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Running Head: Case Study Jane 1
Case Study Assignment: Jane
Key Issues
Biological
Jane, a 54 year old black female was involved in a car accident about three and a half
weeks ago. The car accident required Jane to be taken to the hospital, and resulted in multiple
broke ribs, bruises, abrasions, a broken arm, and a none concussion bump on her forehead. Since
the accident Jane has been suffering from nightmares multiple times a week. She has also been
having trouble sleeping. Jane states she gets under 5 hours of rest each night.
Psychological
Running Head: Case Study Jane 2
Jane is mentally struggling with the events that happened during the car accident. 3 individuals
passed away, and she is having a hard time coping with their loss. Jane also is experiencing
flashback thoughts of the accident. Jane states these recurring memories happen multiple times a
day, affecting her ability to concentrate. During such moments, Jane’s heart will race, she will
become sweaty, and momentarily she will loose sense of where she is at. The main memory she
struggles with is the sight of the first cars hitting head on, and the feeling of being trapped and
having trouble breathing. The thoughts make her feel overwhelmed, creates nightmares, and
causes her to feel anxiety. Jane has became easily angered, irritable, tensed, startled, and at times
unable to calm down. Jane’s work performance and relationships have suffered from her lack of
ability to focus, and her emotional and mental state. The result of the accident has caused Jane to
have a fear of driving, which she has not done since the accident. The idea of driving makes Jane
feel overwhelmed. When she does ride in the car with her husband, Jane becomes easily startled,
She will jump, grab the armrest, and scream. At this time she feels the only way to be safe is to
stay home.
Social
Janes social life has been affected by the recent accident she experienced. Jane’s fear of travel
and driving has resulted in her husband driving her everywhere and having to alter his routes to
get there. While her husband is tolerant, he is also becoming annoyed with her reactions while
riding in the car. Because of Jane’s fear of travel, she has not visited her children or her parents,
nor engage with her friends or in social activities with her community or church group.
Jane fears that her friendships with her coworkers could also soon end. The lack of social
interactions is causing Jane to feel guilt.
Running Head: Case Study Jane 3
Spiritual
Jane believes in God but is currently struggling with understanding why the car accident
happened to her. She feels God let her get into the wreck, and she does not know why he would
do that to her. Her inability to focus is affecting her ability to pray, and her fear or travel is
affecting her attendance at church and able study.
Assessment
Jane is has been suffering mentally and physically due to a recent car accident. An appropriate
assessment to use for Jane would be the International Trauma Questionnaire. The ITQ is an
assessment that identifies Post Traumatic Stress Disorder and Complex Post Traumatic Stress
Disorder. The ITQ uses a 12 question self assessment to analyze individuals exposed to trauma
and or traumatic events. This assessment is considered easy to use in a clinical setting, as well as
easy to understand for a diverse range of clients.
Diagnostic Impressions
After reviewing the case study of Jane, an appropriate diagnosis for Jane would be Post
Traumatic Stress Disorder 309.81 (F43.10). When considering Jane in comparison to the
symptoms listed in the DSM-5 under PTSD:
1. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of
the following ways: A. Directly experiencing the traumatic event. B. Witnessing, in person,
the event(s) as it occurred to others. C. Learning that the traumatic event(s) occurred to a
close family member or close friend. D. Experiencing repeated or extreme exposure to
aversive details of the traumatic event. Jane was involved in a car accident which is
Running Head: Case Study Jane 4
considered a direct traumatic experience. The fatal car accident that took the lives of three
people, and she is experiencing repeated details of the traumatic event.
2. Presence of one (or more) of the following intrusion symptoms associated with the traumatic
event(s), beginning after the traumatic event(s) occurred: A. Recurrent, involuntary, and
intrusive distressing memories of the traumatic event. B. Recurrent distressing dreams in
which the content and/or affect of the dream are related to the traumatic event. C.
