Diagnosing Psychological Disorders Using the DSM-5

For use of this assignment, this learner reviewed three (3) case studies and achieved a diagnosis for each of them. The first being Fred—Fred’s history goes as follows: (1) He was raised in a good home, with a good family. His parents were successful in their careers, and he has two separate brothers; (2) He always got good grades in school and was a top athlete. He did well in continued education, and now has a successful career at a local hospital; (3) Fred began to experience emotional distress, as he contemplated informing his family that he was gay. Upon sharing this information with his family he initially struggled with the idea, but his father and his older brother eventually accepted it. His mother on the other hand will not even speak to him of the idea, and his younger brother accused Fred of purposely trying to hurt his mom by sharing this information; (4) Fred again started to experience emotional distress when the conversation of marriage came up between him and his partner; (5) He complains that he has daily panic attacks when getting ready for work or toward the end of his shift following an armed robbery in the subway four months ago. He now has become avoidant and would rather use a bicycle to get to and form work even though that is the hardest way to navigate the city, he would rather do that than take the subway again; (6) No mental illness reported in the family, aside from a grandfathers alcoholic past. He was briefly exposed to the alcohol as a child when he would smell it on his grandfathers breath, but his mother would refuse to have alcohol in the home. This learner believes that this case study could be diagnosed as Trauma – and Stressor-Related Disorders (DSM-5, 2013)—specifically Reactive Attachment Disorder and Post Traumatic Stress Disorder.

This learner believes that Fred suffers from Reactive Attachment Disorder due to the fact that he had a good childhood, raised under certain morals and beliefs and it was not until he showed signs of stepping outside of those norms for his family that included him coming out to his family that he was gay. This learner would feel comfortable stating that Fred suffers from persistent social and emotional disturbance characterized by minimal social and emotional responsiveness to others, limited positive affect, and episodes of unexplained irritability, sadness, or fearfulness [in the forms of panic attacks] when dealing with family interactions (DSM-5, 2013). This is due to the fact that his mother and brother have created a negative environment for him to bring future plans and successes in his relationship with his partner to them.

This learner could not substantially say based on the information provided in the case study that he was been withdrawn from his family; therefore, characteristic A would not necessarily apply unless further evidence was presented to support that. Characteristic C could be potential as well due to the fact that social neglect has occurred from his family in the forms of having his emotional needs for comfort, stimulation and affection met by his mother and younger brother. Repeated changes of primary caregivers and the inability to form selective attachments would also not necessarily apply unless further evidence was submitted to substantiate those (DSM-5, 2013). According to the DSM-5 (2013) we are asked to specify if the disorder has been present for more than 12 months.

This learner can conclude that the symptoms have been ongoing for longer than 12 months because in this case study it is stated that Fred has been contemplating coming out to his family for years and has had panic attacks about just that thought for many years for the fear of how his family will react and then having them react the exact way he thought that they would. Based on DSM-5 (2013) this case would not be labeled as severe, as Fred does not meet all of the symptoms and his symptom of panic attacks are evidentially based, according to the case study, not severe as they do not interfere with daily life.

Following Fred’s armed robbery in the subway, this learner is confident in saying that he is experiencing Post Traumatic Stress Disorder for reasons being (characteristic A) he was exposed to actual or threatened death by directly experiencing the traumatic event (DSM-5, 2013). Fred currently experiences the presence of intruding thoughts (characteristic B), flashbacks (characteristic B) associated with the event in the form of daily panic attacks involving the memories of the armed robbery. Fred additionally has persistent efforts to avoid the area in which the event occurred (characteristic C), the subway, as his panic attacks occur either before he leaves for work or before he gets off of work—both times when he would be required to ride the subway.

Additionally, persistent negative emotional states—fear—(characteristic D) regarding having to ride the subway again. The duration of the disturbances is longer than 1 month, as it occurred 4 months ago, it causes panic attacks in public and social settings either before work or before leaving work, and they are not associated with the use of substances or other medical conditions. These symptoms would not be dissociative and are not delayed expression either.

