Diagnosis of a Psychological Disorder - Essay Example

?Running head:  Clinical Analysis SECTION A Diagnosis Prior to diagnosing Angela Rathbone’s mental disorder, the abnormalities exhibited by her psychological disorder have to be first examined. This calls for psychopathology, which involves studying mental distress, disorder and abnormal behavior. Though her examination may not comprise a formal diagnosis, it may denote experiences or behaviors that indicate mental illness. An example includes fears and hallucinations that are classifiable as a symptom even though may not supply sufficient symptoms to fulfill the criteria for symptoms listed in the ICD or DSM (Stone, 1987). Generally, any behavior or symptom responsible for distress, disability, or impairment stands to be classified as psychopathology and moreso if it is viewed to arise from a functional breakdown in neurocognitive or cognitive systems in the brain. To establish Angela’s abnormalities, they will have to be put under review using the “four D’s”. The prominent abnormalities The prominent abnormalities Angela displays comprise danger, deviance, distress and dysfunction. The four are generally termed as the “four Ds”. Deviance Certain thoughts, emotions or behaviors that certain individuals may exhibit may be unacceptable within the society. For instance, Angela attempted suicide, which though uncommon and non-hereditary in her immediate family as a part of her family died from natural causes, is unacceptable in the society. Her action is therefore viewed as deviant since her society prohibits such actions. Distress Angela undergoes through negative feelings describable as the toughest moments in her life. This is because she had earlier coped with depressive situations with ease – such as the death of her father some five years back unlike her mother and sister who underwent depression. On account of her current negative feelings about herself and her employment situations including considering quitting, Angela evidently undergoes distress. For instance, she reports feeling confused, frightened, and avoids talking to anyone including her husband and her friends. Dysfunction Angela shows some maladaptive behaviors that affect her ability to perform her normal duties. These prevents her from pursuing her normal lifestyle, meaning it can be suitably be dismissed as involuntary. For instance, following the birth of her first child, she refuses to return to work and is only persuaded by her husband to do so. Though she might as well be perceived to be merely anxious about the birth of her daughter, it to some degree displays some lasting symptoms that later culminate to her attempt to take her own life by overdosing on drugs. She also considers quitting her job, claiming it is not “taking her anywhere”. Danger Though Angela does not display violent behavior directed at others, her behavior hazards her own life. She engages in a suicidal activity when she attempts to overdose herself. This suggests she is suffering from a psychological disorder (Herman, 1997). Diagnostic and Statistical Manual of Mental disorders Diagnostic and Statistical Manual of Mental disorders (DSM) provides a responsive guideline that can correctly offer a diagnosis of Angela’s psychological disorder with regard to the prominent abnormalities (the four D’s) she displays. However, for her diagnosis to be made, she has to fulfill two levels of criteria within the guideline (Janowsky, 1999). Linehan (1991) advices that first, her behavior must originate within her and that it must be a reaction caused by external factors. Secondly, Angela’s disorder must be involuntary, which means she must be suffering a situation where she cannot control mentally or physically her symptoms. She satisfies both levels of criteria (Arlington, 2000). Disorder that Angela Satisfied Angela suffers from a major depressive disorder, which in this case is denoted by the symptoms she displays such as entertaining thoughts of suicide, lack of motivation as she considers to quit teaching claiming it doesn’t pay and general lack of vitality (Linehan et al. 1991). On the part of bipolar disorder, Angela is going through episodic depressive tendencies. For instance, she was referred for assessment upon returning to work, her disorder afterwards culminated to her attempt to take her on life (Brody, 2008). This means she has been undergoimg through a series of depressive episodes that culminate in her recent suicide attempt. In addition, when the second daughter reached 5, Angela was treated with antidepressants for 18 months, meaning she had earlier showed symptoms of psychological disorder. Critical Analysis of Bipolar Disorder Even as awareness of bipolar disorder has increased in the last two decades, the condition remains distinguishable by the functional impairment and disabling burden in relation to morbidity. Although extensive epidemiological researches are lacking, it remains identifiable by severe features such