Diagnosis of Ms. D's Mental Health Issues
HPE1005 - Mental Health Issues
University of Cincinnat
Case Study #1
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
Ms. D is a 30 year-old female who initially complains of experiencing irritability, anxiety, and
confusion. Looking deeper into Ms. D’s history, she was in a long-term unstable relationship
and while in that unstable relationship she married another man. She was only married to this
man for two years before they got a divorce. Her former boyfriend is the father of her son and
she does not have a good relationship with him. Ms. D also reports that she does not get along
well with her mother claiming that “she can’t get along with me”. Ms. D has a history of alcohol
use and has been abstinent for five years. She is slightly overweight and suggests that her boss
made her uncomfortable at work by pointing out that she is overweight. In the past, she has
attempted school and quit all three times.
At a young age, Ms. D experienced sexual abuse and has been hospitalized a total of eight
times for psychiatric reasons. She has not been hospitalized in the last eighteen months, attends
AA meetings twice a week, and is on antidepressant medications. Her sister has custody of her
son due to accusations that Ms. D physically assaulted her son in an attempt to get her son’s
father to talk to her. Ms. D admitted to shaking her son in a desperate attempt to get the father’s
attention. She also does not get along with her sister, due to jealousy over the lifestyle her sister
lives and the fact that she has custody of her son. As a result, Ms. D attends parenting classes
and has supervised visits with her son.
Symptomology
Ms. D has a wide range of symptoms, initially she complains of irritability, anxiety, and
confusion. However, reading deeper into her case she presents with indecisiveness, excessive
worry, insomnia, thought blocking, and impulsivity. She also experiences extreme fits of anger
and tends to get tearful and then immediately quiet at times. She also has a history of suicidal
ideations. Overall, Ms. D has been experiencing disruption, distress, and disability for over two
years now. She was brought up on legal charges for stalking her baby’s father about two years
ago. Also, her son was taken away from her about nine months ago for the physical assault
(shaking) she did to her son.
Ms. D began showing signs of distress and dysfunction n her unstable interpersonal
relationships with her mother, ex-boyfriend, and ex-husband. She also relayed that she feels
uncomfortable when she is alone and family members have noticed that she needs constant
reassurance when making any type of decision. She got married at the age of 20 years old and
was divorced at age 22. Her lack to maintain healthy interpersonal relationships is specifically
concerning. She cannot stick to any goals as evident in her failed attempts to finish school three
times. Medically speaking, she has been psychiatrically hospitalized eight times and has been
prescribed antidepressant medications but has no other known medical concerns.
DSM-5 Diagnoses & Specifiers
There are five likely diagnoses for Ms. D. The first is Mild Major Depressive Disorder (MDD)
with Anxious Distress 296.21 (F32.0) (APA, 2013). She has been observed as being tearful for
at least a 2-week period and has reported not feeling comfortable going to work.
She has had significant weight gain, insomnia, indecisiveness, and suicidal ideations.
According to the diagnostic criteria, a person must experience symptoms during the same
2week period and must possess at least five or more other symptoms (APA, 2013). Ms. D
exhibits five symptoms total and she qualifies as having anxious distress because she has
exhibited difficulty concentrating and excessive worry as well as restlessness.
The second likely diagnosis is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1)
(APA, 2013). The diagnostic criteria for Dysthymia requires a person to have experienced
depressed mood for at least two years. While experiencing the depression, one must present
with at least two or more symptoms (APA, 2013). She has experienced this disturbance and
depressed mood for at least two years while also overeating (weight gain), insomnia, and
difficulty making decisions. Therefore, she meets the diagnostic criteria for Dysthymia.
The next most likely diagnosis for Ms. D is Generalized Anxiety Disorder (GAD) 300.02
(F41.1) (APA, 2013). The diagnostic criteria for Generalized Anxiety Disorder require
excessive worry for at least six months along with three or more other symptoms (APA, 2013).
She reports excessive worrying and reports difficulty concentrating (thought blocking),
irritability, and sleep difficulty. She has experienced this distress for at least two years which
qualifies for the diagnosis of Generalized Anxiety Disorder.
The next most likely diagnosis for Ms. D is Borderline Personality Disorder (BPD) 301.83
(F60.3) (APA, 2013). Borderline Personality Disorder is diagnosed by presenting with
instability of interpersonal relationships, instability of self-image, and impulsivity along with
five or more other symptoms (APA, 2013). She meets all of the previous diagnostic criteria;
she has instability in all of her interpersonal relationships, romantic and genetic interpersonal
relationships. She struggles with her self-image due to the weight gain she has experienced.
She also meets at least five or more of the remaining criteria. Ms. D demonstrates frantic efforts
to avoid abandonment, unstable interpersonal relationships, identity disturbance, intense anger,
and mood instability. Borderline Personality Disorder has no timeline so she could possibly
have had BDP most of her adult life.
Lastly, Diane could possibly have Dependent Personality Disorder 301.6 (F60.7) (APA, 2013).
