Assignment 1: Discussion Assignment
In this module, you learned about assessment and diagnosis using the DSM-5. Understanding how to appropriately record a diagnosis and to use specifiers provides a dimensional diagnostic perspective while also allowing the client to participate in the diagnostic process. One of the most important factors related to diagnosing is being able to provide rationales for the diagnoses you assign. A good clinician can always provide the reasons why the client met the criteria for a specific diagnosis and determine the duration, onset, and severity of the condition. Cultural and developmental factors must also be assessed and considered when developing a client’s diagnosis.
Review the following resources:
F33.2 Major Depressive Disorder, Recurrent episode, with Moderate Anxious Distress
F60.3 Borderline Personality Disorder
Z63.5 Disruption of Family by Separation or Divorce
Z56.9 More problems related to Employment
In accordance with DSM-5 diagnostic standards, Chris is an adult; He reported severe symptoms of depression, anxiety, and personality functioning. He additionally reported moderate symptoms of suicidal thoughts, memory, and repetitive thoughts and actions and slight symptoms of sleep problems. He mentioned that he could sleep longer if need be; In accordance with DSM-5 diagnostic standards, Chris was also administered the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). He reported severe symptoms with understanding and communicating, getting along with others. He had to be motivated by siblings to move forward with activities; however, he did not feel like doing anything but sleeping. In addition, Chris stated that he struggled with extreme symptoms with life activities at work and participation in society.
When reviewing Chris state I have found that Chris symptoms consistent with major depressive disorder, recurrent episode, with moderate anxious distress. Nearly every day, he experiences a depressed mood most of the day, marked diminished pleasure in all activities, weight gain, hypersonic, psychomotor agitation, fatigue, feelings of worthlessness, and diminished ability to think or concentrate. The symptoms are recurring after a similar episode three years prior. Moderate anxious distress is what is noticed with Chris. He also explains that he has difficulty concentrating because of worry, and fears that something awful will happen during most of days of this major depressive episode. Chris mentions several times during the session that he is miserable, constantly worries, and feels sad, hopeless, and horrible. He experiences daily crying spells, reports that he does not want to do anything or go anywhere, and he has gained 10 pounds in six weeks, and is restless and cannot sit still.
It is understandable that Chris struggles through each day, is constantly tired, lacks motivation, and could sleep from 16-24 hours per day. He feels he is a “loser,” that no one will love him and that no one will hire him. He states that everything he touches dissolves and that he is a disappointment to everyone and cannot do anything right. He reports that his difficulties at work and possibly his relationship stem from a lack of ability to concentrate and perform.
All that Chris has mentioned are symptoms causing significant distress and impairment in social and occupational areas of functioning and is not attributable to the physiological effects of a substance or other medical condition (American Psychiatric Association [APA], 2013). The occurrence of this episode is not attributable to the schizophrenia spectrum or other psychotic disorder and there has never been a manic episode (APA, 2013).
Chris also reports symptoms consistent with borderline personality disorder. He reports a pervasive pattern of instability of interpersonal relationships and self-image, as indicated by frantic efforts to avoid abandonment, a pattern of unstable and intense interpersonal relationships, identity disturbance, suicidal behavior, chronic feelings of emptiness, and transient, stress-related paranoid ideation. During intake, Chris reported that he has unstable relationships with his brothers; during the current session, he states he feels he is a disappointment and no one will ever love or hire him. Chris spoke of his unsuccessful relationships with others. He also reflects intensity of relationships, at times paradoxically, stating that this recent girlfriend was “the one” and that his brother is his best friend. It is also known that paranoia was something that he dealt with during this time.
(APA, 2013). Borderline personality disorder also often co-occurs with depressive disorders (APA, 2013). People with borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.
Other diagnoses considered included generalized anxiety disorder, hypersomnia, obsessive-compulsive disorder, and histrionic personality disorder. However, there was either not enough information to fulfill the diagnostic criteria (e.g., frequency and duration) of these disorders (Nolen-Hoeksema & Marroquin, 2017), or the symptoms were better explained by the given diagnoses (APA, 2013). This is where I would consider understanding more with education. I find that the way Chris spoke was something that should be noted. Chris spoke as if he still was in a child’s state although it is clear he was an adult. The reactions of his feelings were expressed childlike. This showed vulnerability in some way. Additional information this counselor-in-training would want to ask the client would focus on his strengths (Argosy, 2018). For example, how does his faith interact with his feelings of depression; what coping skills did he employed during the last depressive episode three years ago? Additional information regarding etiology would include questions concerning what was happening, or what stressors was he dealing with, at the beginning of this and the previous depressive episode.
According to his biopsychosocial assessment at intake (Argosy, 2018), Chris’ highest domain scores on the CCSM-1 (Argosy, 2018; APA, 2013) were rated mild or greater in the domains of depression, anxiety, sleep problems, repetitive thoughts or actions, and personality functioning. His highest score in the domain of suicidal ideation was above slight; the highest score was (3) moderate. Each of these ratings suggest that additional inquiry and follow-ups may be necessary to determine if a more detailed assessment is warranted in these domains (APA, 2013). Detailed follow-up assessments may include the adult Level 2 crosscutting symptom measures (CCSM-2; Argosy, 2018; APA, 2013)
in the domains of Depression, Anxiety, Sleep Disturbance, and Repetitive Thoughts and Behaviors. Chris’ average general disability score on the WHODAS 2.0 was determined by dividing his raw overall score (73) by the number of items in the WHODAS 2.0 (36; APA, 2013). This calculation determined Chris’ average general disability score to indicate mild (2) disability (APA, 2013).
Cultural factors assessed during this diagnostic process include substantial cultural differences in how major depressive disorder is expressed by the individual (APA, 2013; Nolen-Hoeksema & Marroquin, 2017)). Somatic symptoms are often reported in many cultures; insomnia and fatigue are the most often reported across cultures (APA, 2013). Considering gender (Nolen-Hoeksema & Marroquin, 2017), the counselor would have to consider that, while the risk for suicide attempts is higher for women, the risk of suicide completion is highest for men (APA, 2013).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association Publishing.
Argosy University Online. (2018). Diagnosis and treatment of behavioral and emotional disorders: Module 2. Retrieved from https://myclasses.argosy.edu
Nolen-Hoeksema, S., Marroquin, B. (2017). Abnormal Psychology, 7th Edition. [Argosy University]. Retrieved from https://digitalbookshelf.argosy.edu/#/books/1260520749/
Jaquetta Stevens PhD.