Current Issues in Dissociative Identity Disorder - Assignment Example

Assignment- 2, Module- 2 You will create a brief clinical dialogue between you, the therapist, and a client. Describe any physical observations, non-verbal cues and psychosocial descriptions that would help illustrate or capture the flavor of the disorder. Write a brief dialogue that illustrate the symptomatology for each of the following disorders: Generalized Anxiety disorder, panic disorder, agoraphobia, PTSD, conversion disorder, body dysmorphic disorder, pain disorder, and malingering. Clinical dialogue with me as a therapist and a client with generalized anxiety disorder 21 year old Susan was brought to my clinic by her mother who complained that Susan would often worry about petty things in day- to- day life and that she was worried about her getting worked up everyday. On enquiry, Susan complained that she would get irritated and worried about small things like not able to pay bills in time or missing a bus or not able to find her shoes. Further interrogation revealed that Susan suffered from repeated attacks of headaches, muscle aches, sweating, trembling, especially when she had to take a test or an interview or talk to a stranger. She also could not sleep well on many nights making it difficult to sit through classes during the day and the mind becoming blank many times. These symptoms were present in her on and off since 6 months. She also developed dark circles around her eyes. Susan mentioned during the interview that it was indeed difficult for her to control the worries. Clinical dialogue with me as a therapist and a client with Panic disorder 18 year old Julie came to my clinic with complaints of repeated episodes of palpitations associated with sweating and shortness of breath. She said these episodes occurred in any places without warning, each episode lasting for 5 to 10 minutes. During these episodes she said that she felt like running away from the place. These symptoms initially prompted her to meet a cardiologist who then referred her to me. She also complained of uncontrollable fear, trembling and dizziness during these episodes. The attacks occurred about once in every 2 to 3 days. She expressed that whenever she was in a social function or public place she always anticipated these attacks and infact; in one of the social gatherings she found these symptoms very embarrassing. Clinical dialogue with me as a therapist and a client with Agoraphobia 24 years old John approached me with complaints of not able to go to new places or public places due to fear and because of which he was not able to adjust socially and often preferred to remain at home. He said that he was forced to approach me by his friends who found him to be abnormally fear-expressing in public places which infact was embarrassing even to John. On further enquiry, John expressed that he was scared of large open places and avoided traveling through those places even if he was accompanied by some one else. Clinical dialogue with me as a therapist and a client with post- traumatic stress disorder 16 year old Rubie was brought to me by her uncle. Rubie had witnessed an accident 1 year ago in which she lost her father. Since then Rubie has been suffering from irregular sleep, recurrent headaches and frequent depressive episodes. She also refuses to travel in the car. When enquired why she did not want to travel by car, she expressed that she watched her father dying in a car accident which was the worst witnessed event in her life and that the memories of that incident kept haunting her everyday. Other than these symptoms, Rubie looked normal. Clinical dialogue with me as a therapist and a client with conversion disorder 30 year old Josvin was referred to me by a neurologist who had been treating her for symptoms of inability to move the right hand and inability to perceive sensory symptoms in the same hand. She also had complaints of nerve jerks in that hand intermittently. The neurologist performed all the possible tests and observed that there were no neurological deficits in her and thus referred her to me. On arrival into my clinic, I noticed that Josvin was supporting her right hand with left hand as if the right hand was paralyzed. When asked what went wrong with her hand, she explained that she had fallen off the cot one day following which she could not lift the hand or perceive any sensations and there were intermittently abnormal movements. As I engaged her into talking about her personal life, I suddenly took my car keys and pressed into her right palm as hard as possible and noticed that there was no response. This convinced me that there was no malingering component involved and the patient indeed was suffering from conversion disorder. I offered her a chocolate which she took with her left hand and ate it. She did not seem to suffer from any other medical or neurological condition. Clinical dialogue with me as a therapist and a client with body dysmorphic disorder 18 year old Lily was brought to me by her mother who complained that her daughter constantly met a plastic surgeon to change the shape of her nose and the surgeon, who was not sure of the indication, informed the mother about it. One look at Lily, I noticed that her looks or nose was not abnormal. Her mother also complained that Lily showed lot of interest in her looks and that she spent all her pocket money in buying facial make up cosmetics. She also complained that Lily was not interested in studies and was not performing well in school. When asked Lily about the way she thought she looked, she expressed that she was the most ugly looking girl in her class and that was the reason boys avoided her. She also cursed herself for being unlucky to have got that nose. She said that she avoided parties and social functions because she felt embarrassed the way she looked. Clinical dialogue with me as a therapist and a client with Pain Disorder 40 year old Coffey was referred to me by a general physician who had been seeing Coffey for about 6 months for complaints of chronic headache. The physician had performed many tests including Magnetic Resonance Imaging scan of the head to rule out causes for chronic intolerable headache. After he realized that there was no abnormality detectable, he referred him to me. On talking to Coffey, I realized that Coffey was in chronic psychological stress because his wife was suffering from breast cancer and he had to take care of his 3 small kids. Infact, he started weeping when I questioned him whether there was any stress in his life. He also said that added to these problems, the chronic headache which was severe, made his life miserable. On further enquiry, Coffey revealed that he was consuming tremendous amounts of analgesics despite which his pain did not seem to come down. Clinical dialogue with me as a therapist and a client with malingering I was hired by an insurance company to evaluate the physical condition of a gentle man by name Michael who claimed a heavy compensation from the factory he was working because his right leg was paralyzed following a small accident in the factory. The officials were of the opinion that the nature of accident could not pose so much damage to the leg and that Michael was malingering to gain monetary benefit. When I met Michael, I found him on a cot lying listless and not using his left leg. He was however moving all other limbs actively. He had some bruises on his head and shoulder but nothing on his legs. On enquiry, Michael spoke that the carelessness on the part of the management of his factory led to this disability. On examination, the reflexes and muscle power of the leg was normal and the patient responded appropriately to the stimuli. I inferred that the patient had no paralysis of the leg and that he was malingering. 