as he would have done otherwise in the past. He maintained his obligations for speaking engagements and mentioned to have ventured out to eat in the public on his own on several occasions. This is a vast improvement which shows signs that his condition is possibly heading towards recovery, not entirely of course, but to a level where he will eventually not be dependent on his prescriptions and will begin to make further social relationships with others.

Edward has still been suffering from bouts of insomnia and severe nightmares that involved aspects of his incident from ten years ago, which coincides with his diagnosis of PTSD. During the first two sessions of August, patient openly discussed memories of the frequent nightmares, often revolving around certain memories of brutality. He did acknowledge that waking from these dreams left him shaken and a majority of the time emotionally broken to the point of tears. I noted that when he began to mention the other party of the incident from his memories during these revelations, signs of panic attacks would start to appear, and he would cease any further discussion and change topics to focus on aspects of his work, umcoming speaking engagements or his older brother's impending nuptials.

At our third session for August, there was a notable change with the patient in his physical appearance as well as his emotional state. It appeared that there were less noticeable dark circles around his eyes, and his skin appeared to not be as pale as it usually was. The patient admitted to attending a social function held by his parents the night before, and that his current state was due to the events that transpired that evening. In previous experiences, attending this social engagement brought about great stress with the number in attendance due to light agoraphobia associated with his PTSD. Patient admitted to taking the prescribed Xanax and consuming alcohol while in attendance at the start of the evening, in order to "numb" him in attempt to ease his anxiety ahead of time. After further inquiry, the patient also admitted to have made another social connection with a female who was in attendance at the social function. Edward indicated that he had been distracted with her presence after he first took notice of her that he removed himself from the event briefly. He feared that what he felt was possibly an anxiety attack, and hid him away in attempts to avoid disturbing others in attendance. He informed me that he quickly returned to the party and soon after was given the opportunity where he could converse with this woman in private.

The female in question, whom he called "Bella", was there due to being accepted as part of an education fellowship that the patient oversees at the University of Chicago. In previous experiences, because of his incident, the patient typically would not make personal connections with members of the opposite sex since being in close proximity would eventually cause severe panic attacks to arise brought on by flashbacks. Because of this, the patient has not been involved in a sexual relationship since his incident.

After inquiring further, the patient openly admitted to a physically attraction to "Bella". Going into quite a bit of detail in regards to her appearance. There were several moments where the patient would take extended pauses in speaking which appeared to be moments of reflection. When mentioning their interaction the previous night, facial indicators and body language showed signs of relaxation and ease. It is my belief that there is a possibility that the patient is showing signs to make a more dominate connection with "Bella." This is an area which we will need to discuss further if a stronger relationship should occur in future sessions.

Patient also admitted to having slept through the night before our session with no interruption of nightmares or flashbacks. There was no mention as to if there were particular dreams he may have had and their themes, which we may need to attempt another session of hypnotherapy to explore. Before the session ended I inquired about his medication intake, to which he admitted forgetting to take his prescription for the day. After noting that in his file, I was aware that there had been no mention of a panic attack within the last week. Taking into account his current state of mind and the admission of no medication being taken, I suggested talking about decreasing his intake for our next session. I informed the patient that he would need to continue his regular dosage until then.

Being aware that there would be further interactions with "Bella" during the rest of the week, I offered my mobile telephone number in the case that there he would experience a panic attack. I had been expecting a call later on the week, but midday on the Monday after our session, Edward called my number out of breath. He informed me that earlier in the day he did in fact have a panic attack in the stairwell of the building he worked in, which lasted around 15 minutes where he had severe chest palpitations, shortness of breath, dizziness, and mild nausea. He attributed the attack to stress from earlier meeting in the day. His voice indicated that was probably not the true reason, but I decided to not push further. Before he called, he told me that he had just completed presenting to his research team at the university, which "Bella" is a member of. He said that he was having a difficult time breathing afterwards and secluded himself from the others in the room and called me. It is my belief that "Bella" is the reason behind these episodes, for reasons attributed to his trauma.

On Wednesday of the same week, I received another phone call from the patient. He was in emotional distress as he spoke to me with rushed words. "Bella" had just left his office after a meeting they held that morning in his office. According to Edward, he needed to provide her with his outlines and lectures for a class she would sit in as a TA for and he provides her with the materials she would need to assist. He also wanted to apologize for an accident that had occurred between the two of them on Monday. He was taken aback when she arrived at his office and informed him of her intent to leave because she felt that she was not right for the position she was given. He admitted that he was finally able to convince her, but felt hurt that she had thought to leave. He said that he would feel extreme amounts of pressure and would have too many obligations without her assistance that it would trigger an attack. As he spoke there were several instance of stuttering and speech breaks to indicate insecurity, uncertainness, and denial. From this conversation it was evident that Edward has a strong romantic attachment to "Bella" and that was the cause of the hurt he felt. Although a romantic relationship for him at this time may not be in the best interest for his treatment, the brief interactions the two of them have had has brought up some positive changes in the patient where he has been able to sleep without interruptions for a few consecutive nights and more interest in becoming social. Edward admitted to partaking in lunches on campus that week with fellow professors rather than eating meals in his office, and also more nights out to dinner with the couple he works with on his research team. Since his incident, the patient's interactions with his family had become strained and had only attended past functions when he felt that were unavoidable. In a phone conversation on Friday of the last week of August, he confided in me that he was seeing his mother and father after our sessions, which I encouraged. By strengthening familial ties, he will eventually strengthen ties with others.

On the last in-person session for August, we discussed decreasing the patient's intake of the Xanax prescription and also the possibility of taking a milder SSRI. I prescribed klonopin as a new alternative as it would not be as strong as the Xanax and would allow him to take less throughout the day. By doing so, the patient can eventually become less dependent on the medication, with help from regular therapy sessions and practice in stress management. I also suggested that in some sessions down the road to attempt hypnotherapy sessions again in order to look deeper into some hidden memories from his past and as part of a dream analysis, to which he agreed to. There had been previous attempts with his former therapist, and a few attempts in our first sessions that proved little success due to severe panic attacks arising. Since then there has been an improvement with his condition that there may be a possibility it may prove to be successful or at least more beneficial. Patient has also agreed to keep a journal documenting events that occur right before any panic attacks that he has, and to bring it in to our sessions to discuss.

It is my belief that the combination of these practices will help with finding a pattern to his symptoms and possible triggers. Also, I belive that at this time there is a common trigger to the most recent events, which is also a catalyst for the patients' current improvement.

"Bella."

Reader Questions

Q. Will Jasper and Alice ever meet?

A. Yes, but I will not say when. Patience is a virtue... ;)

Q. Does the relationship with Edward and Irina have something to do with Edward's condition?

A. Yes.

Q. Is Jacob secretly gay since he never slept with Bella?

A. No. As of right now, the only gay character in BtB is Mike Newton.

Just because Jacob had no interest in sleeping with Bella does not make him gay, he has his reasons.

This situation will be made clear in future chapters.

If there are any questions that you may have, please post them in your reviews or PMs to me.

I will try and answer what I can.

Also, I have started a new story. It's a side project called "Streets of Blood." It is going to be very dark with very mature content.

For now the prologue is the only thing up.

You can find the link to the story on my author profile page.

Next Chapter of BTB we will hear from Bella.

Please keep sending in your reviews, I love every one I get!