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Case Study Victor Assignment
School of Behavioral Sciences, Liberty University
Case Study Assignment Victor
Victor is a 15-year-old male who has been experiencing behavioral issues since his parents’
divorce. His behavior worsened after his father remarried, and he has refused to see him since
then. Victor used to be very social, had many friends, and participated in several school sports.
However, he has lost interest in all of these activities because he feels his family is “broken” and
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feels embarrassed about the situation..
Client Concerns
Biological factors
Psychological
Social/cultural
Spiritual
Physical symptoms, for
example: neurological,
past present impact
Past and present
Ideas, thoughts
feelings, beliefs,
values about self,
others the world
Past and present
Family systems,
Relationships with
others,
Cultural elements
Past, present
Religious and spiritual
aspects of self/family
Past present
Embarrassed Always been sensitive Parents Divorced Not speaking with
father
Hard to fall asleep Academic decline Father remarried Used to like to go to
church, don’t care
about
it lately
Sadness Losing friends and not
caring about it
Used to be outgoing,
withdrawn lately
Verbal Aggression Embarrassed to have a
broken family
Assessment
In Victor’s case, the Adjustment Disorder–New Module (ADNM) would be an appropriate
assessment tool. Victor is having significant difficulty adjusting to the changes in his family
structure following his parents’ divorce and his father’s remarriage. The ADNM can help
determine what even could triger the patient and how often is happening. Also is could clarify it
that whether he meets criteria for Adjustment Disorder (AjD). Adjustment Disorder is
characterized by the development of emotional and behavioral symptoms in response to an
identifiable stressor. Core features include preoccupation with the stressor—such as persistent
distressing thoughts or rumination—and a failure to adapt, which may present as sleep
problems, concentration difficulties, or withdrawal from normal activities (Lorenz et al., 2016).
Diagnostic Impression
Reviewing Victor’s case and completing the ADNM assessment, his scoring indicates symptoms
in the categories of failure to adapt, depressed mood, impulse disturbance, and preoccupation
with the stressor. Completing this measure helps us better understand how he is feeling
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internally and what factors may be triggering or worsening his symptoms. The ICD-10 code is
F34.81Disruptive Mood Dysregulation Disorder. (American Psychiatric Association,
2022).
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: disorder name
and code number
Client’s Signs/Reported Symptoms from case
study:
Criterion A: F39Unspecified Mood Disorder Victor is struggling to adjust to the new
changes in his family structure.
This category applies to presentations in which
symptoms characteristic of a mood dis-order
that cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning predominate …
etc.
Criterion B: Specifiers for Depressive Disorders
With melancholic features.
Victor used to be very social and had many
friends, but since his father remarried, he has
lost interest in activities he once enjoyed and
has begun to socially withdraw.
A. Loss of pleasure in all, or almost all,
activities. Lack of reactivity to usually
pleasurable stimuli (does not feel much better,
even temporarily, when something good
happens)
Criterion C: F94.1 Reactive Attachment
Disorder
Victor has not spoken to his father or seen him
since the remarriage. He recognizes that his
family will not return to its previous state, and
he feels angry toward his father as a result.
A. consistent pattern of inhibited, emotionally
withdrawn behavior toward adult caregivers. B.
A persistent social and emotional disturbance
Other DSM-5-TR Conditions Considered
When reviewing Victor’s case, Reactive Attachment Disorder (RAD) may initially appear as a
possible consideration because of his resentment toward his father and verbal aggression
toward his mother. Victor had hoped that his parents would reconcile after their divorce, and he
is now angry that this will not happen. These emotional and behavioral difficulties have
persisted for more than 12 months. However, it is important to note that RAD typically develops
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in early childhood and is associated with severe neglect or insufficient caregiving—factors that
may not align with Victor’s history.
Developmental Theories and/or Systemic Factors
Victor previously had a strong relationship with both his parents and siblings, and his mother
reported that he rarely needed discipline, stern voice was usually enough for him to understand
his mother’s expectations. Since the divorce, however, his behavior has changed significantly.
The difficulties intensified after his father’s remarriage. Academically, Victor has shifted from
being a solid B student to now earning mostly D’s. Additionally, the school has been calling his
mother frequently regarding behavioral concerns raised by teachers and his friends.
Multicultural Competencies and Considerations
Victor’s mother’s faith is very important. Victor stated that he used to enjoy attending church
and seeing his friends there. Recently, however, he has not feels the same and feels guilty about
it.
Treatment Recommendations
Key Issues for Treatment
•Aggressive Behavior
•Social Withdrawn
Recommendations for Counseling
Since Victor is only 15 years old and his behavioral changes began after his parents’
divorce, I would recommend beginning with Functional Family Therapy (FFT) with both parents
present. Victor needs space and guidance to mourn and adjust to the divorce, and his parents
play an important role in supporting this process. The therapist listens and validates, provides
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information and teaches skills, models behavior, and engages families in working on new ways
of interacting. Although the therapist brings knowledge, parents are regarded as “experts” on
their child. The therapist and family members collaboratively adapt the techniques/skills to the
needs of the individual family. Family members are encouraged to try activities (i.e.,
roleplaying), and the therapist maintains a hopeful, curious, and collaborative stance.
Normalizing and validating parents’ emotions (e.g., frustration, hopelessness) is essential and
provides a first step in trying new strategies. Ultimately, as with most treatments, listening and
connecting with families’ experiences is essential for competent application of FFT-CD.
(Tompson et al, 2017).
Specific Considerations
Victor is showing signs of social withdrawal and a loss of interest in activities he
previously enjoyed. n addition to family therapy, Victor would benefit from individual Cognitive
Behavioral Therapy (CBT) to help him process his personal challenges with a licensed
professional. Through CBT, Victor can learn healthier ways of coping with the emotional impact
of his parents’ divorce. It is important for him to recognize that the divorce is not the end of the
world, and he needs guidance in learning how to adjust to and navigate this new reality.
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References
References:
American Counseling Association (ACA). (2014). ACA Code of Ethics.
https://www.counseling.org/resources/aca-code-of-ethics.pdf
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Lorenz, L., Bachem, R., & Maercker, A. (n.d.). ADNM-8: Self-report for the assessment of
adjustment disorder (English version). Universität Zürich, Department of Psychology.
https://www.psychology.uzh.ch/dam/jcr:1bf5e05f-fbd5-4cbb-a97e-f8029a090680/
ADNM_8_Homepage_English.pdf
Lorenz, L., Bachem, R. C., & Maercker, A. (2016). The Adjustment Disorder–New Module 20
as a screening instrument: Cluster analysis and cut-off values. International Journal of
Occupational and Environmental Medicine, 7(4), 215–220.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6817961/
Tompson, M. C., Langer, D. A., & Asarnow, J. R. (2017). Family-focused treatment for childhood
depression: Model and case illustrations. Cognitive and Behavioral Practice, 24(3),
269–287.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5617640/
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