Running head: CASE STUDY 1
Case Conceptualization and Analysis: Rose’s Case Study
Veronica S. Booker
Liberty University
CASE STUDY 2
Case Conceptualization and Analysis for Rose
Brief Summary
This case presents a 38-year-old married mother of three named Rose. Rose came in due
to experiencing depression and anxiety after a car accident. She works in sales full-time and has
an intense weekly commute. Physically, she is in good health. Her disposition is sad and anxious.
She recounts many traumatic experiences that may have contributed to her current state.
Growing up, she and her family relocated several times due to her father being in the diplomatic
core of the State Department. Throughout her life, she has encountered many stressful and
traumatic events, either experienced or witnessed. Rose recounts being in an accident three
weeks prior to her visit and though there were no serious injuries, the event was very
traumatizing. For the past two weeks she has displayed many symptoms synonymous with a
diagnosis of Posttraumatic Stress Syndrome and Acute Stress Disorder.
Life Events Checklist for DSM-5 Interpretation
After interviewing Rose and completing the Life Events Checklist for DSM-5
Interpretation (LEC-5) it has been noted that Rose has experienced many potentially traumatic
events in her lifetime. The LEC-5 has seventeen events listed that a client may have had happen
to them, witnessed, learned about, or is a part of their job. During Rose’s interview, she
mentioned some of the events on the checklist as something that had happened to her at some
point in her life.
She moved around frequently and lived in some very dangerous places. Around the age
of ten, she experienced her first traumatic event. Rose talks about living in Turkey and recounts a
bomb destroying a cafe near the hotel where she and her family were living. According to The
Life Events Checklist (LEC-5), experiencing or witnessing fires or explosions can be stressful
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(Weathers, Blake, Schnurr, Kaloupek, Marx, & Keane, 2013). This event could also be
characterized as combat exposure as Rose witnessed the horrific aftermath of the bomb resulting
from a terrorist attack. Though she was not hurt she saw dead bodies and blood. While on
vacation in Tokyo she experienced a large earthquake and though there were no injuries this
natural disaster was an event listed on the LEC-5 as stressful.
Rose has not only experienced events on the list, but she has also witnessed some that are
listed. She witnessed an assault with a weapon (i.e. bomb) which is listed on the LEC-5 Standard
checklist (Weather et al., 2013). There was an account of a traumatic event that occurred in Paris,
France when Rose was 15; she witnessed people being beaten by police during a demonstration.
The last event that took place according to Rose’s interview that was mentioned on the LEC-5
was her recent car accident. Rose has either witnessed or experienced at least ten traumatic
events on the checklist.
PTSD Checklist for DSM-5 Interpretation
Considering the events that have transpired in Rose’s life, she’s now dealing with
traumatic responses. She recounts having nightmares about the crying and screaming from that
day in Turkey occasionally. She referred to the flashbacks she has as a result of her experience
from being amid a 7.1 earthquake in Tokyo while on vacation when she reads or hears about an
earthquake.
Rose had an accident within the last month and according to her interview over the last
two weeks, she has had repeated dreams of the crash that have been bothersome. People who are
involved in a serious motor vehicle accident (MVA) are at higher risk for psychological issues,
primarily Posttraumatic Stress Disorder (PTSD) (Beck & Coffey, 2007). These dreams occur
several times a week leading to nightmares that cause her to get up through the night. Rose is
CASE STUDY 4
only getting about 3 to 4 hours of sleep. She tries to avoid talking about the crash because it
causes physical reactions. She felt as though she had a panic attack while waiting to be rescued
from her vehicle. She recalls feeling like she would suffocate to death. Rose states she does not
like discussing the accident for fear of reliving the event all over again.
Rose’s PCL-5 score of 52 suggests she more than likely has Post-traumatic-stress
disorder (PTSD). For many individuals, the indicators of PTSD resulting from a serious MVA
might comprise of psychologically re-experiencing the, insistent avoidance of feelings or
circumstances associated with the accident, numbing of emotional openness, and increased
physical arousal (Beck &Coffey, 2007).
Clinician-Administered PTSD Scale for DSM-5 Interpretation
Post-traumatic stress disorder (PTSD), is often assessed using self-rated checklists or
tools used by a clinician. Though the self-rated measures are more common, the assessments
used by clinician are recognized as the gold standard for diagnosing a patient. The Clinician
-Administered PTSD Scale for DSM-5 (CAPS-5) was used in Rose’s case. According to the
scores Rose meets the criteria to be diagnosed with PTSD.
