Discussion: Personality Disorder
Discussion: Personality DisordersPersonality 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.By Day 4Post 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 CHEININTAKE DATE: FEBRUARY 2020PRESENTING PROBLEM: Chein voluntarily came to the emergency room complaining that he wanted to kill himself. He also complained that he has been depressed for a period of several months.PSYCHOLOGICAL STATUS: Chein is a 39-year-old, married, Vietnamese, Catholic male. Chein completed 4 years of college with a BS in business. He has been unemployed for the past 4 months. Currently, he resides with his 38-year-old wife and 2 daughters, ages 9 & 4.MEDICAL STATUS: History of gastric reflux (info taken from ER chart).SUBSTANCE ABUSE: Chein denies any history or current abuse.PSYCHIATRIC HISTORY: Chein denies any past inpatient hospitalizations. Since June of 2019 until presentation at ER, he has been attending group therapy 1x per week with Dr. P. In June of 2019, he also saw Dr. E. who prescribed Prozac 20 to 40 mg, which he has been taking for the past 7 months. In February 2014, he had 1 individual session with Dr. I. In 2013 to 2014, Chein went to Dr. A. for individual psychotherapy around feelings of low self-esteem and depression. He was given Prozac and once he felt better, he was taken off the medication.MENTAL STATUS: Chein is a neatly groomed and casually dressed Vietnamese male of slender build who appears his stated age of 39. His posture was relaxed and facial expressions were mobile and mood congruent. Motor activity was normal, and mood was dysphoric. Affect was appropriate to content. Speech was of normal tone with free verbalization. Thinking was logical and goal directed. There appeared to be no evidence of delusions or alterations in perception. Chein was oriented to three spheres. On fund of knowledge questions, Chein correctly answered 11 out of 11 questions asked. Recent and remote memory appeared intact. Intelligence appeared to be above average and judgment did not seem to be impaired. Digital span was 6 forward and 4 backwards. Chein was able to correctly abstract all the similarities. He was able to interpret 3 out of 4 proverbs. Responses to social and personal judgment questions were satisfactory. In response to three wishes, Chein replied “to be liked, to be rich and not to have worries in life.” When asked how he sees himself 5 years from now, Chein replied “hope to see myself accomplishing a lot of my goals – liking myself, more assertive and having a better relationship with my family”. When asked if he would like to change something about himself, Chein replied “change my physical looks.”SUICIDE ASSESSMENT: Chein relates feelings of depression with middle of the night awakening and anhedonia. He has some suicidal ideation. He states, “I think I’d be better off dead.” However, he states that these are “passive thoughts,” and he would not actively hurt himself. He also relates that he stopped taking his Prozac 3 to 4 weeks ago because he wanted to become more depressed. When questioned about his motivation for doing this, the patient replied, “maybe I had a death wish.” However, he reported an improvement in his libido that pleased him. HOMICIDAL ASSESSMENT: Chein denied any current ideation, plan, or intent. SUMMARY NOTES: Chein relates that he has been feeling increasingly despondent over the past 9 months. He relates that several problems have contributed to his depression. He cites his wife states that he suffers from a poor self-image. Secondly, he has great difficulty interacting with people, (“they’re annoying”), as well as communicating with them. Third, Chein states that he has several trust issues (people are always out for themselves) and finally, that he has very few friendships and it is hard for him to initiate social contact. He has always had on again off again relationships with people. Recently, Chein relates that a married female co-worker had sought him out for advice about sexual feelings that she was having for another man. He states that he felt quite special being confided in and began to enjoy having discussions with this co-worker. In April of 2018, he became attracted to her and confided these feelings to her. He reports that at that point she gradually distanced herself from him and began spending more time with a male employee whom he supervised. He was quite hurt by the change in their friendship and by January 2019 he stopped talking to her altogether. He reports that he also stopped eating and started working out in an effort to improve himself physically in her eyes. In addition, he states that he feels he was trying to punish himself by not eating. He relates that he thought about going into the hospital at that time as he became quite anorexic. He reports losing 65 pounds over a 6-month period but has gained some of the weight back over the past few months. He relates that he stopped eating to get her attention as well as to punish her. When she did not notice his condition, he became even more despondent. At this time, Chein indicated that his work performance started to deteriorate, and he was subsequently fired. Chein related that he started seeing Dr. P for counseling. He was attending group therapy 1x per week until 3 weeks ago when he felt he was no longer getting anything out of the group and wanted to leave. At his last group therapy session, he mentioned that he was feeling quite despondent and would probably not be returning. He believed no one really heard that. Over the following week, Chein related that he had suicidal thoughts and feelings. The following week he did not go to group therapy and his wife called Dr. P. At that point Dr. P. suggested that Chein present himself to the ER for a psychiatric evaluation.