Assignment 1
Diagnosing Mental Health Disorders
Please refer to the DSM 5 only.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
(Created 9-26-2018)
Case Conceptualization
Using the DSM 5
Writing a diagnosis and justifying your opinion.
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What you will learn…
The purpose of diagnosing (labeling) an individual is so that they can receive proper treatment.
A diagnosis is an umbrella term for a constellation of symptoms that tend to present around the same time. Having one symptom does not automatically mean you have a diagnosis. Most diagnoses require a minimum number of symptoms that need to be present during a specified period of time.
The DSM 5 is the most recent iteration of the Diagnostic Statistical Manual compiled and written by the American Psychiatric Association. The coding in the manual also match the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems 10 (ICD 10). These codes are used worldwide for insurance billing.
In your course work and profession, you will be called upon to diagnose. Currently, the DSM 5 is used throughout the Psychological/Psychiatric profession. When the American Psychiatric Association issues a new iteration of the DSM, you will be advised by your profession when that manual will be employed for diagnostic purposes. In other words, do not use any of the previous iterations of the DSM for diagnosing as the criteria and coding have all changed.
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Diagnosing
Conceptualizing the client-
What is Case Conceptualization? A case conceptualization is a report that is based on information gathered, organized, and assessed to provide an explanation of a client’s behavior. Counselors look for emotional, stated, non-verbal, and behavioral information that will help to develop a picture of the client’s experience and will lead to collaboration with the client on goals for change.
1. Listen to the client’s story/presenting problem
2. Gather information about how the client perceives his/her world
3. Obtain demographic information including gender identification, marital status, children
4. Explore social, historical, and cultural context
5. Assess client’s strengths, coping skills (note intelligence, level of insight, language proficiency)
6. Assess for risk; create problem list (previous suicide, do they belong to a high risk group)
7. Diagnose
8. Apply theoretical orientation and hypothesize about the nature of the problem
9. Develop goals
10. Plan interventions
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Case Conceptualization and Diagnosing
You will read a case.
You will start to get a picture of who the client is.
As you read, you will begin to hone in on the specific issues (symptoms) they are sharing.
Do not assume anything! If they do not meet criteria, you can present the symptoms they have met and the diagnosis as a “Rule out”. It is possible that the client has not shared all things with you and another session or referring the client to a psychiatrist may resolve the diagnostic issue.
When you write up a diagnosis, make sure to include the DSM 5/ICD 10 coding, specifiers and severity index.
All symptoms must be matched to client reports (their words), behaviors (actions), or your assessment (behavior during the session).
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What will happen next…
Jason is a 24 year old Caucasian Male who has been court mandated to participate in substance abuse counseling stemming from a DUI he received in February of 2018. Jason reports that he has never been in trouble before and denies any need for counseling. However, when asked if he has had any other issues related to drinking, he mentions that he was “kicked out” of college because he spent too much time partying. This situation, he reports, is one of the main issues he has had with his family since they were disappointed with this turn of events and his inability to complete his undergraduate degree.
Jason presents as a bright, young man. He was well dressed and well spoken. He was forthcoming but showed little insight as to his own problems. He reports that he always did well in school and the expulsion from college was a shock to his family. He admitted that his drinking had gotten “out of hand” despite his attempts to “chill”.
Jason admitted to attempting to quit drinking several times. He admitted that he usually drinks more than he wants and spends time figuring out when he can drink again. He also admitted that he was frequently taking a couple of drinks throughout the day to avoid feeling “lousy”. He admitted having a strange experience after he was arrested where he saw things (reported he saw birds circling his car. Also reported he saw the face of a demon) and, once he had bailed himself out, he “fixed” it with more liquor.
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Case Study
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1.Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499–500).
Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
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DSM 5 Criteria for Alcohol Use Disorder (American Psychiatric Association, 2013)
Jason is diagnosed with alcohol use disorder-severe 303.90 (F10.20) as evidenced by the following:
1. Jason admitted that he has unsuccessfully attempted to cut down his drinking (Criteria 2).
2. Jason admitted that he drinks more than he wants to (Criteria 1).
3. Jason admitted to spending time planning when he can drink again (Criteria 3).
4. Jason admits drinking on the job to address cravings and stave off withdrawal symptoms (Criteria 4).
5. Jason has been arrested for drinking while driving, expelled from school (Criteria 5).
6. Jason has admitted that he currently has issues with his family due to his drinking (Criteria 6).
7. Jason willingly admits that he is not fulfilling major roles in his family-or life (Criteria 7).
8. Jason has continued to drink despite all of these problems (Criteria 9).
9. Jason reports symptoms of delirium tremens (withdrawal-severe)
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Diagnosis
Severity is based on number of symptoms and length of sobriety. Since Jason presents with 9 symptoms of this diagnosis and has not stopped drinking- he meets the criteria of having a severity index of SEVERE 303.90 (F10.20).
Specify current severity /remission :
305.00 (F10.10) Mild: Presence of 2–3 symptoms.
(F10.11) Mild, In early remission
(F10.11) Mild, In sustained remission
303.90 (F10.20) Moderate: Presence of 4–5 symptoms.
(F10.21) Moderate, In early remission
(F10.21) Moderate, In sustained remission
303.90 (F10.20) Severe: Presence of 6 or more symptoms.
(F10.21) Severe, In early remission
(F10.21) Severe, In sustained remission
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Severity Index (taken from DSM 5- American Psychiatric Association,2013)
1. It is recommended that Jason receive a complete physical to rule out any physical issues which can exacerbate the effects of alcohol (i.e. diabetics can react negatively to small amounts of alcohol).
2. Due to Jason’s admission of severe withdrawal symptoms (seeing things- Delirium Tremens can result in death), inpatient alcohol detox is warranted.
3. Residential Treatment lasting no less than 6 months followed by 6 months in a sober living facility.
4. Possible referral for psychiatric evaluation (despite the fact that Jason has not shown signs of mental disorder, the prevalence of co-occurring disorders [mental illness and use disorders] warrants a referral.
5. Therapies: Individual and Group Therapy as required in the treatment facility (CBT, Motivational Interviewing)
6. AA Support.
7. Case Management- Job support, Return to School.
Note- You can recommend things- it does not necessarily mean they will complete this. These are all recommendations you can make with the client who will ultimately choose their treatment. Even if they are court mandated, the client may choose to not comply. However, since there is court involvement, the judge may choose to violate their probation if the client does not comply.
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Recommendations