Sara is a 38 year old woman who was referred by her employer for mandatory counseling. She presents as markedly underweight, in baggy clothing. She tested positive for amphetamine on a recent random test at work and is on suspension. It is obvious that Sara does not want to be there, but knows she must cooperate to get her job back. Sara is currently taking anti-psychotic medication and mood stabilizers. When you ask her why, she tells you that “my shrink thinks I’m nuts. OK, I admit that sometimes I think the devil is telling me to kill myself, but I never do it. I just cut myself instead. Nothing serious, just a scratch here and there”. She admits that, “a couple of drinks or a line, calms the beast and the voices stop”. She also admits to loving excitement and risk taking. “I love it when my mind races and I just hop in the car and go. Messes with my job sometimes, but who cares”.
During your psychosocial assessment, you learn that Sara was born in Japan. Her father was a Native-American spirit-seeker. He came to Japan to study Eastern Religions where he met her mother, who she describes as, “a meek and quiet little Japanese woman”. When Sara was 8 years old, they left Japan and moved to the United States, living with her father’s family. She appears nervous talking about this time of her life, but does admit it was a dark and fearful time, except for her grandmother, who she loved deeply, but died when Sara was age 14.
At age 15, she began seeing spirits of her deceased grandmother. She wondered if this was a spiritual sign. It saddened her so much, that she began self-abuse, strict dieting and substance use at about that age. She believes that the devil tells that her grandmother’s death, “was all my fault. I deserve to suffer”. Her guilt and self-loathing have prevented her from committing to a relationship. She has been dating the same man for 15 years who she describes as, “too good for me. I don’t know why he hangs around”.
1. Formulate a Differential Diagnosis for Sara. What comorbid disorders might you see? Support your ideas by discussing what you see in the vignette utilizing your course readings thus far. What information would you look for to confirm your diagnostic impression and why? Use the DSM 5 Checklists in Comer (2014) and the DSM 5 for your differential diagnosis process.
2. Considering the Models of Abnormality outlined by Comer (2014), choose two theoretical models to explain Sara’s clinical presentation and suggested treatment modalities. Support your ideas by discussing the models directly and specifically to Sara.
(Remember to consider culture, law and ethics when diagnosing and treating)
Assignment Outcomes
Analyze the existing etiologic theories of psychopathology
Integrate the major diagnostic categories of the current Diagnostic and Statistical Manual
Evaluate legal and ethical issues
Formulate the impact of culture and human diversity issues
Combine current research to the theory, treatment and prevention of mental illness
Analyze and evaluate information critically and effectively
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