Abnormal Psychology Case study

York University

PSYC3140 Section M

Case Study Assignment: Sara

Worth: 30%

Due: Friday, July 31, 2020via Turnitin through moodle by 11:59pm

1. Based on the information provided in the case study for Sara, provide a formal DSM-V diagnosis(es), providing the following information: a) Diagnosis(es)-if you list more than one, then the first diagnosis listed will be considered the Primary Diagnosisand b) Additional Information(4 marks)

Answering question 1 will result in a very short answer with no sentences appearing in the answer. It is a brief clinical picture for a mental health care professional to have a rough idea of what is happening clinically for the individual, which will help to guide the practitioner in terms of asking relevant questions to confirm a diagnosis or consider another possible diagnosis.

Here is an example of the format and amount of information needed to answer Q1.

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Diagnosis:  Panic Disorder (primary diagnosis)

Substance Use Disorder: marijuana

Additional Information: diabetes; recently divorced

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Question 1a: In terms of the diagnosis – you can provide more than one however, if, for example, you provide 8 diagnoses, you are not taking a stand in determining what the main issues are for that individual. When answering question 2, you will spend the majority, if not all of your answer to Q2 providing the rationale for the PRIMARY DIAGNOSIS that you identified. The first diagnosis that you list will automatically be considered the primary diagnosis.

Question 1b:Additional information: Please provide any other relevant/useful information that may have an impact on the person’s current level of functioning and diagnosis. Additional information includes any medical information/medical diagnoses and current/recent psychosocial stressors in the person’s life (in the last 6 months to one year).

Based on the following case study please answer the following questions below:

2. Please provide your rationale (i.e., reasoning) for your diagnosis, using DSM-V criteria and information from the case studyto support your answer. If relevant, explain how you ruled out other potential diagnoses. Also, please indicate what other information you would want to know to make a more accurate diagnosis for Sara. (10 marks)

3. Please indicate and describe how Sara developed her main issues by employing one particular paradigm (listed below). Specifically, apply the theory or principles from this particular paradigm to explain how Sara’s disorder developed and how it is maintained. You must choose onlyone paradigm from the following choices: (15 marks)
4. Biological
5. Psychoanalytic
6. Humanistic
7. Behavioural
8. Cognitive

4. Please provide a brief treatment plan for Sarafrom the same psychotherapeuticparadigm that you chose for question 3. (6 marks)

Be explicit regarding the reasoning behind the choices that youmake. You have a maximum of 6 typed pages, double spaced, Times New Roman 12 font to answer questions1 to 4.

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Name: Sara

Age: 43

Sex: Female

Race: Caucasian

Marital Status: married

Socioeconomic Status: middle class

APPEARANCE

Stylish dress; looks younger than age, speaks rapidly, smiles often, has a nervous laugh, makes appropriate eye contact; has a lot of energy, fidgets with her jewellery periodically when speaking.

LIVING SITUATION

Has been working for a large computer company in operations for the past 5 years; previously worked for a bank where she met her husband. She lives with her husband (Adam, 50) and their three cats in a house.

PRESENTING PROBLEM

Client reports a growing feeling of being overwhelmed and exhausted with her current life. She has been aware of underlying problems in her life, specifically her anxiety and as she describes it her “ridiculous health concerns”. Despite her awareness that her health concerns are unwarranted, she has been worrying much more about her health lately and spending “too much time” researching about the potential illnesses that she may have. As a result, she has been feeling exhausted and ineffective at work. She currently feels a lot of pressure at work and believes that her work performance is slipping. For the past 3 years, she has been experiencing increasingly worse GI symptoms and she was recently diagnosed with irritable bowel syndrome. She was diagnosed with Celiac disease when she was 25. She noted that she has had difficulty sleeping for the past 6 months, and finds that her mind “races” when she goes to bed. Periodically, she experiences dizziness, heart palpitations, and headaches. She also indicated that she has become more irritable in the past 6 months, and a couple of times she has “snapped” at her coworkers. She is quite distressed by this, as it is quite out of character for her. She also noticed that she is more sensitive and emotional than usual, crying over little things, and that she has a harder time keeping her emotions under control at work. She expressed a few times her concern about recent weight gain, however, the client presented as slim and fit during the interview. She noted that she is tired of her incessant worrying but she does not know how to stop. She realizes that it is affecting her work life and her home life and she is worried about her husband leaving her and potentially losing her job. She noted that her life lacks the meaning it once had, as she feels consumed by her worry regarding her physical health, which at times leaves her feeling depressed and hopeless.

