VICTOR CASE STUDY 2
CASE STUDY ASSIGNMENT INSTRUCTIONS
Client Concerns
Symptoms Behaviors Stressors
Sadness Anger outbursts Parents’ divorce
Anger Grades slipping Grades slipping (it is a
behavior and a stressor due
to not meeting the
expectations he had
previously set)
Disinterest in friends and
sports
Crying Father’s remarriage
Difficulty concentrating argumentative Not taught how to express
emotions, which may
amplify them
Difficulty sleeping
Verbally aggressive at
school
Assessment
The Diagnostic Interview for Adjustment Disorder (DIAD) assessment is a 29-question
assessment to identify adjustment disorder. What makes this assessment superior according to
O’Donnell et al. (2019) is that it determines the severity of the distress, as well as the degree of
functional impairment, both important requirements for adjustment disorder.
Diagnostic Impression
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The diagnostic impression is acute adjustment disorder with mixed disturbance of
emotions and conduct (F43.25).
Signs and Symptoms
Note: Criteria below used from The9Diagnostic and Statistical Manual of Mental Disorders(5th
ed.; DSM–5; American Psychiatric Association, 2013)
DSM-5-TR Diagnostic Criteria: Bipolar 1
disorder, major depressive episode
Client’s Signs/Reported Symptoms:
1) 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 became sad during time of parents’
divorce, but became “sad and angry” during
father’s remarriage. Around the time of the
remarriage, Victor’s mom started getting calls
from school (within 3 months)
2) These symptoms or behaviors are
clinically significant, as evidenced by one
or both of the following (3 and/or 4):
3) 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.
Victor’s mom stated she felt his behavior was
out of proportion compared to siblings.
4) Significant impairment in social,
occupational, or other important areas of
functioning.
Victor’s academics are severely struggling,
and his ability to behave and remain in good
standing at school is also struggling. Does not
want to hang out with friends.
5) The stress-related disturbance does not
meet the criteria for another mental
disorder and is not merely an exacerbation
of a preexisting mental disorder.
No diagnosis of other disorder, does not appear
to meet criteria for another disorder.
6) The symptoms do not represent normal
bereavement and are not better explained
by prolonged grief disorder.
Does not meet requirement for prolonged grief
disorder as there is no death.
7) Once the stressor or its consequences have
terminated, the symptoms do not persist
for more than an additional 6 months.
Undetermined. Victor is still subject to
stressor.
Other DSM-5-TR Conditions Considered
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Acute stress disorder is a consideration as this could be considered a traumatic event, but
there are very few symptoms present that are listed as requirements in Criterion B of acute stress
disorder. Another consideration is prolonged grief disorder as Victor is clearly “grieving” his
parents’ marriage and the life associated with it, but PGD requires a physical death, not just an
emotional/relational death.
Developmental Theories and/or Systematic Factors
Victor being 15 puts him in the “identity versus role confusion” conflict that is associated
with Erikson’s adolescent stage. This divorce seems to be impacting Victor significantly, likely
due to the erosion of Victor’s identity. Everything he had known for over 12 years was “Mom
and Dad are married”. He could construct who he was and who he wanted to be on that fact. But,
in the last couple years, that fact became untrue, and Victor has had to wrestle with what that
means for him. Tullis et al. (2021) found that emotional and behavioral problems increased post-
divorce, their conclusion being that the post-divorce changes (re-location, estrangement from one
parent, financial troubles) are more impactful than the pre-divorce conflicts. A relevant
conclusion that can be drawn is that the post-divorce changes undermine what the adolescent
believes to be true and has built their lives around (in essence, their identity).
Multicultural and/or Social Justice Considerations
Victor’s mother has expressed that while Victor has always been good about talking
about his emotions, it was not a skill his father taught him. It may be that this situation has
developed past Victor’s competencies for talking about his emotions. This appears to be by far
the biggest emotional issue that Victor has had to face, and he seems to be struggling. Huerta
(2022) stated that men of color almost universally struggle with reaching out for help. It is
VICTOR CASE STUDY 5
important to consider that Victor’s race and cultural background may make it difficult to admit
he is struggling with the adjustment. Victor has shared that he is “sad and angry”, but it will be
important for the therapist to get deeper than these two surface level emotions. If pushed too
hard, though, Victor may interpret sharing his emotions as being weak, and shut down. The
therapist must push but not push too hard.
