Kalani Carrion Abnormal Psychology Final Paper 5/7/12

This assignment provided the opportunity to come to a diagnosis using the given information the same way a clinician would. I was given 5 very different cases with all types of information about the patient, including their medical history, education, marital status, and more. It was up to me to determine the general type of disorder, and then the specific classification of that disorder. I had the option to choose between anxiety disorder, dissociative disorder, mood disorder, personality disorder, and schizophrenic disorder. My first patient was a 27 year old man, with the initials of N.K. He is seeking treatment because he suffers from frequent dizziness, and occasional heart palpitations. He is tense and irritable most of the time, and sometimes begins shaking. He is uncertain of the cause of these symptoms. He worries about his future, although he does nothing about it. The interviewer observed that N.K. is pale in appearance and is obviously nervous with the way he swallows frequently, and clicks his fingernails (Ludwig, n.d.). The general type of disorder that N.K. is suffering from is an anxiety disorder, and the specific classification is generalized anxiety disorder. Individuals suffering from generalized anxiety disorder are constantly worried about practically anything (Comer, 2011 p.96). As with N.K., these patients are able to carry on a social life and career. The symptoms for generalized anxiety disorder include feeling restless, keyed up, or on edge; tire easily; have difficulty concentrating; suffer from muscle tensions; and have sleep problems (Comer, 2011 p.96).

I found the first oddity in diagnosis with this case. According to the activity, N.K. suffers from generalized anxiety disorder. Although this was not an option, I would diagnose this man with having a panic disorder. His symptoms match more closely with panic disorder. Panic disorder is when an individual has repeated and unexpected panic attacks, without an apparent cause. Panic attacks occur when at least 4 of the following symptoms occur. Symptoms include: palpitations of the heart, tingling in the hands or feet, shortness of breath, sweating, hot and cold flashes, trembling, chest pains, choking sensations, faintness, dizziness, and a feeling of unreality (Comer, 2011 p.116). With the given information, it stated that N.K. experiences dizziness, heart palpitations, and shaking (Ludwig, n.d). There may be more symptoms that are not mentioned. N.K. has also stated that there is no apparent cause for his symptoms. He also worries about his future, as well as other patients with this disorder do. If N.K. does in fact, suffer from generalized anxiety disorder, the cause may be genetic and further tests must be done. If he is suffering from a panic disorder, it is a possibility that he may misinterpret his bodily sensations. According to the cognitive perspective, a panic attack may occur when the individual unexpectedly experiences an unfamiliar sensation and they immediately interpret it as there being something wrong with them (Comer, 2011 p.118). This unfamiliarity turns into panic. I would suggest cognitive therapy. The goal of cognitive therapy is to teach the client how to interpret these sensations (Comer, 2011 p.120). Some clinicians have combined both drug treatments and therapy, but it is still unclear as to whether the combination is more effective than the therapy alone (Comer, 2011 p.121). The second patient is a 52 year old woman, with the initials of D.G. She is seeking treatment because she is continually sad, discouraged and listless, has no energy or appetite, and has had insomnia for the past 3 weeks. She has been contemplating suicide. Close friends claim that

she has withdrawn from their environment. She no longer attends church or community events, and spends much of her day in bed. The interviewer observed that she did not make eye contact, has a hard time concentrating, seems guilty and remorseful, weeps frequently, and her speech was slow and halting. She feels as if she is a failure at everything, and has ruined the lives of her husband and children (Ludwig, n.d.). D.G. suffers from the mood disorder, major depression. Symptoms of depression include feeling sad, loss of the desire to pursue usual activities, negative views of themselves, less sleep, and the loss of appetite (Comer, 2011, p.195). D.G. displays all of these symptoms. She admitted to her loss of appetite and feeling sad, and has mentioned having insomnia. The loss of the desire to pursue usual activities is displayed in her withdrawal from her social environment, and no longer attending church and community events. The negative views of herself is displayed with her feeling of constant failure, and her idea that she ruined the lives of her husband and children (Ludwig, n.d.). These are just a few of the many symptoms D.G. has displayed. She is having a manic depressive episode. A manic depressive episode may last 2 weeks or more (Comer, 2011, p.197). Her insomnia has began 3 weeks ago, so it is likely that this is when the episode had begun (Ludwig, n.d.). Since D.G. does not have a history of mania, she will receive a diagnosis of major depressive disorder. Major depressive disorder is the presence of a major depressive disorder, without the history of mania (Comer, 2011, p.197). The cognitive model can be a possible theory explaining the cause of D.G.s depression. This model introduces the concept of learned helplessness. The learned helplessness theory states that depression begins when the individual feels that they no longer have any control of their lives, and that they are responsible for being so helpless (Comer, 2011 p.209). D.G. blames herself for her husband leaving her and her oldest child moving away. She is convinced that she has ruined their lives (Ludwig, n.d.).D.G. bases her self worth around the success or failures of what she at-