Dissociative reactions in which the individual feels or acts as if the traumatic events were
recurring. D. Intense or prolonged psychological distress at exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic event. E. Marked physiological
reactions to internal or external cues that symbolize or resemble an aspect of the traumatic
events. Jane has been experiencing trouble sleeping due to frequent nightmares about the car
accident. The nightmares are happening multiple nights a week. She has had multiple
flashbacks about the accident where she feels as if she is reliving the event over again. Jane
also is having a hard time mentally getting past the fear of driving.
3. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the
traumatic event(s) occurred, as evidenced by one or both of the following: A. Avoidance of
or efforts to avoid distressing memories, thoughts, or feelings about or closely associated
with the traumatic event. B. Avoidance of or efforts to avoid external reminders that arouse
distressing memories, thoughts, or feelings about or closely associated with the traumatic
event. An avoidance in Jane’s life is driving and traveling, and the highway. Ever since the
accident Jane has not driven. Jane is overwhelmed with he thought driving, has become
tensed and startled while riding in the car, and fears for her safety. Jane also avoids any travel
on the highway. She has found alternate routes to get her destinations.
Running Head: Case Study Jane 5
4. Negative alterations in cognitions and mood associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more)
of the following: A. Inability to remember an important aspect of the traumatic event. B.
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the
world. C. Persistent, distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others. D. Persistent negative
emotional state. E. Markedly diminished interest or participation in significant activities. F.
Feelings of detachment or estrangement from others. G. Persistent inability to experience
positive emotions. Jane is living in a constant state of fear regarding traveling and driving.
Jane is experiencing anxiety from the accident which is affecting her work performance as
well as interfering with her daily life and routine. Jane has not be able to engage in her
regular activities and the things she enjoys such as visiting family, and being involved with
the community and church events. Jane is starting to feel guilty because of the impact the
accident has had on her husband having to drive her everywhere, her lack of attendance at
church, and her absents and neglect in tending to her parents.
5. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning
or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the
following: A. Irritable behavior and angry outbursts. B. Reckless or self-destructive behavior.
C. Hypervigilance. D. Exaggerated startle response. E. Problems with concentration. F. Sleep
disturbance. Jane reported having difficulties falling and staying asleep, partially due to the
nightmares. Jane also noted difficulties with concentration, becoming startled and being
hypervigilance while in the car.
Running Head: Case Study Jane 6
6. Duration of the disturbance is more than 1 month. It has only been between 18 days and
three and a half weeks since the accident.
7. The disturbance causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning. Jane does not have any other mental issues, distress,
or impairments.
8. The disturbance is not attributable to the physiological effects of a substance or another
medical condition. Jane does not have any history of substance or medical conditions.
Treatment Recommendations
The treatment I would specifically recommend for Jane would be Cognitive Behavioral Therapy.
CBT is a treatment that has been found to successfully improve the effects of PTSD. A study was
conducted on individuals whom suffer from PTSD and have symptoms related to sleep
disturbances, anxiety, depression, nightmares, and insomnia. The study found that the use of
cognitive behavior techniques improved the participants quality of sleep, as well as the severity
of their symptoms (Germain et al, 2007).
Specific Considerations
One thing to consider is Jane’s concerns with traveling, driving, and leaving her home. Her fears
with leaving her home and traveling may interfere with her abilities to attend counseling
sessions. Because of Jane’s fears, virtual sessions and in home session may be the best option
until the anxiety and fear are at a manageable level.
Running Head: Case Study Jane 7
Reference
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).
Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T.,
& Hyland, P. (2018). The International Trauma Questionnaire: Development of a self-
report measure of ICD-11 PTSD and Complex PTSD. Acta Psychiatrica Scandinavica,
138(6), 536–546. https://doi.org/10.1111/acps.12956
Germain, A., Shear, M., Hall, M., & Buysse, D. (2007). Effects of a brief behavioral treatment
for PTSD-related sleep disturbances: A pilot study. Behaviour Research and Therapy,
45(3), 627–632. https://doi.org/10.1016/j.brat.2006.04.009
Running Head: Case Study Jane 8
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