as suicidal attempts, attention deficit and anxiety disorder, all of which Angela has exhibited. However, this condition sets a therapeutic challenge as using methylphenidate or antidepressants could induce mania. Then again, the guidelines for treating this disorder have largely been criticized for being outdated (Herman, 1997). DSM-IV TR DSM-IV TR, which is the current version of DSM, applies a multifaceted system of classification that demands that an individual undergoing through psychological disorder has to be placed on five different axes that describe likely mental health factors. A majority of the disorders are state dependent and are classified as Axis I. Those that are trait dependent are categorized under Axis II, while Axis III defines existent physical conditions. Axis IV on the other hand illustrates environmental or psychosocial stressors and Axis V is often applied to denote the client’s global assessment of functioning. A survey of the six blocs shows that Angela’s disorder can be classified under Axis I. In this case, etiological theories such as Bio-Social Theoretical Model and Hippocampi theory apply (Linehan, Heard & Armstrong, 1993). Etiological theories explaining Angela’s condition Several theories try to explain the causes of depression. Bio-Social Theoretical Model. The bio-social theory is among the most criticized etiological models. According to Linehah (1993), BPD is majorly a disorder or emotion dysregulation and originates from interactions of humans to the environment. Even as the dysfunction the theory proposes is one of the broadest on all major aspects of emotional response, literature on the biology behind emotion dysregulation is very limited. Moreover, this theory is a likely product of the BPD conceptualization. Whereas emotion dysregulation is nearly connected by the time borderline pathology, emotional dysregulation has been proven to be able to develop independently and sequentially thus enabling varied aspects of functioning. In addition, a review of the etiological mechanism shows that most biological associations of BPD tend to be similar to those observable during impulse control disorders. In the case of hippocampi, which is perceived to be entrenched in memory and learning, it is said that intense or chronic stress can increase the level of the hormone called cortisol that is released from the hippocampi. It has been suggested that this may cause the hippocampi to shrink thus decrease an individual’s ability to remember things or solve problems. The emotional reactions in Angela’s case could be suitably explained by this theory (Elliott, 1998). While this theory seems convincing, it does not satisfy the expectations of some researchers as most researches on the neurochemical mechanism of depressive tendencies in human beings do not particularly state the imbalances that occur during depression (Book, Katherine & Vernon, 2001). In addition, since humans have different personalities and temperaments, is it difficult to predict to what level the hormone cortisol would be released. In addition, on analysis of the evidences on the treatment of depression, the theory would not be realistic enough if it is applied to specify that all levels of depression are mechanistically related (Elliott, 1998). SECTION B Marsha Linehan and the Bio-Social Theoretical Model Linehan (1997) explains that the causes of biological predisposition, in addition to being nurtured, are based on the environment. According to Bio-Social Theoretical Model, an individual is inclined to suffer emotional disorders depending on the invalidating environment (Masterson, 1997). The biological predisposition in this case involves the formation of cyclical transaction over time. Angela’s biological predisposition to emotional extremes progresses sensitive to the environment, invalidation and neglect. Treatment Approach Dialectical Behavior Therapy as Treatment Approach Dialectical Behavior Therapy (DBT) is specifically designed to treat individuals who exhibit self-harming tendencies such as suicidal attempts. DBT is based on the social theory of borderline personality disorder (BDP), which Linehan (1991) observes results from emotionally vulnerable people who have grown up through environmental situations she describes as the Invalidating Environment. DBT treatment is therefore a cognitive behavioral approach that stresses on the psychosocial aspects of treatment. According to the theory behind this approach, some individuals are vulnerable to reactions in intense or out of the ordinary emotional situations, particularly those found in family situations and other personal relationships (Linehan, Heard & Armstrong, 1993). The DBT theory advises that certain individual may be aroused to high levels pf emotional stimulations depending on certain situations compared to an average person who, when has attained the high levels of emotional stimulation, can return to the baseline. An emotionally vulnerable person’s