Primary or Secondary
While the presenting complaint in the case of Charles appeared to be depression, it was quickly clear that this was secondary to his social anxiety. He was anxious and avoidant of social situations, as a result of which he suffered symptoms and feelings of depression, isolation, and hopelessness.
Additionally, although Charles is a white male identifying as American, his cultural background functions as an invisible factor in his social life. He said he felt most connected to people from Eastern European backgrounds, not American, but felt guilty talking about this because he understood the privileges he enjoys as a white male. He knew other cultural identities, other racial groups, experience much greater discrimination. He never felt like he fully belonged in either US or Eastern European cultures, but it felt disrespectful to complain about that.