HISTORY OF PRESENTING PROBLEM

The client has been working since she was 15 years old. She initially started working part-time at a bank while she was in high school and continued working there through university (receiving a business degree) and afterwards. Although she received a great deal of praise for her work and had saved the bank a great deal of money with some of her innovative ideas, she never felt secure in her job and constantly strived to perform better. She noted that her achievements at work have been primarily driven by fear (e.g., fear of losing her job) and to a lesser extent her ambition to succeed. She is proud of her independence and her ability to support herself and work hard. The client worked her way up to senior management at the bank. She eventually had to quit her job due to conflict with one of her bosses. Her boss was very demanding and demeaning of her work. Despite her coworkers and other bosses praise of her work – the client felt increasingly depressed and hopeless when she was unable to win her boss’ approval. The situation at work became “intolerable” to the client so she quit her job. The client never thought that she would leave the bank, as she had been working there for the past 22 years and felt “comfortable” there. She noted that she does not like change and strives for stability and routine in her life “like most people do”.

At 37 years old, she left the bank and quickly obtained a relatively high-level position at a large computer company in the operations division. It was when she started this new job that her depression, anxiety and health concerns started to get worse. The client also married her husband during her first year of work at the new company. She noted that the job was much more demanding and that her coworkers were very competitive. She noted that she became much more aware of her insecurities regarding her abilities, and as a result “threw” herself into her work to establish herself. While she enjoys the projects she is working on, she does not like the work environment. She is afraid to leave because she is worried she may not be able to find as good a job.

The client decided to seek individual therapy for the following reasons:

1. A physician whom she initially consulted could find no organic or medical basis for her physical symptoms (e.g., dizziness, headaches, sleep difficulties). In her words her major symptoms were: “I sometimes feel very panicky and sped up, especially at night when I try to fall asleep. Sometimes I go and run on my treadmill to try and get all the adrenaline out of my body – sometimes it works, sometimes it doesn’t. My stomach often hurts after I eat and I often experience diarrhea. It’s like my stomach is all churned up and my intestines are twisted, that’s what it feels like. I often get tension headaches and I’m seeing a massage therapist due to the tension in my shoulders & back. I can’t shut my brain off anymore; I’m worrying all the time, particularly about my health. I know it sounds stupid but I think I have MS or I will end up with ALS. I’ve always had lots of energy but now at times I struggle to get out of bed and I drag myself through the work day – I feel like I’m in a fog half the time – maybe I have Fibromyalgia, I don’t know. And I’m having trouble controlling my emotions even at work, which is very troubling for me, it’s extremely unprofessional, I’m afraid I may have a brain tumour – it’s ridiculous but it’s possible”.

1. She is aware that she has lived a very structured and disciplined life, which up until now she has been very proud of however now she is wondering whether she can continue successfully engaging in the same routine. She feels like she can’t keep up with the demands of her job and maintain a good relationship with her husband at the same time. She loves her husband and feels that he understands her “quirks” but she is afraid she will lose him if she doesn’t spend more “quality time” with him. She admits that it was a difficult transition for her when she started living with her husband – since she had been living by herself since she was 16 years old. She wishes that she could “let go” of certain things and be ok with her husband arranging things differently in the house, but she explains that these types of things upset her more than they should and create tension within their marriage.

1. In thinking about her future, the client has a rather bleak outlook, which she realizes does not make much sense. She feels consumed with the notion that she will become ill with MS or ALS – and a generalized, vague apprehension that her current life will deteriorate. She had difficulty articulating exactly what would happen; however, she described always having a foreboding feeling when thinking about her future.

1. Recently the client has been quite concerned about gaining weight and losing her “looks”. Three years ago, she learned that she cannot have children, and since then she has felt less desirable and “womanly”. Her husband tells her that he finds her very attractive however she still worries about her appearance and noted that she is more preoccupied with her body image. All of the above factors combined provided enough motivation for the client to seek individual therapy. It appears that the greatest catalyst for entering therapy was her perceived inability to maintain her career and relationship in addition to her symptoms regarding her anxiety about her health becoming “out of control”.