autonomic nervous system reacts extensively to relatively low levels of distress, and often takes longer than normal to resume baseline even after the stress factor is removed. Proponents of this theory argue that this kind of emotional stimulation results from a biological diathesis. The philosophy that underlies the concept of best practice in this kind of treatment that is suggested requires that the process be science-based, meaning the treatment program has to be based on research to ensure that the intervention uses a proven model that subsequently ensures that the results or outcomes are measurable. In fact, the principle of best practices has become the standard for determining efficacy of the intervention programs suggested to clients with mental health problems (Linehan, Heard & Armstrong, 1993). Critical analysis of DBT in relation to Angela’s case Linehan (1991) suggested a biosocial theory that forms the basis of her conceptualization of BPD. In fact, its close association with self-affliction or suicidal injuries is what makes it very relevant treatment intervention for Angela. Accordingly, the major difficulties Angela faces are percieved as deriving from primary physiological difficulty resulting from emotional disregulation coupled with a history or background of an invalidating environment. Linehan (1997) emphasizes that the focus on using BPD should be led by client’s parasuicidal and sel-injurious behavior as it has the capacity to bring these behaviors under control. However, this conclusion is subject to how medical risk is defined and does not determined when the DBP subject, in this case Angela, is compared to those who successively received the treatment. With this, it can be argued that DBT is effective, although not differentially effective in reducing the risky suicidal behavior Angela has exhibited (Linehan, Heard & Armstrong ,1993). Justification of Treatment Choice The features of BDP, as grouped by Linehan (1993), illustrate Angela as showing dysregulation in the area of emotions, behavior, relationships, self-consciousness and cognition. According to some theorists, the consequence of the situation exhibit typical behavioral patterns. The first one includes emotional vulnerability where the patients are aware of their conditions and may blame others. Secondly, the clients have internalized the characteristic of Invalidating Environment and therefore may feel angry and ashamed with themselves. The two comprise dialectical dilemmas (Linehan, 2001). An individual may also experience frequent traumatic environmental events that may be related to their dysfunctional way of life. Given their emotional turmoil, they may have negative feelings associated with loss or earlier grief. Angela, who shows this behavior, meets the criteria for the borderline personality disorder (BPD). It is common for BPD individuals to be diagnosed with bipolar disorder, depression, anxiety and post traumatic stress disorder (PTSD). Angela suffers from depression and may be classified as also suffering from post traumatic stress, she also suffers from anxiety (Kliem et al, 2010). DBT, which is largely an empirical supported treatment, is a development of cognitive behavioral therapy (CBT). A major assumption of DBT is that suicidal behaviors are coping techniques for intensely negative emotions such as fear, shame or anger (Linehan, Heard & Armstrong 1993). In addition, Angela has mood disorder. This is characterized by generalized anxiety or major depression, which are not controlled by standard medications, leading to her state of emotional turmoil. Either one of these may be responsible for emotional vulnerability. An individual in this state undergoes emotional reactions that make her life seem utterly jumbled up (Linehan, Heard & Armstrong 1993). Therapy in DBT Linehan (2001 suggest that for a client’s comprehensive psychotherapy to be met, the therapy must cover five factors. First, the therapy must motivate the client into accepting transformation. Second, it should offer the client an opportunity to develop his interpersonal skills. Next, it should assimilate the new skills developed so the client can apply them in relevant situations. It should also develop the therapist’s personal abilities and lastly, it has to provide nonjudgmental environment that assures of a secure healing process. Three major modes of treatment are recommended for individual in standard DBT, namely skills groups, phone coaching and individual therapy (Linehan, 1997). In individual therapy, an individual is offered once-a-week individual sessions, typically one or one and half hours (Lisa, 2003). They must further attend skills groups that run for two hours each week. However, unlike regular group psychotherapy, these kind of skills group appear as classes during when clients are taken through a range of essential skills such as interpersonal effectiveness, mindfulness, distress tolerance and emotion regulations (Linehan, Heard & Armstrong, 