According to the CAPS-5 sheet Rose met criterion A because she has been exposed to
actual death. Growing up Rose witnessed the carnage of dead bodies after a terrorist attack. She
has also experienced multiple intrusion symptoms ranging from intrusive memories to
distressing dreams. She stated talked about at least one avoidance symptom which presents the
metric for meeting criterion C. Rose stated she avoids talking about her car accident due to not
wanting to experience startle responses. There have mood changes and arousal and reactivity
symptoms; she therefore meets both criteria D and E.
Primary and Secondary Diagnostic Impressions
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Post-traumatic stress disorder, PTSD, can be diagnosed in adults, adolescents, and
children over the age of six (The Diagnostic and Statistical Manual of Mental Disorders (5th ed;
DSM-5; American Psychiatric Association, 2013). The traumatic event had to have been
experienced , observed, experienced by a loved one or close friend and then learned about, or
experienced recurrently at the workplace (for example, police officers exposed to details of child
abuse frequently) (American Psychiatric Association, 2013). In order to be diagnosed with
PTSD under DSM-5 criteria, an individual must possess one or present intrusion symptoms,
“persistent avoidance of stimuli related with the traumatic event”, “negative adjustments in
cognitions and mood connected with the traumatic event”, and “noticeable alterations in arousal
and reactivity connected with the traumatic event” (American Psychiatric Association, 2013, p.
272). These symptoms must cause clinically significant distress or social/occupational
impairment for more than one month (American Psychiatric Association, 2013).
Rose experiences several intrusion symptoms. For example, one intrusion symptom as
described in the DSM-V is, “recurrent, involuntary, and intrusive distressing memories of the
traumatic event(s)” (American Psychiatric Association, 2013, p. 271). When Rose experiences
reoccurring dreams of her car crash and when someone asks about the crash she feels as though
she is reliving the event. These thoughts are distressing and involuntary.
Individuals with post-traumatic stress disorder persistently avoid stimuli associated with
the traumatic event (American Psychiatric Association, 2013). Rose tries to avoid sleeping at
night due to dreams of her accident. Another defining feature of post-traumatic stress disorder is
that affected persons experience “negative alterations in cognitions and mood associated with the
traumatic event” (American Psychiatric Association, 2013, p. 271). To exhibit this symptom, an
individual must meet two criteria listed in the DSM-5. Rose meets these criteria. One criterion
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which shows this symptom is that an individual may have “persistent and exaggerated negative
beliefs of expectations about oneself, others, or the world” (p. 272). Rose has recurring thoughts
of death and dying. She mentions that though she isn’t afraid of driving she fears having an
accident.
To be diagnosed with post-traumatic stress disorder, a person must also experience
“marked alterations in arousal and reactivity associated with the traumatic event” (American
Psychiatric Association, 2013, p. 272). This symptom requires two or more criteria be met. One
of the criteria is “irritable behavior and angry outbursts” (p. 272). Rose finds herself being
irritable and snapping at her children for minor things.
In order to be diagnosed with post-traumatic stress disorder, a person must meet all the
previously mentioned criteria. These symptoms must cause significant distress or impairment in
social or occupational areas of functioning and must be present for more than one month
(American Psychiatric Association, 2013). Rose has not been able to concentrate at work. She
feels as though her energy is depleted and has had to take days off due to flashbacks of the
accident.
Exposure to multiple traumas, particularly in childhood, can result in a complex of symptoms
that includes posttraumatic stress disorder (PTSD) as well as a inhibited, but adjustable group of
symptoms that focuses on self‐regulatory disturbances (Cloitre, Stolbach, Herman, Kolk,
Pynoos, Wang, & Petkova, 2009).
Primary Diagnosis with Culture/Gender Issues, Suicidal Risks
Several findings suggest females are found to be diagnosed with PTSD after trauma twice
as often as males accompanied by stronger PTSD symptoms (Schupp, 2015). The lifetime
prevalence of PTSD in females is higher (10.4%) than in males (5.0%) (Schupp, 2015). Women
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tend to experience a longer duration of symptoms and they display more re-experiencing,
avoidance and hyperarousal (American Psychiatric Association, 2013).
