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CASE STUDY ASSIGNMENT: VICTOR
Case Study Assignment: Victor
Tristen Dudley
School of Behavioral Sciences, Liberty University
Author Note
Tristen Dudley
School of Behavioral Sciences, Liberty University
I have no known conflict of interest to disclose
Correspondence concerning this article should be addressed to Tristen Dudley
Email: [email protected]
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CASE STUDY ASSIGNMENT: VICTOR
Client Concerns
Symptoms Behaviors Stressors
Sadness Anger Outbursts Parents’ Divorce
Hopelessness Argumentative Dad’s New Marriage
Anger Isolation
Tearfulness
Trouble Sleeping
Lack of Interest
Trouble Concentrating
Academic Regression
Assessment
One assessment that would be utilized to clarify Victor’s diagnosis would be the ADNM-20.
This assessment is the Adjustment Disorder-New Module 20 Screening Assessment. This
assessment is designed to measure adjustment disorder as a reaction to an identifiable stressor.
Liang et al. conducted a study in which their conclusion was, “Both ADNM-20 and ADNM-4
were reliable and valid to assess probably AjD,” (2021). This assessment would help to confirm
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CASE STUDY ASSIGNMENT: VICTOR
the diagnosis of adjustment disorder, through self-assessment of distressing events and
experienced symptoms since encountering the identified source of distress.
Diagnostic Impression
The primary diagnostic impression based on the DSM-5-TR is as follows:
F43.25 Adjustment Disorder, Acute, With Mixed Disturbance of Emotions and Conduct.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: F43.25
Adjustment Disorder, Acute, With Mixed
Disturbance of Emotions and Conduct
Client’s Signs/Reported Symptoms:
A.
The development of emotional or behavioral
symptoms in response to an identifiable
stressor(s) occurring within 3 months of the
onset of the stressor(s).
Victor is exhibiting anger outbursts and
verbal arguments with family, friends, and
peers, as well as isolating himself from those
he used to enjoy spending time with.
B.
These symptoms or behaviors are clinically
significant, as evidenced by one or both of the
following:
1.
Marked distress that is out of proportion to
the severity or intensity of the stressor, taking
into account the external context and the
cultural factors that might influence symptom
severity and presentation.
2.
Significant impairment in social,
occupational, or other important areas of
functioning.
Victor is experiencing trouble sleeping,
trouble concentrating in school, academic
regression, lack of interest in activities that
used to bring him joy. Victor is also having
social issues due to his feelings of anger,
sadness, and hopelessness and experiencing
issues within his family. Victor has not
spoken to his dad since the divorce.
The stress-related disturbance does not meet
the criteria for another mental disorder and is
not merely an exacerbation of a preexisting
mental disorder.
There is no pre-existing mental disorder.
The symptoms do not represent normal
bereavement and are not better explained
by prolonged grief disorder.
There was no qualifying death.
Once the stressor or its consequences have
terminated, the symptoms do not persist for
more than an additional 6 months.
Symptoms are currently ongoing and it has
only been four months at the time of
assessment.
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CASE STUDY ASSIGNMENT: VICTOR
Other DSM-5-TR Conditions Considered
Other diagnoses considered for Victor are Disruptive Mood Dysregulation Disorder; however,
there is precipitating event causing disruptive behavior. Additionally, Victor’s symptoms have
not been present for at least 12 months. Major Depressive Disorder was also considered;
however, Victor only meets three of the criteria. Oppositional Defiant Disorder was also
considered, but he has not been experiencing his symptoms for at least six months, only four.
Developmental Theories and/or Systemic Factors
Current systemic factors that appear to be having an impact on Victor’s behaviors/symptoms
include his parents’ recent divorce as well as his dad’s new marriage. Although it is common for
many marriages to end in divorce – as of 2023, "Nearly 1 million women (992,677) divorced in
2023, a nominal increase of 3,159 women from 2022 when 989,518 women divorced,”
(Westrick-Payne, 2024) – for Victor, his family is the only family within his extended family
that has experienced a divorce. This realization, alongside the actual divorce, and his dad’s new
marriage, have Victor feeling alone in his emotions and circumstance. Additional research on
children of divorced parents suggests, “The risk of post-traumatic or acute stress disorder is
increased in children who have been exposed to a conflict situation between their parents… In
cases where the child is forced to manage the distress resulting from parental conflict, the child
may develop a range of problems, such as attachment disorder, adjustment disorder, or
behavioral disorders,” (Adriana DICU, 2024).
