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Case Study: Victor 1
Case Study: Victor
School of Behavioral Sciences, Liberty University
COUC 546
June 22, 2025
Author Note
Case Study: Victor 2
Client Concerns
Symptoms Behaviors Stressors
Sadness Crying a lot Father and mother separated;
he had hoped they would get
back together
Anger Verbally aggressive towards
mother, siblings, and at
school
Father remarried four months
ago, making the client angry
Withdrawn No longer playing sports and
hardly hanging out with
friends,
Developed a disinterest in
everything ever since the
father remarried
Sleeping Problems Has stopped speaking to his
father and did not attend the
wedding
The hopelessness of his
parents getting back together
Declining academically Grades are dropping, received
ISS due to aggression and
fighting, difficulty
concentrating
Divorce and the father getting
remarried
Assessment
An assessment that has the potential to assess the many symptoms, behaviors, and stressors that
Victor is having is the Adjustment Disorder-New Module 20 (ADNM-20). The Adjustment
Disorder-New Module 20 is a self-report measure that consists of two parts (Lorenz et al., 2016).
The first part is a stressor list, which captures acute and chronic life events in the last two years
of an individual's life (Lorenz et al., 2016). The second part is an item list, which measures the
symptoms that are occurring in response to the distressing events that are occurring or have
occurred (Lorenz et al., 2016). This self-report measure uses a four-point Likert scale with one
signifying never and four signifying often. It has twenty items divided into six different
subscales. The subscales are: preoccupation (4 items), failure to adapt (4 items), avoidance (4
items), depressed mood (3 items), anxiety (2 items), and impulse disturbance (3 items) (Lorenz
et al., 2016).
Case Study: Victor 3
Diagnostic Impression
Victor’s symptoms began around two and a half years ago, upon the separation of his
parents, one year ago, when the divorce was finalized, and four months ago, when his father
remarried. He meets the criteria for the primary diagnosis of Adjustment Disorder with depressed
mood, corresponding ICD-10 code F43.21.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Adjustment
Disorder with depressed mood, F43.21
Client’s Signs/Reported Symptoms:
Criterion A: Development of emotional and
behavioral symptoms caused by the stressor
occurred within three months of the stressor
happening
The client had initial feelings of sadness since
the separation two and a half years ago, but
began to feel the biggest symptoms four
months ago when his father remarried
Criterion B: Symptoms or behaviors are
significant by one or more of the following
The client is dealing with distress that is much
more than the severity or intensity of the
stressor and has caused impairment in his
social and academic functioning
Criterion C: Stress-related disturbance doesn’t
meet the criteria for another mental disorder
or isn’t based on preexisting mental disorders
The client hadn’t presented any other
symptoms until the separation of his parents
and his father getting remarried
Criterion E: Once the stressor has occurred,
symptoms don’t persist after six months
The client’s symptoms have been happening
for the last four months
Other DSM-5-TR Conditions Considered
One other diagnosis that was considered for the case of Victor is Major Depressive
Disorder. The client reported multiple symptoms that met the criteria of Major Depressive
Disorder, single episode, corresponding ICD-10 code F32.0. Victor has expressed a depressed
mood and a loss of interest in his activities and social life; he has also expressed some sleeping
troubles, feelings of hopelessness, but not enough to meet at least five of the symptoms for the
criteria, making the Adjustment Disorder diagnosis more fitting.
Case Study: Victor 4
Developmental Theories and/or Systemic Factors
Human development plays a vital role in the identity development of an individual. When
stressors and traumatic events occur, they can impact the development of who an individual is
and what their outlook on life is. Erikson's psychosocial development theory highlights the
various stages that individuals go through as they age. Erikson believed that identity is constantly
developing throughout one's life, while placing importance on identity development in the
adolescent stage (Maree, 2021). Erikson displays human development in eight stages: basic trust
vs mistrust, autonomy vs shame, initiative vs guilt, industry vs inferiority, identity vs role
confusion, intimacy vs isolation, generativity vs stagnation, and ego integrity vs despair (Maree,
2021). Victor is currently in the identity vs role confusion stage with an age range of thirteen to
nineteen years old. During this stage of human development, children need constant support and
encouragement from significant others so they can successfully form a sense of self and become
independent from others (Maree, 2021). With the separation, divorce, and most recently his
father getting remarried, the much-needed support from his parents isn't present for Victor
anymore. He feels as if his family is broken and has lost hope to the extent that it provokes
sadness, anger, and a disturbance in his daily functioning.
Multicultural and/or Social Justice Considerations
Predominantly in the United States, but in various different countries, there is a common
idea that young individuals lack or haven’t developed certain capacities or abilities that are
needed to assume responsibilities that are part of adulthood or to enjoy the privileges that come
with adulthood (Icenogle et al., 2019). Children and adolescents are given more protection when
participating in contracts, the way that criminal matters are handled, and the ability to drive and
consume alcohol (Icenogle et al., 2019). The American Psychological Association (APA)
submitted an argument to the Roper v. Simmons to abolish the juvenile death penalty, arguing
that individuals younger than eighteen lacked sufficient psychological maturity to be held
Case Study: Victor 5
responsible for crimes (Icenogle et al., 2019). This is just one example of many others when
assessing an adult's maturity versus a child or adolescent. Victor is currently in a stage of his life
where his psychological maturity hasn’t fully formed, potentially creating confusion and
resulting in the adjustment disorder diagnosis. He has been hyper-focused on wanting his parents
to get back together without considering the initial reason for the separation, but more so his
feelings about the situation and the hopelessness of having his family separated.