Upon reading the case study for Phil, this is easily explained as Obsessive Compulsive Disorder. This learner feels confident in diagnosing Phil with OCD for these reasons: Characteristic A—recurrent and persistent thoughts, urges or images that are intrusive and cause anxiety or distress, and upon the thoughts occurring they are attempted to be neutralized by performing a compulsion and repetitive behaviors or mental acts that must be applied rigidly (i.e., folding all of the clothes in the store even after having promoted to management and being responsible for delegating that task, but will not delegate the task due to the fact that it is a calming response to continuously fold the clothes regardless of position) and when Phil was required to delegate the tasks but chose to repeat the duty himself it was a stress relief for him, even though it eventually led to his termination; characteristic B—his compulsions are time consuming; the symptoms are not attributable to another medical condition; specifically Phil does not necessarily believe that he has a disorder, he just believes that he likes things clean and in order. Phil according to the case study has not been presented with a history of a tic disorder.

For the third case study, this learner would confidently say that Stacey is suffering from the Autism Spectrum Disorder (DSM-5, 2013). This is believed due to deficits in social communication and social interactions ranging from reduced sharing of emotions with others and failure to initiate social interactions with others and would rather spend all of her time outside of work with animals only—this approach has been utilized since she was a child. Even her husband stated that she was a “doormat with no personality” and was reclusive even from him—this would show a deficit in maintaining and understanding relationships in various social contexts.

In the context of having to change her routine of reclusively, she withdrew from social that furthered her education because of the avoidance of social interactions and performances. She does not show sensory sensitivity, therefore classification B would not apply. Symptoms of autism presented itself in early childhood, showed a significant impairment on her ability to create or maintain friendships or social interactions as a child, and these disturbances are not better explained by another disorder (DSM-5, 2013). This is without an accompanying intellectual impairment, without an accompanying language impairment, and not associated with a medical or genetic condition.

Treatment

When looking at treatment for one of the three (3) case studies presented above, this learner chose to focus on Phil’s case study of OCD. Obsessive Compulsive Disorder could be cured by medication, surgical methods, or by Cognitive Behavior Therapy. Cognitive Behavior Therapy uses a technique called ERP (Exposure and Response Prevention)—this is when you would expose yourself to situations or images that would cause anxiety for you (Bjorgvinsson, n.d.). In Phil’s case, this could potentially work because of the fact that he is open to seeking help and understanding where he could improve. He may not have otherwise understood that OCD was his case, but the fact that he is seeking counseling and assistance is a promising feature.

With ERP an individual is directly aiming to break the cycle or repetition of avoiding what causes their fear and tolerate distress (Hezel & Simpson, 2019).

“According to emotion processing theory, fear and other emotions are stored in memory structures that contain information about stimuli that elicit the emotional response, as well as the response itself.” (Hezel & Simpson, 2019)

This is explained why it would be so effective in treating OCD. The fact that the fears or triggers are stored in Phil’s memory and is then accessed by the ERP it can cause distress in ways that will cause the emotions to surface and allow a platform for those emotions to be worked through with help of a licensed counselor. It is not suggested to perform these tasks on their own, especially in severe cases of OCD, or mental disorders, but even having virtual assistance (i.e., online therapy) could be beneficial in overcoming the emotions and triggers that cause OCD. This learner believes that the article speaks very closely to what Phil is experiencing due to the fact, that ERP can relate to individuals that may not even understand the trigger of their condition. We may be able to address the cause of the disorder, without Phil knowing what it is.

As a professional in my career, I would use information learned from these articles and this assessment to inform my professional behavior in ways of coming at different situations with an open mind. Even if someone is so sure that they do not have a disorder, or if they do know what the cause could be or are unwilling to share that information, having them safely exposed to stressful or other triggering situations could be verification needed regarding the type of disorder present.

Resources

• Bjorgvinsson, T., n.d. Exposure and Response Prevention. Internal OCD Foundation. https://iocdf.org/about-ocd/ocd-treatment/erp/

• DSM-5: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, 2013. American Psychiatric Association. ISBN 978-0-89042-555-8

• Hezel, D. M., and Simpson, H. B., 2019. Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Review and New Directions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408/