tempts. This is referred to as a maladaptive attitude (Comer, 2011 p.211). D.G. feels she has failed at everything she has tried, therefore, she considers herself a failure overall (Ludwig, n.d.). I would suggest D.G. take part in cognitive-behavioral therapy. This therapy works to increase her mood, and change her overall attitude in a total of 4 phases. The phases include: increasing activities and elevating mood, challenging automatic thoughts, identifying negative thinking and biases, and changing primary attitude (Comer, 2011 p.212). This therapy requires less than 20 sessions, and can definitely be a great pick me up for D.G. Itll help her realize that she is not helpless, and that she is not to blame. The third patient is a 34 year old man with the initials of J.S. He is seeking treatment not because he feels he has a problem, but because his wife has threatened to divorce him. His wife is frightened by him and claims to have been beaten more than one time. She also fears that he may kill or molest their daughter. A friend claims that J.S. does not have many friends due to his unpredictable temper. The friend also claims that J.S. will pick fights and insult other individuals regardless of if he is drunk or sober. He is disliked by neighbors for his cruel behavior toward animals, and cannot seem to maintain a job for long. He has been to jail 3 times and is constantly in trouble with the law (Ludwig, n.d.). J.S. displays the personality disorder, antisocial personality. An individual with antisocial personality disorder can be defined as someone who persistently disregards and violates others rights (Comer, 2011 p.402). These individuals have difficulties maintaining a job, and can be quick to start fights. They cannot keep close relationships and view their victims as deserving of what has happened to them (Comer, 2011 p.403). This describes J.S. almost perfectly. It was mentioned that he cannot maintain a job, and is a trouble maker. He cannot keep a positive relationship with his wife and her daughter (Ludwig, n.d.). It is a possibility that he has beaten his wife on several occasions because he feels that it is what she deserved. It is

also true that individuals suffering from this personality disorder are linked to criminal activity (Comer, 2011 p.402). This would further support my diagnosis and explain J.S.s criminal record. There are a few theories regarding the cause of antisocial personality disorder. Psychodynamic theorists believe that the cause of the disorder stems way back into the childhood of the patient and their relationship with their parents. These theorists believe that a lack of love and nurture from the parents to the child can teach the child a lack of trust, leading them to become distant emotionally, with destruction as their way to bond (Comer, 2011 p.404). It is true that this parental love was absent for J.S. His mother did not have time for him. His father was extremely hard on him, punished him often, and eventually disowned him. Treatment for antisocial personality disorder is commonly ineffective. Clinicians have used psychotropic medications to treat such patients to reduce certain features of the disorder (Comer, 2011 p.406). I would suggest taking medication as well as taking part in cognitive therapy. The goal of cognitive therapy is to get these patients to take other individuals into consideration. Therapists try to get the patients to think of morality and the needs of others. Although treatment is not completely effective, hopefully a difference is seen when combining two forms of treatment. The fourth patient is a 61 year old male with the initials of L.T. He is seeking treatment because he is convinced that someone is trying to make him crazy by depriving him of sleep. He wakes up often and hears noises. The wife claims her husband has cut the phone lines and has invested in a pistol because he is certain that someone is after his secret discovery. The brother states that L.T. was extremely devoted to his work until the school urged him to retire. The interviewer observed that L.T. has a difficult time concentrating; appears tense, upset, and suspicious; and is not completely rational. The interviewer also states that L.T. had examined the windows and doors

before taking a seat (Ludwig, n.d.). L.T. suffers from the schizophrenic disorder, paranoid schizophrenia. Individuals suffering from a paranoid type of schizophrenia have an organized system of delusions and auditory hallucinations that may guide their lives (Comer, 2011 p.364). Symptoms include delusions, hallucinations, and social withdrawals (Comer, 2011 p.362). L.T. experiences many delusions. Delusions are ideas that the individual believe with complete certainty, but have no basis in fact (Comer, 2011 p.360). He experiences delusions of persecution and delusions of grandeur. Delusions of persecution is when the individual believes that someone is spying on them or plotting against them (Comer, 2011 p.360). This applies to L.T. with his belief that someone is trying to make him crazy by depriving him of sleep (Ludwig, n.d.). Delusions of grandeur is when the individual believes they are a very empowered person, like a religious savior or great inventor (Comer, 2011 p.360). This applies to L.T. with his belief that he has made a great discovery. He has experienced both delusions of persecution and grandeur when he cuts the phone line and buys a pistol to protect this secret discovery (Ludwig, n.d.). L.T. also experiences hallucinations. Hallucinations can be defined as perceptions that occur in the absence of external stimuli (Comer, 2011 p.361). L.T. experiences the most common type of hallucination, which are auditory hallucinations. Auditory hallucinations is when the individual hears something outside of their head (Comer, 2011 p.361). L.T. constantly wakes up in the middle of the night because he hears noises (Ludwig, n.d.). L.T. also displays a great social withdrawal. Social withdrawal is when the individual does not take part in his social environment and simply tends to his own ideas (Comer, 2011 p.361). His brother claimed that he has never had close friends, nor did he have any hobbies. He was mainly involved in his work (Ludwig, n.d.).