Treatment Considerations
Key Issues for Treatment
●Ways to better express and understand his emotions about his parents' divorce
●Reducing the anger
●Coping skills for his sadness
Recommendations for Individual Counseling
A recommended form of treatment for Victor and his diagnosis of Adjustment Disorder is
to implement Dialectical Behavior Therapy, specifically for adolescents (DBT-A). This treatment
places importance on addressing issues hierarchically and helps guide therapists to address any
presenting issues by using a modal approach to achieve the implemented treatment goals, address
psychiatric problems, and focus on keeping the client engaged in the treatment (Hiller & Hughes,
2022). DBT-A teaches various forms of behavioral skills that address the key issues of adolescent
development (Hiller & Hughes, 2022). Victor’s sadness and anger is a result of the situation that
has developed around him, in the past he has always been able to communicate how he is feeling
and what his emotions are, but now it transpires as sadness, anger, and a complete withdraw of
the activities and individuals that he likes doing or being with. Mood instability, impulsive
behavior, and identity confusion are common for the adolescent population (Hiller & Hughes,
Case Study: Victor 6
2022). Treating these behaviors can create an opening for new emotions and understanding of his
parents' divorce, rather than trying to push them back together.
Ferrar & Kirchner (2018) discuss how challenges can lead to the development of
psychological symptoms. When psychopathology occurs in response to the stressor, it can begin
to interfere with the functionality of the client. The diagnosis of Adjustment Disorder develops
because of the presence of stress, ultimately creating an inappropriate response to stressors and
affecting coping mechanisms (Ferrar & Kirchner, 2018). Coping is defined as the ability to adapt
to stress and difficulties, which is a central goal of human development (Ferrar & Kirchner,
2018). There are two ways in which individuals can negotiate the stressful event: by attempting
to actively manage the stressor or by attempting to reduce the emotional distress that is being
caused. Victor can implement the first strategy by using approaches like active, engagement, and
problem-focused coping. Tasks like problem solving, logical analysis, and positive reappraisal
would be used. Victor could also implement the second strategy by using approaches like
passive, avoidance, disengagement, or emotion-focused coping. Tasks like venting his feelings,
resignation, and seeking rewards can be beneficial.
Based on the diagnosis and the level of severity, medication is not recommended at this
moment. Adjustment disorder is caused by a stressful event that causes symptoms that eventually
disturb the daily functioning of an individual. Although Victor’s symptoms are very unlike him,
he is carrying a lot of hurt and a sense of betrayal from his parents, and can eventually decrease
the symptoms through the use of individual counseling. If symptoms were to persist, then the
possibility of implementing antidepressants is possible if deemed necessary by a certified
psychiatric mental health practitioner.
Specific Considerations
Victor is in a critical stage of human development, and overall good health and well-
being. The National Healthcare Quality and Disparities Report (2022) states that fifteen percent
Case Study: Victor 7
of young people with an age range of ten through nineteen experience a mental health disorder.
Fifteen percent of adolescents ages twelve through seventeen years have had a depressive
episode, thirty-seven percent have had persistent feelings of sadness or hopelessness, and twenty
percent have reported considering suicide (National Healthcare Quality and
Disparities Report, 2022). At this age, depending on the severity of the diagnosis, it is possible to
guide adolescents to a more positive mindset by using a softer approach than what would be used
for adults with the same diagnosis. Because Victor is a minor, parental consent from both the
father and mother is needed to treat the child. Including the family systems in the counseling
treatment could help Victor resolve some of his symptoms.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental
Disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Press, Inc.
Ferrer L, Kirchner T. How do adolescents with Adjustment Disorder cope with stressful
situations? Relationship with suicidal risk. Rev Psiquiatr Salud Ment (Engl Ed). 2020
Apr-Jun;13(2):63-72. English, Spanish. doi: 10.1016/j.rpsm.2018.11.002. Epub 2018 Dec
14. PMID: 30558955.
Hiller, A. D., & Hughes, C. D. (2022). Dialectical Behavior Therapy for Adolescents: Treatment
Outcomes in an Outpatient Community Setting. Evidence-Based Practice in Child and
Adolescent Mental Health, 8(4), 488–505.
https://doi.org/10.1080/23794925.2022.2056929
Icenogle, G., Steinberg, L., Duell, N., Chein, J., Chang, L., Chaudhary, N., Di Giunta, L., Dodge,
K. A., Fanti, K. A., Lansford, J. E., Oburu, P., Pastorelli, C., Skinner, A. T., Sorbring, E.,
Tapanya, S., Uribe Tirado, L. M., Alampay, L. P., Al-Hassan, S. M., Takash, H. M. S., &
Bacchini, D. (2019). Adolescents' cognitive capacity reaches adult levels prior to their
Case Study: Victor 8
psychosocial maturity: Evidence for a "maturity gap" in a multinational, cross-sectional
sample. Law and human behavior, 43(1), 69–85. https://doi.org/10.1037/lhb0000315
Liberty University. Theo Case Study. [Case Study Assignment: Theo]. School of Behavioral
Sciences, Liberty University, Canvas. https://canvas.liberty.edu/
Lorenz, L., Bachem, R. C., & Maercker, A. (2016). The Adjustment Disorder--New Module 20
as a Screening Instrument: Cluster Analysis and Cut-off Values. The international journal
of occupational and environmental medicine, 7(4), 215–220.
https://doi.org/10.15171/ijoem.2016.775
Maree, J. G. (2021). The psychosocial development theory of Erik Erikson: critical overview.
Early Child Development and Care, 191(7–8), 1107–1121.
https://doi.org/10.1080/03004430.2020.1845163
National Healthcare Quality and Disparities Report [Internet]. Rockville (MD): Agency for
Healthcare Research and Quality (US); 2022 Oct. CHILD AND ADOLESCENT
MENTAL HEALTH. Available from: https://www.ncbi.nlm.nih.gov/books/NBK587174/
