Question

Hi! Below is the case study and I want to make sure I'm on the right track. I bolded the questions I'm interested in (1-5). Looking for people who are familiar with the DSM-5/abnormal psychology and able to answer all questions completely. Thank you! - no ICD 10 please!

Questions:

1. Diagnosis; what is the evidence for it? For this one, assume the patient has borderline disorder and answer the rest accordingly.

2. Treatment; typical treatment used for this diagnosis AND most effective treatment. IF the person is in treatment, what should we target first in terms of symptoms? How likely are they to stay in treatment and how likely are they to recover? Are meds involved and if so, what broad “type” of meds work for this disorder,?

3. Differential diagnosis (why is it this disorder and not this disorder)

4. Does the person have more than one diagnosis, what would DSM say about the criteria for diagnosing that

5. What would the primary causal theories be?

CASE STUDY BELOW (it's posted under here)

Lena is a 22 year old college student who is very upset that she has such troubles with friendships and relationships. Lena has always had issues with anxiety and she has a past history of panic attacks/panic disorder. Lena also has had a very traumatic childhood, her mother was verbally abusive and very controlling and Lena was very happy to have escaped to go to a college far away from home. She rarely visits at home as she truly hates her mother and hopes to never see her mom again. Fortunately, her parents are divorced and she can go to her dad’s house whenever she has a break at school. Lena comes to therapy not to try to resolve her issues with her mom, but rather to complain about how all of her friends always seem to abandon her and how painful this is to her. She has lots of friends, but none of them stay long or live up to her expectations. She also has lots of romantic relationships, but she says they are very chaotic as no guy has ever been able to keep up with her demands. She has very low self-esteem and only feels good about herself when she thinks other people love her. But her friends all say that she is ridiculously moody and controlling and she seems to be a rollercoaster of emotions -one minute she totally loves you and the next she totally hates you and is yelling and screaming. She is often great fun to be around, but it is very emotionally draining for her friends and partners, as she gets super upset so often.... She is also extremely jealous and possessive and this drives people crazy. She comes to therapy to figure out what is wrong with everyone else - she is not really very insightful but is willing to consider whether part of the problem might be her....

Answer 1

Evidences for the diagnosis of Borderline personality disorder in Lena: unstable self-image, perception of real or imagined abandonment, unstable interpersonal relationships, affective instability and feelings of emptiness.

Some of the common treatments used include: Dialectical behaviour therapy (DBT), Transference-focused therapy (TFT), Schema-focused therapy (SFT) and Mentalization-based therapy (MBT). Among these, DBT is considered the most effective. The symptoms that need to be targeted first include: suicidal ideation (if present), substance abuse (if present) and managing other intense emotions that result in impulsive behaviour. Recovery may take several days (some cases requiring hospitalization and psychiatric medication), due to the intensity of symptoms involved and therapeutic work that goes into it. However, once adequate insight is attained, the process will speed up and the individual will be more likely to stay in treatment due to noticing positive changes first-hand. A psychiatrist may best advice on the type of meds involved.

Differential diagnosis: Bipolar disorder. The type of bipolar, however, cannot be identified, as additional details regarding the episodes may be required from the case history to do so.

Primary causal theories – The nature-nurture equation may be taken into consideration, as there is an equal amount of biological vulnerability and environmental influence that play a role. Further, invalidating environments and contexts around which the individual grows, result in an inability to effectively handle and express emotions.