Integrative Psychotherapy in Adult Developmental Dyslexia with Secondary Anxiety: A Case Report

Developmental dyslexia is typically identified during childhood, but some individuals remain undiagnosed until adulthood, particularly when intellectual functioning is average, and compensatory strategies allow academic progression. In such cases, literacy-related inefficiencies may become clinically significant when occupational or interpersonal demands increase, leading to anxiety, avoidance, and functional impairment. This report describes a 26-year-old male presenting with longstanding reading and writing difficulties associated with marked anxiety during written communication and interpersonal conflict. Assessment revealed average intellectual functioning with reduced processing speed, persistent literacy-related deficits across reading, spelling, writing, and phonological processing domains, along with moderate anxiety symptoms. Findings were considered suggestive of developmental dyslexia with secondary anxiety-related difficulties. Treatment was based on a formulation-driven, integrative approach combining cognitive-behavioral therapy, functional analysis, compensatory skill training, graded exposure, and interpersonal interventions. Therapy focused on reducing avoidance, improving efficiency in literacy-dependent tasks, and addressing maladaptive beliefs related to performance. Following the intervention, anxiety severity decreased, engagement in written communication improved, and interpersonal difficulties reduced. This case highlights the clinical usefulness of an integrative, formulation-based psychotherapy approach in adults with previously unrecognized dyslexia. It emphasizes the importance of addressing both neurodevelopmental vulnerabilities and secondary emotional responses.