Assignment: Case of Presenting Issues
Assignment: Case of Presenting Issues
The Case of Laura Presenting Issues: Preoccupied with negative thoughts; Ungrounded fears; Inability to remove thoughts from her mind; Anxiety; Trouble falling asleep; Fatigue; Irritability; Persistent behaviors aimed at preventing the ungrounded fears. Symptoms lasting for a year.
Broad DSM-5 Categories: Generalized Anxiety Disorder: Excessive anxiety and worry occurring more days then not for at least 6 months; Difficult to control the worry; Anxiety and worry are associated with fatigue, irritability, and sleep disturbance; Worry causes clinically significant distress or impairment in normal life functioning; The intensity of the anxiety and worry is out of proportion to the actual likelihood of the event; Difficult to control the worry, often worrying about the health of family members or misfortune of children (DSM-5). Obsessive Compulsive Disorder (OCD): Recurrent and persistent intrusive and unwanted thoughts that cause anxiety or distress; The individual attempts to neutralize intrusive and unwanted thoughts with some other thought or action; Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession; Behaviors or mental acts are aimed at preventing some dreaded event or situation, however, these behaviors are not connected in a realistic way with what they are designed to prevent and are clearly excessive; The obsessions or compulsions cause impairment in social functioning (DSM-5).
Diagnosis: Obsessive Compulsive Disorder 300.3 (F42) with absent insight/delusional beliefs. At first look a Generalized Anxiety Disorder diagnosis appeared to be the accurate diagnosis for Laura. However, as I begun to read the differential diagnosis in the DSM-5, OCD was listed. Ellis, Hutman, and Diehl (2013) emphasize the importance of integrative case conceptualization and a key aspect of this is differentiating a diagnosis, or discriminating the most significant issues. The difference between Generalized Anxiety and OCD is that in Generalized Anxiety “the focus of the worry is about forthcoming problems, and it’s the excessiveness of the worry about the future event that is abnormal” (DSM-5). Whereas with OCD, “the obsessions are inappropriate ideas that take the form of intrusive and unwanted thoughts” (DSM-5). Laura’s symptoms are better matched with OCD criteria. Laura has become preoccupied with thoughts that her loved ones are going to become injured or ill; So much so that she has been calling her family members several times a day even when they cannot take calls, begging them to be safe and asking them not to drive or participate in social events because they could be in an accident or contract a deadly disease. She also drives to her daughter’s house at night to check whether the family is home safe or if they have guests that could pass on a disease. These actions fall within the OCD criteria of “excessive behaviors aimed at preventing some dreaded event or situation” that stem from” inappropriate ideas that take the form of intrusive thoughts”. The added diagnosis of absent insight/delusional beliefs is supported by the fact that logical discussions have not convinced Laura that her fears are ungrounded. Additional Information: More information is needed to pinpoint the underlying cause of Laura’s fear of loss. Information on her childhood and any traumatic situations in her life will help. Focusing on her developmental life stage is also important. In addition, Scott and Cervone (2016) emphasize the importance of one’s personality and self-schemata when conceptualizing a case; An assessment of self-schemata can highlight where Laura fits with valance, competence, rejection sensitivity, self-beliefs, competence, and self-efficacy (Scott & Cervone, 2016).
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Ellis, M. V., Hutman, H., & Deihl, L. M. (2013).
Chalkboard case conceptualization: A method for integrating clinical data. Training and Education in Professional Psychology, 7(4) 246–256.
Scott, W. D., & Cervone, D. (2016). Social cognitive personality assessment: A case conceptualization procedure and illustration. Cognitive and Behavioral Practice, 23(1), 79–98.