Treatment Recommendations
Key Issues for Treatment
Acceptance of divorce
Psychoeducation on how to deal with emotions
Recommendations for Individual Counseling
As mentioned previously, there appears to be some resistance from Victor about talking
about deeper feelings to some degree, potentially stemming from his Puerto Rican upbringing,
but at the least inherited from his father. De La Cerda (2023) cites another author, Ingoldsby,
who stated that the reason for Latino machismo is due to feelings of inferiority, requiring the
Latino man to compensate. This may be the reason for Victor’s lashing out. He may be feeling
less of a man for feeling what he is feeling and is seeking to compensate by picking fights with
his mother, and other authority figures at school. What Victor does not seem to recognize is that
picking fights does not define manhood, which is why cognitive behavioral therapy may be a
great fit. The core process behind CBT is to confront incorrect beliefs. CBT may help Victor re-
orient what it means to be a man, focusing on a more healthy and productive standard.
Hussin et al. (2020) conducted a study involving psychoeducation among secondary
students. That study found that psychoeducation is very effective in developing skills necessary
for emotional intelligence/regulation. Victor would certainly benefit from significant
VICTOR CASE STUDY 6
psychoeducation, such as learning how to name feelings (for example, through the use of the
feelings wheel) and how to process feelings (journaling, trusted friend).
Specific Considerations
Being 15, Victor certainly has a lot going on. What makes this case particularly difficult
is that at his age, and in this situation, Victor has little control—he cannot make his parents re-
marry. Thus, in treatment, Victor may have a goal of “fixing” the problem (á la The Parent
Trap), but the therapist must reorient the goal to a focus on Victor and his wellbeing. In the
context of the family system, Peris and Emery (2014) present the concept of boundary
dissolution. In essence, due to the absence of one parent physically, and perhaps the other parent
emotionally, the delineation between parent and child begins to dissolve. This is similar to the
concept of the stereotypical “you’re the man of the house now”. If Victor does feel a need to be
more of a man in the absence of his father, it would be important to help him define how he fits
into the relationships with his mother and siblings.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed., text rev.). American Psychiatric Press, Inc.
De La Cerda, A. (2023). Machismo: The psychological effects on women (Order No. 30313177).
Available from ProQuest Dissertations & Theses Global. (2788429740).
https://go.openathens.net/redirector/liberty.edu?url=https://www.proquest.com/
dissertations-theses/machismo-psychological-effects-on-women/docview/2788429740/
se-2
Huerta, A.H. (2022). Exploring undergraduate students’ emotional vulnerability in men of color
programs. Journal of College Student Development 63(1), 51-68.
https://doi.org/10.1353/csd.2022.0006.
Hussin, U. R., Mahmud, Z., & Karim, D. N. F. M. (2020). Psychoeducation group counselling
for emotional intelligence among secondary school female students. Journal of
Counseling, 1(2), 53-57.
O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment
disorder: Current developments and future directions. International Journal of
Environmental Research and Public Health, 16(14), 2537.
https://doi.org/10.3390/ijerph16142537
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Peris, T. S., & Emery, R. E. (2014). Redefining the parent-child relationship following divorce:
Examining the risk for boundary dissolution. In Implications of Parent-Child Boundary
Dissolution for Developmental Psychopathology (pp. 169-190). Routledge.
Tullius, J. M., De Kroon, M. L. A., Almansa, J., Reijneveld, S. A., et al. (2022). Adolescents’
mental health problems increase after parental divorce, not before, and persist until
adulthood: A longitudinal TRAILS study. European Child & Adolescent Psychiatry, 31,
969–978. https://doi.org/10.1007/s00787-020-01715-0
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