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 #4

Sharon is a 19-year-old, single, European American college student who was brought to the emergency room because she had been vomiting for the past 24 hours and had been unable to drink water or consume any food; she was treated for dehydration and released. The previous night she had gone out drinking at the local college bar, Barney’s. After about three hours of consuming an indeterminate amount of alcohol, she lost consciousness and was brought home to her apartment by her roommates. Sharon reports that this is the first time she has ever lost consciousness due to alcohol consumption. She typically drinks to intoxication only once or twice a week. On a typical “drinking” night she will drink 7-8 beers, shots, or other alcohol drinks. She reported that she does drink much more than when she first came to college, but she has built up a tolerance so she can now drink 7-8 drinks without becoming seriously impaired. Sharon also reported that occasionally she will drink at home, in her apartment. She stated that she drinks 1-2 drinks before bed to help herself get to sleep because she has had difficulty sleeping for the past two months. In addition, she sometimes has one drink in the morning to help her “deal with things.” When asked whether there were any significant life events associated with her increase in drinking, Sharon stated that she has been struggling for after she had a “bad breakup” with her boyfriend from high school eight weeks ago. Since the breakup she has felt very sad and lonely almost every day. She has not really felt motivated to be around people (she stated that she drinks in part to get up the “courage” to be around people) and she feels she has lost interest in most of her usual activities and school. The breakup also led her to feel worthless, she stated, “I feel like no one will ever love me again.” She stated that she may be drinking more to alleviate the sadness she feels about the breakup, but she feels she could stop drinking at any time if she needed to. She reported that she does not feel that her drinking affects her functioning significantly. She does sometimes skip classes on Fridays due to hangovers, and her relationships with her roommates have become tense because she will sometimes behave impulsively or need “taking care of” when she is drunk. Sharon expressed insight that her drinking is probably not helping her deal with the breakup in a healthy way, but that she is fine with her current level of alcohol intake because she feels she needs “something to help me get through this.” She admitted that since the breakup she has occasionally has passive thoughts of suicide but that she has no intention to act on those thoughts, and that drinking sometimes makes those thoughts “go away.”

Answer 1

Primary Diagnosis:

The present case meets the DSM-V criteria for substance use disorders (alcoholic type) as she shows typical signs of consuming an indeterminate amount of alcohol which has also lead to medical emergency due to loss of consciousness. Moroever, she reported engaging in binge alcohol use once or twice a week involving large amounts (7-8 pints) of beer on a regular basis.

Other than the high amount of frequent and regular substance use, she also shows symptoms like her continued use of alcohol despite knowing that it interferes in her interpersonal relationship with her roommate as well decreased productivity in her academic career. She shows an acute dependence on alcohol during episodes of low mood and uses alcohol to alleviate sadness.

A differential diagnosis of major depressive mood disorder is made as it is found that the case shows signs of low mood, feelings of sadness and worthlessness after loss of her love relationship. However, her breakup in relationship has reinforced her dependence on alcohol and her continued feelings of depression feed into her symptom of alcohol dependence as a stress releaser. Therefore, she fits the criteria for substance use disorder as per the DSM V criteria.

Treatment plan:

Given that the case shows considerable self understanding and insight about her emotional condition and dependence on alcohol, it is proposed that she can benefit from an eclectic treatment approach that combines psychopharmacological treatment with psychotherpy. The pharmacological approach such as the use of substance inhibitors would help to reduce the negative withdrawal symptoms associated with alcohol dependence and help her cope during the process of drug rehabilitation. In addition, cognitive behavioural therapy is suggested as part of individual therapy. Given that she is emotionally expressive and insightful, CBT would help confront her maladaptive thoughts and beliefs about relationships and sadness and alcohol as a suitable relief and empower her to change negative thought patterns for more adaptive and positive beliefs and behaviours which would reduce her dependence on alcohol on a long-term basis.