01 Aug Module 6: Week 6 – Externalizing Disorders? ?Read: Parritz & Troy: Chapters 10, 14? ?Read: Wilmshurst: Chapters 3, 6: Cases 11?12, 20?ExampleCasePresentation.docxCasePresentat

Example Case Presentation: Mr. D.

Your Name

Department of Psychology, Liberty University

EXAMPLE CASE PRESENTATION

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I. Key Clinical Issues

A. Client Demographics

Mr. D. is a 28-year-old, male who currently is employed as a Wall Street Investment advisor. Mr. D. reports that he had a wealthy upbringing in a small, northeastern, suburban town. Mr. D. is an only child of two intelligent, educated, professional and successful parents; and he is newly married to an intelligent, educated, professional and successful woman. Mr. D. reports that he recently was promoted to group manager at his work.

B. Presenting Problem

The client comes in presenting with stomach problems that have caused him: 1) to be absent from work and 2) to not finish assigned work on time. The stomach problems started about 2 months ago—about 1 month after his promotion to group manager at work. The stomach problems have been medically evaluated, and no physical cause was found. Because of his absences and incomplete work, he is in danger of losing his job. The client also reports anxiety-producing thoughts about his own feelings of competence and about his credibility with his bosses. His wife “pushed him into counseling.” He says that he does not have a problem, and is only in counseling to “make his wife happy.”

II. Diagnosis

A. Diagnostic Impressions

1. Social Anxiety Disorder, Performance Only: Client has marked anxiety about giving presentations to his bosses at work, in part because he is worried about what they think of him. He endures these presentations with anxiety, and his anxiety is causing significant occupational impairment.

2. Somatic Symptom Disorder: Client is experiencing somatic symptoms (i.e., stomach problems) that are disrupting his functioning at work.

3. Adjustment Disorder: Client is experiencing an emotional response to an identifiable stressor (i.e., being promoted at work and having to give presentations). His symptoms are clinically significant in that they are impairing his functioning at work.

B. Differential Diagnosis

1. Client most likely is not experiencing Social Anxiety Disorder because his symptoms have not been present for at least 6 months (Criterion F), and because his anxiety is not out-of-proportion to the threat (Criterion E; DSM-5, 2013). It is likely that most new, young executives on Wall Street would be similarly anxious presenting in front of their bosses.

2. Client most likely is not experiencing Somatic Symptom Disorder because he does not have excessive concern about his somatic symptoms (e.g., he is only in treatment at his wife’s prompting, Criterion B), and the stomach problems have only been present for about two months (Criterion C; DSM-5, 2013).

C. Full DSM Diagnosis

1. The most likely diagnosis for Mr. D is Adjustment Disorder, with Anxiety ( DSM-5, 2013).

(A) Client has developed anxiety-related and somatic symptoms (i.e., stomach problems) in response to a promotion at work and new responsibility of giving presentations. Symptoms began within 1 month of his promotion.

(B) Client is experiencing significant impairment in occupational functioning as evidenced by absences from work, unfinished work, and the resultant possibility of losing his job.

(C) Client does not meet the criteria for any other mental disorder, and he reports no history of a preexisting mental disorder.

(D) The symptoms are not a result of normal bereavement as the client reports no recent loss.

(E) Because the stressor is ongoing, this final criterion currently does not apply to the current case.

2. The specifier “with Anxiety” was chosen because, although Mr. D. does not explicitly report anxiety, he appears to be experiencing some consequences that indicate the presence of anxiety (e.g., somatic symptoms, worry about his competence and about what his bosses think of him).

3. A provisional diagnosis is necessary as Mr. D. meets all of the necessary criteria for a full diagnosis. After an adjustment period to his new responsibilities at work, re- assessment of Mr. D’s symptoms is recommended to see if they would abate once he has gotten used to his new role and tasks as group manager.

III. Etiology of the Problem/Disorder

A. Biological Theory: As a stressor-related disorder, Adjustment Disorder requires exposure to a stressful event for diagnosis (e.g., Mr. D.’s promotion at work and a stressful new responsibility). In the normal physiological response to stress, the HPA- Axis is activated (Parritz & Troy, 2018). In the case of chronic stress, sustained hyperactivity of the HPA-Axis has the potential to cause physical consequences (e.g., Mr.