Multicultural and/or Social Justice Considerations
A multicultural consideration to be taken, using the RESPECTFUL model, would be the
consideration of ethnic/racial identity. As notated in the case study, Victor’s family is Puerto
Rican. If we take a look at the divorce rates among Puerto Rican culture, according to census.gov
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CASE STUDY ASSIGNMENT: VICTOR
2021 data, Puerto Rico has among the lowest divorce rates at 3.9. This information can definitely
shine a light onto why Victor is feeling alone and possibly a reason why he is experiencing the
symptoms that he is. Further research on Puerto Rican culture and the impacts of divorce on
children indicate, “Puerto Rican children who transitioned to a single-parent family had more
than four times greater odds of internalizing disorders than children in stable two-parent families,
even after controlling for age, gender, poverty, and other variables,” (Santesteban-Echarri, 2016).
This is important to maintain awareness of, so that appropriate, ethical treatment can be
provided. According to ACA guidelines, it is the responsibility of the clinician to maintain a
cultural awareness to best treat clients.
Key Issues for Treatment
Verbal Arguments
Isolation
Sleep Disturbance
Treatment Recommendations
Based upon the information obtained about Victor from the case study, alongside his diagnosis
and symptoms, I would recommend that Victor engage in talk-therapy and CBT. Research
suggests that there is minimal research conducted in efficacious treatment for adjustment
disorder at this time. One article states, “To date, there is only one published systematic review
of treatments available for adjustment disorder,” (O’Donnell, 2019). Despite this lack of research
and information on effective treatment, based upon the symptoms that Victor has reported, it
appears that CBT could be an effective treatment in helping to reframe the thoughts that he is
having surrounding his parents’ divorce. Further articles on AjD suggest similar information, that
additional research is needed to identify effective treatment for individuals who have been
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CASE STUDY ASSIGNMENT: VICTOR
diagnosed with this disorder. Zelviene and Kaslauskas states, “The best treatment approach for
AjD remains unclear, and further treatment studies are needed to provide AjD treatment
guidelines to clinicians,” (2018).
Medication Considerations
There are several articles that ascertain that pharmacological intervention may be the best
approach for addressing AjD; however, given the fact that the research is still unclear, coupled
with Victor’s age and the type of medications suggested (Benzodiazepines), I would not
recommend medication right away. I would prefer to engage Victor in talk-therapy and CBT
first, then explore medication options as needed.
Specific Considerations
Victor’s age may affect diagnosis and treatment recommendations due to being in-between
adulthood and adolescence. Victor is old enough to understand quite a bit, yet not old enough to
grasp the reality of the divorce and circumstances being something that is not “world-ending”.
This may impact his treatment and diagnosis through being certain that he meets all diagnostic
criteria for age and any special indicators, as well as ensuring he is able to utilize his autonomy.
It is important to keep his family involved to an extent, but also ensure that they are aware that
Victor, although not an adult, he is also not a child who is unassuming. His privacy should be
respected. For the family system, I would also recommend therapy so that they can also develop
effective coping skills to assist with managing the divorce.
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CASE STUDY ASSIGNMENT: VICTOR
References
DICU, A. (2024). The family environment of children with divorced parents and their emotional
disturbances.LANTHROPOLOGICAL RESEARCHES AND STUDIES,L14(1), 438–451.
https://doi.org/10.26758/14.1.29.
Liang, L., Ben-Ezra, M., Chan, E. W. W., Liu, H., Lavenda, O., & Hou, W. K. (2021).
Psychometric Evaluation of the adjustment disorder new module-20 (ADNM-20): A
multi-study analysis.LJournal of Anxiety Disorders,L81, 102406.
https://doi.org/10.1016/j.janxdis.2021.102406.L
O'Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment
Disorder: Current Developments and Future Directions.LInternational journal of
environmental research and public health,L16(14), 2537.
https://doi.org/10.3390/ijerph16142537.
Santesteban-Echarri, O., Eisenberg, R. E., Bird, H. R., Canino, G. J., & Duarte, C. S. (2016).
Family structure, transitions and psychiatric disorders among Puerto Rican
children.LJournal of Child and Family Studies,L25(11), 3417–3429.
https://doi.org/10.1007/s10826-016-0498-2.
Trauma- and Stressor-RelatedLDisorders. (2025). Diagnostic and Statistical Manual of Mental
Disorders.
https://doi.org/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_
Disorders.
Westrick-Payne, K. K. Refined Divorce Rate in the US: Geographic Variation, 2023.
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CASE STUDY ASSIGNMENT: VICTOR
Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: current
perspectives.LNeuropsychiatric disease and treatment,L14, 375–381.
https://doi.org/10.2147/NDT.S121072