PSYCHOSOCIAL HISTORY

The client is an only child. Her father left when she was six months old and she has never attempted to contact him, and he has not contacted her. Her mother was a nurse who often worked the night shift. As such, the client was often left alone at night, as young as 5 years old. She remembers being terrified when she woke up in the middle of the night when there was a storm or she heard a noise in the house and her mother was not there. During the day, her mother rarely interacted with her, as she slept most of the day. She described her mother as “distant” and somewhat cold. Her mother often talked about the patients at the hospital and often discussed and researched different diseases in her spare time when she was at home. When the client was 12 years old, her mother obtained a good nursing position, however it required that she move and work long hours. At this point, her mother arranged for the client to live with her aunt and uncle and their two children, who lived in the same town. The client indicated that she was treated like a “second-class citizen” and wasn’t cared for by her relatives. In fact, she felt that they were often jealous of her academic accomplishments (e.g., she was always an honour roll student) and as such they would pick on her or put down her accomplishments. Her aunt and uncle also did “strange things” that made her feel uncomfortable and degraded. For example, when the children had to bathe the same water was used for all of them, and she was always the last to be able to enter the bath. She remembers how “disgusting” the water was and how it was almost always cold by the time she was able to use the bath. Additionally, her aunt and uncle made her keep the bathroom door open whenever she showered or bathed. The client remembered feeling “self-conscious” and “embarrassed”.

In her social relationships, the client had no difficulty making friends and was fairly popular in elementary and high school. However, the client revealed that she did not confide in any of her friends regarding her home life and enjoyed having friends to escape her home. She noted that she often takes on a nurturing or helping role in her relationships; for example, in high school she helped her friends with their homework and she would always be the one they’d turn to when they had a problem. The client enjoyed school very much and developed strong ties with some of her teachers. She noted that it was their motivation and kind words that helped her to persevere and never give up.

The client moved out of her aunt & uncle’s house at 16 years old, as soon as she could support herself and continue with her studies. She noted that she never really felt that she had a childhood when growing up. At 17, her mother moved in briefly with her however due to some “conflict” her mother moved out. She keeps in touch with her mother; however, she finds her mother to be quite critical of her and very defensive. The client quickly noted that she does love her mother and would not want to hurt her.

SARA’S AUTOBIOGRAPHY

I have become acutely aware of how tired I am. I feel so tired of being, well, me. I don’t hate myself, I don’t want to kill myself, in fact, my life is really good. I have a lot to be thankful for and I am thankful for what I have – I have a wonderful husband who understands me and supports me, a challenging job that pays well, I have friends, I have a house that I love, I have so much – I shouldn’t feel bad, I have no reason to feel badly but I am afraid. I’m not sure of what, but I am afraid that things will change, for the worse. And now I come to my ridiculous fear, the thing that has been weighing me down lately, my fear that I will get sick. I know it’s dumb but I am afraid that I will get MS or ALS. Lately, I have displayed some of the early symptoms associated with these diseases. I just can’t get this idea out of my head. At times I feel overwhelmed by my anxiety and worry. I’ve always been an energetic type that works well off of nervous energy, but it’s different now. I feel like my anxiety is sucking the energy right out of me.

I love working hard and getting things done but lately I haven’t been able to keep up with the schedules I make for myself. I love crossing items off my list during the day, feeling productive and useful. People tell me at work that they like working with me because they know if I say I am going to do something, I am going to follow through on it. Even if it means working late and helping on other people’s projects – I will always meet my deadlines. I can’t understand why some people just don’t take responsibility for their own work.

I love my husband very much, but sometimes I worry that he may leave me. I am working a lot and when I am at home, I am often distracted, thinking about my projects. He works regular work hours and I think he expects me to keep his same schedule. I feel guilty that I can’t always get home to make dinner with him or even eat dinner with him. He deserves to have a good wife but I can’t do everything. I feel pulled in too many directions of late and I feel like I’m failing at all of them. I have been less focused at work, I’m not being attentive enough to my husband, and I have been unable to do as much volunteer work as I was doing before. I just can’t seem to keep up with everything lately. I am always running, always running.

One of the biggest losses for me in recent years was when I learned that I could not have children. I really couldn’t accept it at first. The strange thing is, is I wasn’t sure if I even wanted to have children, but finding out that I never could have my own, really affected me. I think that my husband would have liked to have had children – one more of my failures.

Again, I have so much to be thankful for. My husband is planning to retire early in 5 years and if I keep working hard, I should be able to retire at 50! Then we can travel and see the world. I can’t wait! I want to learn more dances; I love to salsa but I want to learn different ballroom dances as well. I have a lot to feel happy about, I want to start feeling better and enjoy what I have instead of always feeling like something bad is lurking around the corner. I am tired of being afraid but I’ll be damned if I know how to stop feeling the way that I do.