D.’s stomach problems; Chang et al., 2009). This chronic stress response is the most likely cause of the client’s problems that should be treated first in order to reduce his acute feelings of distress.

B. Cognitive-Behavioral Theory: Because of Mr. D.’s’s family history, he has developed some distorted and illogical beliefs about success and failure. These distorted cognitions likely are creating and maintaining an anxiety response that is producing physical symptoms (i.e., stomach problems) and behavioral consequences (i.e., missing work, not finishing work) for Mr. D. (Parritz & Troy, 2018). From a very young age, Mr. D.’s parents have instilled in him the idea that failure is not an option. Mr. D. reports that whenever he was not performing up to his parents’ expectations, they would intercede to ensure his success. Also from a very young age, he worked hard so that he would be successful at whatever he did (e.g., high grades, soccer “star”). Because of his parents’ tremendous professional success, Mr. D. likely feels that he must be as successful on the job as they are. Although he has not said so explicitly, the thought of failure likely is intolerable to Mr. D. because of the importance that his parents have placed on the appearance of success.

IV. Treatment Receommendations

A. Biological Intervention: Because Mr. D.’s anxiety appears to be very narrowly circumscribed to the stress of having to give presentations to his bosses at work, it is recommended that Mr. D. gets evaluated by his primary care physician or a psychiatrist so that he could receive pharmacological treatment for his symptoms. Specifically, it is suggested that Mr. D. would benefit from taking a beta-blocker medication only on days

when he is required to give presentations to his bosses in order to reduce his sympathetic nervous system response to that stressor (Bailly, 1996).

B. Cognitive-Behavioral Interventions: In order to help Mr. D. learn to cope with the chronic stress that comes with being a Wall Street investment advisor, the use of somatic management techniques (e.g., progressive muscle relaxation, diaphragmatic breathing) is recommended to help ameliorate the effects of chronic stress on Mr. D.’s physical and emotional functioning (Parritz & Troy, 2018). Utilization of some cognitive restructuring exercises is also recommended to help Mr. D. learn a more realist and adaptive understanding of failure (i.e., failure tolerance; Parritz & Troy, 2018).

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.

Bailly, D. (1996). The role of β-adrenoceptor blockers in the treatment of psychiatric disorders.

CNS Drugs, 5(2), 115-136. https://doi.org/10.2165/00023210-199605020-00004

Chang, L., Sundaresh, S., Elliott, J., Anton, P. A., Baldi, P., Licudine, A., Mayer, M., Vuong, T., Hirano, M., Naliboff, B. D., Ameen, V. Z., & Mayer, E. A. (2009). Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome.

Neurogastroenterology & Motility, 21, 149-159. https://doi.org/10.1111/j.1365- 2982.2008.01171.x

Parritz, R.A. & Troy, M.F. (2018). Disorders of Childhood: Development and Psychopathology

(3rd ed.). Wadsworth.

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PSYC 645

Case Presentation Template

(Use the template below as a guide for both the content and organization of your case presentation assignments. Be sure to include an APA-formatted title page and references page.)

I. Key Clinical Issues

A. Client Demographics [This section includes a summary of demographic characteristics like age, gender, employment information, ethnicity/race, SES, marital status, and other significant relationships that the client discusses.]

B. Presenting Problem [This section includes information about the problem(s) that the client reports, the history of the problem(s), and why he/she came for help. The presenting problem can be anything from a single symptom to a full blown disorder. If the relevant information is provided in the case file, then discuss when the problem started, how it developed, and the impact it is having on the client’s life/functioning. Be sure to briefly review the results of any relevant psychological or neuropsychological testing. Another important element of the problem history is why the client is coming in for assistance/what the client is looking to accomplish. Is it by his/ her own choice, or did someone else require him/her to come (e.g., loved one, court)?]

