Personality disorders can arise through trauma, and they often carry added stigma. In this Discussion, you analyze a case study focused on a personality disorder while also reflecting on how power, privilege, and stigma affect such diagnoses.
To prepare: Review the case provided by your instructor for this week’s Discussion and consider your differential diagnostic process for them. Be sure to consider any past diagnoses and what influence those might have on their current diagnosis and needs. Finally, return to the Week 1 resources on stigma and reflect on stigma related to personality disorders.
Post a 300- to 500-word response in which you address the following:
- Provide the full DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
- Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
- Support your decision by identifying the symptoms which meet specific criteria for each diagnosis.
- Identify any close differentials and why they were eliminated. Concisely support your decisions with the case materials and readings.
- Explain how diagnosing a client with a personality disorder may affect their treatment.
- Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorders.
- Identify how trauma affects the case, either precipitating the diagnosis and/or resulting from related symptoms or treatment of diagnosis.CASE of SHANICE
Intake Date: January 2021
Shanice is a 32 year old, single African American female, with no siblings. Shanice reports never being married. She works full time at the library.
CHIEF COMPLAINT/PRESENTING PROBLEM:
Shanice reported having sudden attacks and feeling anxious. She described feelings coming over her so quickly where her heart was pounding, and she couldn’t breathe. Recently when shopping, she wanted to just run out of the store because she suddenly was so dizzy she wanted to vomit. She even stopped going to the library.
HISTORY OF PRESENT ILLNESS:
Shanice notes “I like people, but I don’t deal well with them. I never seem to meet a lot of people. I guess I have always been this way. I remember rarely inviting other kids to my birthday parties. “I didn’t think they really wanted to come”.
Shanice described feeling anxiety and panic over the past three weeks when she was assigned a new boss. She believes her work is unsatisfactory and feels very dissatisfied with her job. She doesn’t like the anxiety she is now experiencing. Over the past two years, her other boss would cover up for her mistakes when her concentration was off, and she couldn’t make a decision. She may need to quit her job. She cannot believe that she gets accommodations at work. She cannot figure out why.
PAST PSYCHIATRIC HISTORY:
Shanice initially started psychiatric treatment at 18 years old after her mother complained about her depressed mood and lack of social activity. She just lost all interest in trying to do things because it just did not work. Shanice believes she is just not the type that has a lot of energy for things. She states she did not know how to go about being social. After several years, she finally admitted to her mother that she always thought about killing herself. She remembers being upset because her fingers bled because she would pull the extra skin off by her nails, and then her nail would look terrible. Everything was “going haywire” at that time. Her energy was “zapped”, she did not want to try and build her social circle, her sleeping and eating habits got worse. At 25, she made a suicide attempt by drinking a glass of wine and taking valium. She describes being unsure how much valium she needed, so she took half a pill. At this time, Shanice was admitted to a psychiatric unit for thirty days.
Shanice reports being involved in psychotherapy previously, over a ten year period. She would attend one session, then never go back. There was only one clinical social worker that she stayed with for any length of time. Shanice states she enters treatment when she feels anxious or depressed. Most of the time, her mother would bring her to the first session. She has been prescribed Prozac and Paxil in the past – ten years ago and five years ago, respectively. Shanice reports both medications helped “somewhat” but did not really help much.
SUBSTANCE USE HISTORY:
About one year after discharge from the psychiatric hospital, Shanice’s depressive symptoms were still present, so she started drinking at home. Her drinking increased so much over that one year that she knew it was contributing to her depression. Shanice’s mother confronted her about the drinking and brought Shanice for alcohol treatment. She completed outpatient treatment and slowly began attending AA meetings. She states she is a recovering alcoholic for five years. Shanice denies any other drug use. She has never had a sponsor, and does not attend any AA functions other than a meeting. Presently, she attends one AA meeting a week. It is on a Friday afternoon during lunch time. Shanice reports always enjoying this meeting in the past because all three attendees get a chance to talk if they want. Over the last two years, Shanice reports losing interest even in attending this AA meeting, but she goes because they serve lunch.
Shanice had her tonsils removed at 8 years old. She denies any other distinguishing medical problems. Shanice has used Paxil and Prozac in the past when her anxiety became overwhelming. She stopped her Paxil three years ago because she felt better.
FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC:
Her parents were divorced when she was 11 years old. Shanice resides with her mother in Austin, TX. Shanice describes her relationship with her mother as “very close.” She does worry about disappointing her mother since mom, for as long as she can remember, complained about Shanice being depressed all the time.
CURRENT FAMILY ISSUES AND DYNAMICS:
Shanice reports never having many friends because of her relationship with her mother. She believes if she moved out of her house she would be able to increase her social circle.
Shanice reports having a boyfriend in college, who she knew since childhood, but she didn’t know really how to be a girlfriend. She stopped taking his phone calls. She remembers going to the movies with him a few times. Shanice reports being unsure how to act on a date. Shanice would like to get married and have children.
MENTAL STATUS EXAM:
Shanice presented in a very plain non-descript manner. She was dressed appropriately in casual attire, a skirt and blouse. She apologized for not wearing makeup, but she described herself as being unable to be like other woman who know how to put makeup on. Shanice spoke in almost a whisper, with very flat affect.
She states her concentration is definitely affected by her lack of sleep since she wakes up every couple of hours. She sees herself as more irritable than ever, even her mother commented on her irritability. Shanice states she also is feeling some muscle tension.
She denies homicidal ideation. When asked about suicidal ideation Shanice responded “You mean right now, or this moment, no, but they are there. I don’t think I’ll ever kill myself, but you never know, do you?”.