In the case of L.T., more information must be given to determine a theoretical cause. It is likely that the cause of L.T.s condition is biological, and would need more testing to confirm. As far as treatment goes, I would suggest L.T. begin antipsychotic drugs to reduce his symptoms. Along with the drugs, I suggest he takes part in either Milieu therapy or a token economy program. Both have been seen to be effective, and can help L.T. regain responsibility and get back on his feet. The last patient is a 33 year old female with the initials of B.H. She is seeking treatment because she has frequent blackouts. There have been instances where she finds herself in strange locations with no recollection of how she got there, or even why she is there. Her husband claims that she can be quiet and relaxed sometimes, and other times very energetic and cheerful. He claims she will go missing for days at a time, and describes an instance where he saw her outside of town, but she did not recognize him. The neighbor states that B.H. sometimes dresses in clothing that appears flashy, and leaves in a taxi although she has her own vehicle. The interviewer observed that she is a calm, rational, and intelligent woman that is disturbed by her blackouts (Ludwig, n.d.). B.H. is suffering from dissociative identity disorder. Individuals with dissociative identity disorder develop two or more personalities (Comer, 2011 p.180). It is as if there is a completely different person inside of them, with their own set of memories, behaviors, thoughts, and emotions (Comer, 2011 p.182). The personalities can switch at any time. It does seem as if B.H. has a second personality. It is likely that her second personality has taken over when she dresses in flashy clothing and leaves in a taxi. She may have also been in that personality that instance where she did not recognize her husband. Although this was not an option in the diagnosis, it sounds to me as if B.H. suffers from dissociative fugue. Dissociative identity disorder does not explain the blackouts. Individuals with dissociative fugue forget their

identities and leave to an entirely different location (Comer, 2011 p.180). The length of their fugue varies, and just ends abruptly. The switch of personalities as mentioned with dissociative identity disorder may also occur in dissociative fugue disorder. When the fugue is over, the individual will suddenly awaken and have no idea of how or why they are there (Comer, 2011 p.180). The same blackouts were described by B.H. She mentions having no recollection of going there (Ludwig, n.d.). The psychodynamic view states that dissociative disorders are caused by a traumatic childhood. The individual may attempt to block off the memories altogether to avoid facing the issue. In depth details of B.H.s child are not mentioned, but it does mention both of her parents being deceased. B.H.s father was an alcoholic, and she was abandoned at age 7. She then lived with her aunt. Her could aunt not be located for an unknown reason (Ludwig, n.d.). This repression is a likely cause for her disorder. I would suggest B.H. take part in therapy. To treat this disorder, therapists help their client to recognize fully the nature of their disorder, recover the gaps in their memory, and integrate their subpersonalities into one functioned personality (Comer, 2011 p.188). I feel as if this treatment would be especially helpful for B.H. Not only does it educate her about her disorder, it helps fill in the gaps that she cant seem to figure out. I found the reason for seeking treatment and the information from the individuals around them to be the most useful. Matching the symptoms with a disorder was the best place for me to begin. I used their self-description of personality, occupation, and miscellaneous information to confirm my diagnosis. At least some of the information given has matched other individuals suffering from a certain disorder. For example, many individuals suffering from antisocial disorder have a difficult time maintaining job. This was the same case with the patient mentioned also suffering

from antisocial disorder. When determining a theoretical cause for the disorder, I put more focus into their marital status, self-description of childhood, and family background. Many of the theories regarding the case of the disorders are regarding the individuals childhood. Having an idea of the disorders caused helped determine what treatment would be most effective for this patient. I enjoyed this assignment greatly. I would say that it was undoubtedly more enjoyable than any other final paper or final exam, which is great because much more is being put into it. Theres so much information and ways to apply the information, that there was never a moment when I found myself typing just to fill up the pages. I felt as if I was taking on the role of an actual clinician. Although I was thrown off my the patient with generalized anxiety disorder, and the patient with dissociative identity disorder, I had diagnosed every patient correctly. I had also diagnosed the specific classification prior to even reading the options for it. It helped me gain an even greater understanding of these disorders. Its an excellent way to end the class and instill the information one more time.

References

Comer, R.J. (2011). The Fundamentals of Abnormal Psychology. New York: Worth Publishers. Ludwig, T.E. (n.d.) PsychSim5: mysteryclient. Retrieved from http://bcs.worthpublishers.com/psychsim5/Mystery%20Client/PsychSim_Shell.html