The Primary Diagnosis in Smiths - Case Study Example

Project Task Project Task Primary Diagnosis The primary diagnosis in Smith’s case is that she exhibits abnormality in personality – interpersonal and individual – functioning and pathological personality attributes. Impairments in personality functioning are reflected by abnormalities in self-functioning, which comprises two features. These include identity and self-direction. In Smith’s case, her identity is pertinently impoverished. In addition, Smith’s behavior shows that her identity is poorly developed. Smith also exhibits an unstable self-perception that is closely linked to self-criticism and acute feelings of loneliness and emptiness, as well as dissociative behavior under duress. Regarding self-direction, Smith displays instability in aspirations, career objectives, and values. Smith also exhibits abnormalities in interpersonal functioning because she is unstable, needy, is anxiously obsessed with real or fantastical abandonment. She has been in multiple conflicted relationships, and she views most of her relationships from acute perspectives of devaluation and switching between withdrawal and overindulgence. Still on primary diagnosis, Smith exhibits emotional instability that entails constant mood changes and extremely sensitive emotions. Her reactions are also intense and out of sync with events and situations. Smith also exhibits extreme feelings of nervousness and panic, usually in response to interpersonal duress or worries over the negative implications of previous bad experiences and future unpleasant outcomes. Smith also displays fears of self-destruction and loss of control. She also feels fearful and can be apprehensive on occasion. Smith fears rejection by or separation from close friends and family. These fears are linked with fears of extreme dependency and total loss of independence. Smith shows feelings of depressivity, which involve feeling down, hopeless or miserable. Amidst all this, Smith also shows challenges in rebounding from her moods, negativity about the future, suicidal behavior and thoughts, and feelings of low self-worth. Smith also shows signs of disinhibition, which are marked by impulsivity (difficulty in creating and following schedules, urgency, and self-mutilating behavior under emotional duress). Secondary Diagnosis Drug abuse is a significant aspect of Smith’s secondary diagnosis. Her history of drug abuse is a result of the impairments in her personality, which have led her to abuse drugs so that she can escape from her condition. Her long history of drug abuse shows that she has deeper problems that she feels she cannot tackle by herself and therefore she has to seek solace in alcohol and drugs. Smith has also experienced several tragedies in her life, which could have influenced her current behavior. The fact that she cannot maintain employment for longer than 6 months also shows that she has a big personality and interpersonal problem (American Psychiatric Association, 2013). Smith tends to engage in risky activities. These activities are dangerous and potentially self-injurious and careless. However, she does not recognize this because impairments in her personality hinder her ability to rationalize her actions. Smith also displays unconcern for her limitations and refute of personal hazards. Smith is also exhibiting antagonism, which is characterized by hostility. She can display frequent feelings of anger or irritability in reaction to minute insults. The abnormalities in Smith’s personality functioning and personality trait manifestation are quite stable over time and uniform in most situations. The abnormalities in Smith’s personality functioning and personality attribute manifestation are not better interpreted as normative for her developmental phase or socio-cultural setting (Hoeksema, 2014). Finally, the impairments in Smith’s personality functioning and her personality attribute manifestation are not strictly as a result of direct physiological impacts of any substance (drug abuse, medication) or a normal medical condition (head injuries, etc.). Differential Diagnoses For Smith, differential diagnoses may include ignoring her personality impairments and simply concluding that she is just affected by childhood experiences that have defined her adult behavior. For example, she is the first born in her family, and she played her mother’s role by taking care of her younger sisters after school because her mother resumed work when she was just 12 years old. This shows that Smith became responsible at an early age, but not because she chose to. She was forced to assume responsibilities that were beyond her age because her mother neglected her duties. This leads to another circumstantial diagnosis, which is that she was neglected as a child. Since she was taking care of her siblings as her child, she missed an important phase of her childhood and grew up too fast. Another aspect of Smith’s childhood that may be important for differential diagnoses is that she was abused as a child. She stated that her mother physically and emotionally abused her by hitting her, yelling at her, and shoving her around. While she faced such abuse at the hands of her mother, her father overindulged in alcohol. However, she exhibited academic ability and tolerance despite her problems. She took part in academic-related activities and was never a recipient of special educational services or face significant behavioral challenges during her time in school. In fact, she viewed the classroom as a safe environment in which she could feel like a “kid.” She also graduated from high school, showing that she was of sound mental capacity. Smith started engaging in self-mutilating activities when the situation at home became too unbearable for her. This shows that she was “normal” up to that time and remained that way until she saw no other avenue to let out her frustrations than through drugs and self-harmful activities. According to DSM-5, Smith could have borderline personality disorder but she still retains some semblance of normalcy that makes her capable of understanding the people and situations around her. The Reasons for Selecting the Differential Diagnoses DSM-5 recommends through examination and evaluation prior to the conclusion of a particular case (Hoeksema, 2014). Under normal circumstances, it would be logical to infer that Smith is suffering from borderline personality disorder because of the impairments in her personality functioning and her self-mutilating behavior. However, Smith is also capable of leading a normal life because she can engage in normal activities like working and being in relationships. She also exhibits adequate self-awareness to recognize that she needs to seek gainful employment and to engage in productive activities. Justifications for Actual Diagnoses DSM-5 requires that cases similar to Smith’s are diagnosed based on accurate evaluations of personality impairments and pathological traits. In Smith’s case, her self-mutilating behavior and her inability to maintain productive relationships (most of her relationships are violent), added to her drug abuse, shows that her personality is clearly impaired (Hoeksema, 2014). In most clinical situations, the primary diagnosis is often the most important aspect of all diagnoses. Primary diagnosis provides the biggest clues on how to address medical conditions. Secondary diagnosis is also vital because it provides a complimentary approach that ropes in all possible scenarios. A consideration of whether a diagnosis of other conditions that maybe a focus of clinical attention is warranted. This is because the traits exhibited by Smith require urgent diagnosis and, if possible, treatment. The likely medical diagnosis from this situation is that Smith suffers from borderline personality disorder, but there could be possibly other conditions she could be suffering from (American Psychiatric Association, 2013). DSM-5 recommends that therapists, counselors, and mental health practitioners adopt a holistic perspective when examining their patients. It is unfair to rush in diagnosing patients without considering all possible conditions and circumstances that may affect possible interventions. Finally, some disorders (e.g., bipolar and borderline personality disorders) exhibit similar symptoms that may confuse therapists and counselors (American Psychiatric Association, 2013). It is necessary to expediency because misdiagnosis is highly likely if all possible angles are not considered. In conclusion, health practitioners, especially mental health practitioners, should exercise due diligence by following the DSM-5 and being through during diagnosis. References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th Ed.). Washington, D.C.: American Psychiatric Association. Hoeksema, S. (2014). Abnormal psychology (6th Ed.). Boston: McGraw-Hill. Read More