Dependent Personality Disorder (DPD) is characterized by submissive and clinging behaviors
along with an immense fear of separation (APA, 2013). There is no timeline for DPD but the
diagnostic criteria includes five or more of the listed symptomology. Ms. D expresses five of
the symptoms: difficulty making decisions with an excessive amount of advice, difficulty
initiating projects, feeling uncomfortable alone, urgently seeking other relationships when one
ends, and needing others to assume the responsibility for most areas of her life.
However, out of the five diagnoses I have listed, in my professional opinion Ms. D has
Borderline Personality Disorder 301.83 (F60.3) comorbid with Dependent Personality
Disorder 301.6 (F60.7) as well as Generalized Anxiety Disorder 300.02 (F41.1) (APA, 2013).
Interrupted education, recurrent job losses, and divorce/ separation are all very common in
individuals with Borderline personality Disorder 301.83 (F60.3) (APA, 2013). Borderline
Personality Disorder and Dependent personality disorder are also most prevalent in females
(APA, 2013). Individuals diagnosed with Dependent Personality Disorder desire affection and
acceptance and may fantasies about ideal relationships with others; Ms. D fantasizes about her
perfect romantic relationship with her son’s father (APA, 2013).
Differential Diagnoses, Comorbidity, & Treatments for Differential Diagnoses
I ruled out Dysthymia and Mild Major Depressive Disorder with anxious distress because of
timeline discrepancies. For Mild Major Depressive Disorder with anxious distress, she does
exhibit symptoms of anxiety which is why the anxious distress specifiers was justified,
however, it is unclear in the case as to whether or not she has been experiencing recurrent
depressive episodes or just one depressive episode. She exhibits more anxiety driven symptoms
than depressive symptoms which. Helped me rule out depressive disorders both Major
Depressive Disorder and Dysthymia. Due to her alcohol use in the past, I briefly considered a
substance use disorder as the cause of her anxious symptoms, but due to her being abstinent
for five years and attending AA meetings twice a week I ruled out a substance use disorder
instantly.
It is not unheard of to have multiple co-occurring personality disorders. In fact,
Borderline Personality Disorder commonly occurs with other personality disorders (APA,
2013). It is also very common for people diagnosed with a personality disorder to also have an
anxiety disorder. In fact, 80% - 84% of people with personality disorders also have anxiety
disorders (Latas & Milovanovic, 2014). The treatments for differential diagnoses include anti-
anxiety medications, antidepressant medications, and psychotherapy (Drummond, 2005).
Treatments & Culture Implications
There are a variety of overlapping treatments for both personality disorders and anxiety
disorders. However, the treatments for Generalized Anxiety Disorder are Selective Serotonin
Reuptake Inhibitors (SSRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepine
(Benzo’s) medications (Drummond, 2006). Benzodiazepine medications have a high addictive
quality which makes them very dangerous for patients, especially if they have a history of drug
or alcohol use/ abuse. Other therapeutic treatments for Generalized Anxiety Disorder includes
Cognitive Behavioral Therapy (CBT) and psychotherapy. CBT for Generalized Anxiety
Disorder focuses on the development of a functional analysis, psychoeducation, cognitive
approach to GAD, and experimentation with new behaviors and emotions (Borza, 2017).
For Dependent Personality Disorder and Borderline Personality Disorder the treatments
include SSRI’s and antipsychotic medications (Drummond, 2006). Other treatment options
include Psychosocial treatment and psychoanalytic therapy (Bateman et al., 2015).
Psychosocial and psychoanalytic therapy treatments include CBT and psychotherapy as well
as behavioral therapy (Bateman et al., 2015). Another therapy used for Borderline Personality
Disorder specifically is Dialectal Behavior Therapy (DBT), which focuses specifically on
clients who have parasuicidal problems (Swales et al., 2000).
Culturally speaking, Dependent Personality Disorder may have relations to acculturation
following immigration (APA, 2013) however, there was no mention of immigration in Ms. D’s
case. For Borderline Personality Disorder, patterns have been identified between dealing with
emotional instability, anxiety-provoking choices, conflicts involving sexual orientation, and
social pressures as a giving the impression of developing a borderline personality disorder
(APA, 2013). Finally, Generalized Anxiety Disorder has no cultural variations (APA, 2013).
References
American Psychological Association (APA). (2013). Diagnostic and statistical manual of
mental disorders (5th ed.)
Bateman, A.W., Gunderson, J. & Mulder, R. (2015). Treatment of personality disorder.
Lancet. 2015 Feb 21; 385 (9969): 735-43. Doi:10.1016/S0140-6736 (14) 61394-5.
Borza, L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical
neuroscience, 19(2), 203-208. https:doi.org/10.31887/DCNS.2017.19.2/lborza
Drummond, E. (2006). The complete guide to psychiatric drugs. John Wiley & Son’s Inc.
Hoboken, NJ.
Swales, M., Heard, H.L., & Williams, J.M.G. (2000). Lineham’s dialectal behaviour therapy
(DBT) for borderline personality disorder: overview and adaptation. Journal of Mental
Health. (9)1, 7-23.