II. Diagnosis

A. Diagnostic Impressions: [Based on the specific information provided in the case file, use the current edition of the DSM to identify every plausible disorder the client might be experiencing. For each possible disorder, write a sentence or two summarizing specific DSM criteria that the client appears to meet as well as supporting examples from the case file to explain why you think the client meets the criteria. Identify all potential disorders, including the one you think it is.]

1. Disorder #1

2. Disorder #2

3. Etc.

B. Differential Diagnosis: [For all disorders from above, rule out the ones that cannot be justified by identifying the specific criteria from the DSM that you used to eliminate them. For each disorder that you decide to rule out, explain which diagnostic criteria the client is missing using data from the case file to support your rationale (e.g., “symptoms should persist at least 6 months, while his only have been present for 2 months”).]

1. Disorder #1

2. Disorder #2

3. Etc.

C. Full DSM Diagnosis [Based on the information provided in the case file, use the current version of the DSM to accurately diagnose the client.]

1. Identify the final diagnosis that you have selected after ruling out the other possibilities. To build an argument in support of your diagnosis, briefly describe each diagnostic criterion in the current version of the DMS for the chosen disorder in your own words, and then use specific examples from the client’s case file to demonstrate how he/she meets each one. In all real-world cases, clients express a wide range of symptoms, so it sometimes is difficult to determine a diagnosis. Keep in mind that there is not necessarily a “correct” answer. The important thing is that you carefully review all of the clinical information and provide a persuasive argument about why the particular diagnosis that you chose is appropriate.

2. If necessary, identify any missing criteria that would warrant a provisional diagnosis (i.e., if the client does not meet one or more of the criteria of the disorder that you have chosen, then mention it here). If key criteria are missing, then the diagnosis that you give above would be “Provisonal.”

3. Please bear in mind that there may be only one appropriate diagnosis, so do not feel compelled to include more than one. If you do include more than one diagnosis, provide a persuasive rationale using data from the clinical file to support each one.

III. Etiology of the Problem/Disorder [In this section, identify and explain two causal theories of why the current problem/disorder developed or is being maintained. One of the theories has to be biological (e.g., neurotransmitter dysfunction, brain structure abnormalities etc.), and the other has to be psychosocial (e.g., behavioral, cognitive-behavioral, psychodynamic, family systems etc.). Substantiate each theory that you choose using specific examples from the case file and at least one scholarly source to support your rationale. If you cannot justify the etiological theory using case information, then explain what additional information you would need to support your theory. For example, for a biological theory, you cannot just say that one potential cause is “genetics.” You have to provide data from the case to support a genetic theory, and if you cannot build an argument using case data, then you have to explain what additional information you would need to support a genetic theory.]

A. Biological Theory: (Identify ONE biological theory of causation (or maintenance), and then cite information from the case file AND at least one scholarly source to support your rationale). If you cannot justify the etiological theory using case information, then explain what additional information you would need to support your theory.

B. Psychosocial Theory: (Idenitfy ONE psychosocial theory of causation (or maintenance), and cite information from the case file AND at least one scholarly source to support your rationale). If you cannot justify the etiological theory using case information, then explain what additional information you would need to support your theory.

IV. Treatment Recommendations [Based on your views of etiology described above, briefly identify and describe two treatment approaches that you would use—one related to each of the theories you described in the Etiology section above. Specifically, you must explain ONE treatment you would use to address the biological cause that you identified, and ONE treatment you would use to address the psychosocial cause that you identified. When making your treatment recomnedations, make sure that they 1) directly address the causal theories presented in the Etiology section, 2) are relevant to the case, 3) are able to be implemented by the client, and 4) are supported by scholarly sources.]

A. Biological Intervention: (Identify ONE biological treatment recommendation that you would use to address the biological cause that you listed above, and cite at least one scholarly source to support your choice. Make sure that there is an explicit, logical rationale to support the link between your biological treatment recommendation and the the biological cause that you posit in the Etiology section above).

B. Psychosocial Intervention: (Identify ONE psychosocial treatment recommendation that you would use to address the psychosocial cause that you listed above, and cite at least one scholarly source to support your choice. Make sure that there is an explicit, logical rationale to support the link between your psychosocial treatment recommendation and the the psychosocial cause that you posit in the Etiology section above).