1993). Clients are in addition advised to call their therapists for skills coaching before they engage in any activity that may injure them (Decker, 2008). The therapist, in this case, will take them through optional self-harm or suicidal behaviors. Linehan (1997) advises that in standard DBT, it is the individual therapist who must take full charge of the treatment and not the client, meaning it is the therapist’s responsibility to control the treatment with psychiatrists, skills group leaders and counselors. Alongside the client, who in this case is Angela, the therapist will have to keep track of how the treatment goes and how the client progresses. Interpersonal effectiveness The skills group training will also teach Angela interpersonal response patterns, many of which are similar to those imparted in interpersonal problem solving sessions. The response patterns may include strategies for requesting for what one desires, managing interpersonal conflicts and “saying no” (Masterson, 1988). Theorists agree that individuals for BPD generally have good interpersonal skills though the problem arises in the application of these skills in certain situations. For instance, though Angela may be able to give a detail account of her behavioral sequence -- as she clearly explained her history --, she may however be incapable of carrying out similar behavioral sequence when asked to analyze her own situation (Melia et al., 2000). The interpersonal effectiveness response is focused on circumstances where the objective of the skill is to help an individual to accommodate certain changes or to resist some changes. The skills imparted are designed to maximize her chances in meeting specific goals in her life, while at the same time helping her to build her self-respect (Holmes, 2005). In this regard, a client-therapist relationship would be emphasized. Client-therapist relationship Theorists have suggested that suffering from depression is closely linked to a social disconnection, meaning the fastest way to get a patient out of the condition would be through establishing a rapport with the client. The most significant element depends on the quality of relationship established with the client, such as how trustworthy and consistent the established connection is (Melia& Wagner, 2000). In fact, this kind of relationship is a necessary ingredient for many reasons including the fact that it is some kind of living laboratory. The rapport has been found to act as a catalyst that fastens recovery. As a matter of fact, establishing connects amid difficulties is a practical healing process. Learning how to resolve problems while maintaining connections is often a pathway out of depressive condition (Melia& Wagner, 2000). Acceptance techniques’ and ‘change techniques’ Although DBT helps to change an individual, it is different from CBT as it focuses on enabling an individual to accept who she is. Angela will therefore have to be coached to balance change techniques and acceptance techniques (Linehan, 1997). Acceptance techniques will focus on her understanding of who she is and the things she does. Using these approach, the therapist may be prompted to her self-harming behavior makes some sense, even though it is not in the therapy’s best interest in the long run (Holmes, 2005). Change techniques in DBT involve using the transformation approach to change Angela’s behavior, as well as teach her more effective means of dealing with her distress. She will have to be encouraged to replace her self-harming behaviors with those that can help her move forward with her life (Linehan et al., 200). Ethics in Therapy The therapist must observe the ethical code of practice which details out the standards of excellence in treatment intervention. In this case, the client has the right to seek a counseling with particular expectations on her therapist’s professionalism or values. The therapist is expected to protect the privacy of the client by maintaining confidentiality of the client’s records. Concerning informed consent, the therapist must inform her client of the manner in which the intervention will be conducted and what it would entail. The therapist must also treat her client with respect without harassing or intimidating them. She is also obligated to safeguard the client’s personal welfare and integrity (Barnitt, 2000). In conclusion, in the case of Angela, the stigmatized diagnosis of BPD is viewed as a logical and empirical system of treatment applied to help her with her developmentally arrested, traumatized and biologically disposed situation. This is targeted at helping her to move forward with an emotionally healthy life. Though theorists may tend to differ on etiological views, the understanding of how nature, nurture and fate play critical roles in formulating BDP symptoms stick out as vital in establishing the alternative treatments to explore (Linehan, 1997). References Arlington, VA 2000. 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