Question

To complete each assignment, you will need to read the case study. Assume that the client described in each case study meets criteria for a DSM-5 disorder. You will then consult the DSM-5 criteria and write 1-2 detailed paragraphs in which you assign a primary diagnosis for the client and justify that diagnosis. In this section you should reference EACH of the DSM-5 criteria for the diagnosis you are assigning and provide evidence from the case study for or against the presence of that criterion. If you have no information for a particular criterion you should specify this. For example, if the DSM-5 criteria specify that the symptoms cannot be accounted for by a medical condition and you have no evidence that the client has a medical condition that would explain their symptoms, you should state this. Next, write a paragraph in which you provide an example of at least one related diagnosis that you are ruling out based on the information you have. This is a process called “differential diagnosis.” As you know, the categories provided in the DSM-5 do not represent “true” categories in nature, and often clients will often have symptoms in multiple categories. As a clinician, you need to rule out other categories or explanations for the symptoms. For example, if someone is experiencing panic attacks in the wake of a traumatic event, you might consider the diagnoses of Posttraumatic Stress Disorder, Acute Stress Disorder, or Panic Disorder. The DSM-5 criteria will help you figure out which is the most appropriate diagnosis, and you should specify why you are ruling out another disorder, providing specific justification for ruling it out. The best disorders to rule out are those that share features or symptoms described in the case but are not the best diagnosis for the client. Finally, you will write one paragraph in which you may specify the use of a psychosocial treatment, a psychoactive medication, or both. You must briefly describe how this treatment works and you must justify your choice of treatment based on the research evidence for the efficacy of the treatment.

Case Study #1

Linda is a 36-year old, Afro-Latina, married insurance executive living in the Northeast United States. She has been experiencing symptoms of anxiety since she was in high school, but they have recently become much worse after the birth of her second child, a son, 4 months ago, prompting her to seek treatment. She says that for the last 4 months she has felt keyed up, anxious, and “on alert” almost constantly. She has difficulty sleeping, significantly diminished concentration, and is irritable. In addition, several times a day she has “attacks” that involve involve “full terror.” The episodes last for about 10-15 minutes each, and usually involve profuse sweating, muscle tension, increased heart rate, feelings of dizziness, trembling, intense fear, and crying. When asked what triggers these episodes, Linda says that they usually occur when she is at home alone with her infant son or when she has memories of his delivery, during which she suffered a rare complication (she learned after delivering that both she and her baby could have died during the delivery). She tries very hard not to think about the delivery, but images and memories of it pop into her head frequently. In addition to these episodes of “terror,” Linda says that since her son’s birth she feels worthless, ashamed, and guilty for not “bringing him into a safe world.” She also states that she feels sad much of the time, and is detached from her son (she does not feel she has bonded well with him). Linda has started to sometimes call out sick from work when she has the sense that she is “having a bad day” and might have an episode, and she says she is increasingly withdrawing from her son because she finds that being with him triggers her anxiety. She says that she feels “utterly alone” and avoids hanging out with other mothers of infants because she finds they cannot relate to her experiences. Linda does not use any substances or have any medical conditions that could explain these episodes.

Answer 1

The symptoms of Linda are:

• Anxiety
• Difficulty in sleeping (insomnia), significantly diminished concentration, and irritability.
• Episodes of ''attacks' that lasts for 10-15 minutes during which she sweats profusely, her muscles get tensed, her heart beat increases, feels dizzy, trembles, feels scared and crying.

Cause for Linda's distress and impairment is learning that she had a complication in delivery that could have taken her and her child's life. Since, then the memory of delivery brought up issues and problems in her life. Now she is not able to look after her child, she feels guilty and ashamed for not bringing her child safely into the world. Her thoughts regarding the memory of her delivery compulsively revolves in her mind, especially when she's is alone at hime with her child. This is hindering her bonding with the child, she avoids her child, and mothers of infants because she feels they cannot understand her experience. This makes her feel lonely. These symptoms have started effecting her work as she has call off from work when she feels she could have an episode of attack. These signs and symptoms for a psychological distress is present from last 4 months, since the birth of her child.

The symptoms of Linda indicates that she is having a Post Traumatic Stress Disorder, as her conditions meets the criteria of DSM 5 of PTSD.

• Criterion A: Learned about a threatening situation that could have caused the death or posed danger to the life of a dear one. Linda came to know about the rare complication during the birth of her child that posed threat to both the lives.
• Criterion B:
  • Upsetting memories that keeps on coming consciously or unconsciously. Linda cannot keep off the memories, which comes to her mind frequently even if she tries to avoid them.
  • Strong bodily reaction upon exposure to the memories of the traumatic experience: Linda experiences attacks that last 10-15 minutes, during which she feels strong bodily reactions and feels agonized.
• Criterion C: Avoidance of people and things associated with traumatic event. Linda avoid her infant, feels detached towards him, and also, avoids the mothers of infants like hers.
• Criterion D:
  • Elevated self blame: Linda blames herself for not bringing her child safely into the world.
  • A negative emotional state that pervasive: Linda feels angry ashamed and scared pervasively.
  • Feels detached from others:Linda feels detached towards her son, and feels lonely.
• Criterion E:
  • Feeling constantly "On guard": Linda constantly feels " on alert" and is anxious persistently.
  • Irritability: Linda feels irritated all the time.
  • Trouble sleeping: Linda has sleeping trouble.
  • Difficulty in concentration: Linda feels her concentration has diminished significantly.
• Criterion F; The above symptoms being experienced by more than a month: Linda is experiencing these symptoms from past four months.
• Criterion G: The symptoms is interfeing with different areas of life: The symptoms are effecting her bonding with her child, it effecting het work, and also, all the aspects of her life.
• Criterion H: The symptoms are not due to substance abuse: It is clearly mentioned that the symptoms that Linda is experiencing is not not due any substances or any medical conditions.

Differential Diagnosis: The symptoms that Linda is experiencing is not factitious or malingering as these symptoms are causing hindering her from having a normal life and a good motherhood. They are not because of any substance abuse or medical condition. The episode of attacks are not panic attacks as they are related to the traumatic experience of her son, and meets all the necessary criteria for a PTSD. The symptoms are interfering with Linda's carrying out her day to day life activities, they are hindering to have a positive bond with her child, and is disabling her to have a positive attitude and normal life.

The treatment and medications for PTSD in Linda's case would include:

• Cognitive Behavior Therapy: The talk therapy to modify her negative thoughts and emotional responses towards the traumatic experience.
• Exposure and Response prevention: The talk therapy that would focus on exposing Linda to the traumatic experience in a safe setting to desensitize her and to reduce the psychological distress associated with it.
• Meditation: Selective Serotonin Reuptake Inhibitor (SSRI) to ease the symptoms of mood and anxiety that Linda experiences while having the episodes of attack.