2. In considering your understanding of Dissociative Identity Disorder, describe, specify, and illustrate through creating a case example, the three kinds of relationships among the sub personalities. Be sure to clearly identify the 3 types within your case illustration. The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines Dissociative Identity Disorder (DID) as "a mental condition whereby a single individual evidences two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment." Previously, this condition was known as multiple personality disorder. It is one of the most challenging disorders (Kluft, 71-72). To make a diagnosis of DID, the person should have at least 2 personalities routinely taking control of the individuals behaviour. Also, the person should have associated memory loss that is actually beyond normal forgetfulness. It is important while making the diagnosis that symptoms of DID must not be the direct result of substance abuse or a more general medical condition (Kluft, 71-72). There are 3 kinds of relationships between personalities: 1. Mutually amnesic relationships 2. Mutually cognizant relationships 3. One-way amnesic relationships To understand the relationships between sub personalities, let us discuss about Christie, a 26 year old lad who was admitted to a human resources center. Christie was a victim of childhood abuse after his mother died and his father left him in a relatives house who beat him often badly, made him do lot of heavy work and gave him no proper food. This affected Christie psychologically and as he grew up he suffered from dissociative episodes, flashbacks, and self-destructive and suicidal impulses. These aspects made his father admit him to the human resources center. According to the father, even as a child, Christie appeared withdrawn, frightened and uninvolved. His friends expressed that Christie had fluctuating abilities, moods, fears, and anxieties; shifting preferences; inconsistent knowledge; and other evidence of erratic access to information and skills. Added to these he suffered from auditory hallucinations. The 2 distinct personalities noticed in Christie were Child Christie when he spoke like a child and cried, wept and narrated about all the beatings and helplessness he had to suffer silently as a child and Adult Christie when he threatened to contact a lawyer and send the bad relative to court. In case of Christie, Adult Christie was the dominant personality. If Adult Christie and Child Christie personalities are not aware of each other, then the relationship is called mutually amnesic relationship. If both Adult Christie and Child Christie personalities are completely aware of each other, then the relationship is called mutually cognizant relationship. If one of the personalities is aware of the other without the reverse being true, then it is known as one-way amnesic relationship. This is the most common relationship. The type of relationship between sub personalities differs from case to case (Comer, 2007). 3. Discuss how cultural factors influence the DSM categories and the process of assessment and diagnosis of clinical disorders The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and serves as a centrally important tool in dissemination of psychiatry’s understanding of psychological suffering (Douthit, 2006). In spite of its widespread adoption within the mental health arena, scholars from the counseling community have been sharply critical of DSM (Douthit, 2006). One of the criticisms mounted is limited cultural consideration (Kress, Eriksen, Rayle, & Ford, 2005). Cultural factors have a lot of influence on the DSM categories and also on the assessment and diagnosis of clinical disorders. This is because individuals of poor communities and culturally diverse populations are exposed to a multiplicity of physical, social and psychological stressors. Many a times, individuals from such populations indicate behaviors that do not meet any one diagnosis but whose severity demand therapeutic intervention (Canino, 2000). Clinicians should be aware of these aspects because other times these individuals behaviors are solely a reflection of the exposure to continuously environmental stressors and hence the diagnosis of a condition must be reserved for unresponsive political and social interactions (Canino, 2000). It is also possible that these individuals truly suffer from emotional disorders with chronic symptoms and overlapping or multiple diagnoses. It is due to these complex factors associated with diagnoses that the clinician should indicate in his or her assessment any diagnostic uncertainty, address exclusionary criteria and also comment on the severity, significance, and course of the symptoms (Canino, 2000). The way that culture is understood and operationalized within the DSM diagnostic scheme becomes particularly germane to counselor identity. Culture serves as the nexus of counseling practice and as a fundamental theoretical construct in understanding the change process (Douthit, 2006). References Canino, I. A., & Spurlock, J. (2000). Culturally Diverse Children and Adolescents: Assessment, Diagnosis, and Treatment. (2nd ed.). New York: Guilford Press. Comer, R.J. (2007). Abnormal Psychology. (6th ed.). New York: Worth Publishers. Douthit, K.Z. (2006). Preserving the Role of Counseling in the Age of Biopsychiatry: Critical Reflections on the DSM-IV-TR. VISTAS 2006 Online. Retrieved November 15, 2007, from http://counselingoutfitters.com/Douthit2.htm Kluft, R. (2003). Current Issues in Dissociative Identity Disorder. Bridging Eastern and Western Psychiatry, 1 (1), 71- 87. Kress, V. E. W., Eriksen, K. P., Rayle, A. D., & Ford, S. J. W. (2004). The DSM-IV-TR and culture: Considerations for counselors. Journal of Counseling and Development, 83(1), 97-104. Read More