Secondary Diagnosis with Culture/Gender Issues, Suicidal Risks
Rose also presents symptoms of acute stress disorder. In the weeks following a traumatic
event, people might develop an anxiety disorder called acute stress disorder (ASD) (Schupp,
2015). ASD usually happens within one month of a traumatic event and it lasts at least three days
and can continue for up to one month (Schupp, 2015). People with ASD have symptoms like
those seen in PTSD.
There is a variation of symptoms of ASD across cultures, particularly regarding
dissociative symptoms, nightmares, avoidance, and somatic symptoms (American Psychiatric
Association, 2013). There are cultural groups that could show a variety of dissociative responses,
like possession or trancelike behaviors in the initial month following the traumatic event. ASD is
more prevalent in women (American Psychiatric Association, 2013).
Recommendations
Rose has experienced several traumatic events in her life. She seen the carnage of bodies
left behind after a terrorist attack, experienced a large earthquake, witnessed people being beaten
the streets and arrested, the horrific experience of an accident that could have been fatal. Her
symptoms meet the DSM-5 criteria for a diagnosis of post-traumatic stress disorder with a
secondary diagnosis of acute stress disorder. Self-assessments should be administered to confirm
this diagnosis. She is likely to benefit from cognitive behavioral therapy, and her symptoms
should be monitored in the future.
Recommendation 1
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Eye Movement Desensitization Reprocessing, or EMDR would be recommended for
Rose. This technique couples eye movements with cognitive processing of the traumatic
memories (Solomon, Solomon, & Heide, 2009). The initial phases of EMDR involve affect
management techniques, like relaxation. This will enable Rose the ability to talk about her
experience avoiding a startle response. During the processing stage of therapy, the patient talks
about the traumatic memory and identifies and labels the images, beliefs, and physiological
symptoms provoked by it (Solomon, et al., 2009). The patient is instructed to focus on these
aspects of the traumatic memory while moving their eyes back and forth.
The hypothetical basis for EMDR is that PTSD symptoms result from inadequate
managing and incorporation of sensory, cognitive, and affective elements of the traumatic
memory (Solomon, et al., 2009). The two-sided eye movements are planned to enable
information processing and integration, allowing clients to fully process traumatic memories.
Recommendation 2
Prolonged exposure therapy would be recommended. Rose needs to not only heal from
the trauma of her car accident but also the trauma she experienced throughout her life. When she
repeats exposure to her trauma-related thoughts, feelings, and situations it can help reduce the
power they have to cause distress (Nishith, Resick, & Griffin, 2002). Prolonged Exposure
Therapy entails imaginal exposures, which encompasses recounting the traumatic memory and
processing the revisiting experience, as well as in vivo exposures in which the client repeatedly
confronts trauma-related stimuli that were safe but previously avoided (Nishith et al., 2002).
Recommendation 3
Cognitive Processing Therapy would be helpful. Rose would attend a course of treatment
for about 12 weeks for 60-90 minutes. She will be able to speak on the trauma she has
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experienced and how her thoughts about the events have affected her life (Nishith et al., 2002).
Then she could take time and write about what took place. This therapy will help her examine
her thoughts about trauma and find a new way to cope.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: Author.
Beck, J. G., & Coffey, S. F. (2007). Assessment and treatment of PTSD after a motor vehicle
collision: Empirical findings and clinical observations. Professional psychology, research
and practice, 38(6), 629–639.
Cloitre, M., Stolbach, B. C., Herman, J. L., Kolk, B. V. D., Pynoos, R., Wang, J., & Petkova, E.
(2009). A developmental approach to complex PTSD: Childhood and adult cumulative
trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399–
408.
Nishith, P., Resick, P. A., & Griffin, M. G. (2002). Pattern of change in prolonged exposure and
cognitive-processing therapy for female rape victims with posttraumatic stress
disorder. Journal of Consulting and Clinical Psychology, 70(4), 880–886.
Schupp, L.J. (2015). Assessing and treating trauma and PTSD (2nd ed.). Eau Claire, WI: PESI
Publishing & Media.
Solomon, E. P., Solomon, R. M., & Heide, K. M. (2009). EMDR: An Evidence-Based Treatment
for Victims of Trauma. Victims & Offenders, 4(4), 391–397.
Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M.
(2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the
National Center for PTSD at www.ptsd.va.gov.
