Question

What would be the diagnosis and treatment?

Peter is a 40 year old male who came to the office with complaints of anxiety, sadness, nightmares, and difficulties concentrating. He also reported poor memory, low libido, feelings of guilt, despair, hopelessness and helplessness and occasional suicidal thoughts. In addition, he has difficulties in his marriage. He had been married for 10 years to a woman 15 years his senior. His wife is a very attractive woman, who looks younger than her age. For over three years he has been unable to have sexual intimacy with her, but he added he always had sexual difficulties in his marriage to her. Yet, he says he loves her and she is “the most beautiful woman in the world for him”. He had quit his job after suffering a severe stress reaction when his boss ridicule him in front of other managers and told him he would never amount to anything. His mental status revealed a slightly overweight male superficially pleasant, but guarded. He was restless and constantly moved in his seat. His mood was anxious, depressed and angry and his affect constricted in range. He denied psychotic symptoms and his thinking was linear and goal directed. He reported occasional suicidal thoughts with no plan.

In terms of history he reported a lonely and difficult childhood. His father was aloof and uninvolved and his mother was physically and sexually abusive of him. Her sexual seduction and subsequent abuse started during late elementary school and lasted until early adolescence. As soon as he could, he left his home, joined the Marines and began his adult life. He was able to do well in the military. Upon discharge he went to college graduating with a business degree and found a job in management. He had a couple of long-term relationships while in college, but never thought about marrying until he met his wife. However, during his first major professional job, a “sadistic, mean boss” drove him to the verge of suicide. He left that job and since then (now 5 years) he has been unable to go back to work. He has difficulties with sleep, overeats, has frequent nightmares, intense startle response, and his anxiety is “over the top”. He has been on various SSRIs medications with only limited success, and wants therapy to help him sort out his problems.

Answer 1

The diagnosis for the present case would be Major Depressive Disorder with comorbid anxiety issues and overeating problems

The SSRIs he has been taking are a type of antidepressant and help with depression and anxiety-related issues.

It has been seen that people only taking medications do not get that extent of relief as the people who take medications coupled with therapy to help them achieve proper treatment and relief from their condition

The treatment suitable for Peter is that he should be put under a therapist who can use the approach of Cognitive Behavioral Therapy as that would help the client to recognize his own distorted thought pattern, and work towards them with the help of a therapist. CBT helps in also treating clients who have suicidal thoughts and tendencies. The client in the present case can also be put under medication using some other drugs other than SSRIs as he has been on them for a long time and they might not be effective for him now. Changes in medications as well as using CBT approach can be very helpful for him.