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PSYC 645

CASE FILE: SARAH

Sarah is a 13-year-old, white female who has been suspended from school 3 times in the past 3 months. She lives with her mother, who is an attorney, and her father, who is an investment banker. Sarah was referred for therapy by her middle school guidance counselor because of frequent behavior problems at school.

According to Sarah’s teachers, she often threatens classmates with physical violence to get her way. Most recently, Sarah was suspended from school for punching a classmate in the stomach because she wouldn’t “get out of her way” in the lunch line. Another time, she pushed a classmate into his locker to “get her pen back.” As it turns out, the pen belonged to the classmate, not Sarah. On two occasions, Sarah was caught going through a classmate’s backpack in order to steal lunch money. Another significant concern is that Sarah skips school at least once every two weeks.

Sarah’s parents report similar behavior problems at home. Sarah’s mom says that Sarah repeatedly sneaks out of the house out night in order to meet up with a 16-year-old boy who lives down the street. Sarah’s father says that she becomes angry and defiant when either he or his wife tries to reprimand her for breaking the rules at home. Just recently, Sarah was brought home in a police car at 2 a.m. because she and some friends had broken in to a local swim club to go skinny dipping. They cut a giant hole in a chain-link fence in order to get into the club, and then they vandalized the snack bar with spray paint.

Because of the frequency and severity of Sarah’s behavior problems, the school principal explained to her parents that, if there is another violent offense at school, then Sarah will be expelled.

During Sarah’s initial psychological evaluation, the psychologist asked Sarah about her relationship with her parents. Sarah said, “I don’t know. It’s fine, guess. They both are pretty busy with work all the time. As long as I stay out of their way, then they leave me alone.”

When asked about the classmates with whom she was physically aggressive at school, Sarah replied, “They had it coming to them. I will not be disrespected.” Sarah’s developmental history revealed that her mother had separation of placenta while pregnant with her. Sarah did not crawl, and was somewhat delayed in starting to talk. She fell down the basement steps at age 3, and lost consciousness briefly.

Sarah’s parents report that they are very concerned about the course that Sarah’s life appears to be taking. They say that Sarah is an intelligent young lady with potential to excel in school.

They want assistance in creating a treatment plan for home and school that will help to get their daughter back on track.

Submit Case Presentation 3 by 11:59 p.m. (ET) on Sunday of Module/Week 6.

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PSYC 676

PSYC 645

Case Presentation Assignment Instructions

Overview

The purpose of the Case Presentation assignments is to give you experience with applying theoretical principles of child and adolescent psychopathology to real-world situations. An additional aim is to practice building a logical rationale for ascribing diagnoses using available information. A final goal is to foster critical thinking skills regarding the connection between causation and treatment of mental illness.

To complete each Case Presentation assignment, you will read the assigned case file and then use the information provided in the case file, the textbook (and/or other scholarly sources), and the current edition of the DSM to address the following 4 major topics: (1) Key Clinical Issues, (2) Diagnosis, (3) Etiology of the Problem/Disorder, and (4) Treatment Recommendations.

Before beginning these assignments, please review the Case Presentation Sample and its associated Sample Case File to get an idea of assignment expectations.

Instructions

Content Requirements

· Include a title page, 4–5 pages of expository content, and a references page.

· IMPORTANT: Follow the Case Presentation Template as a comprehensive guide for both the content and organization of your case presentations.

· Below is a brief overview of the content to be included in each case presentation. When writing your case presentation, please use the specific directions provided in the Case Presentation Template to fully and succinctly address the required content for each major section of the case presentation.

I. Key Clinical Issues

A. Client Demographics: Include a summary of demographic characteristics (e.g., age, gender, race/ethnicity etc.)

B. Presenting Problem: Summarize information about the problem(s)/disorder(s) that the client reports, the history of the problem(s), and why he/she came for help. Be sure to briefly review the results of any relevant testing,

II. Diagnosis

A. Diagnostic Impressions: Based on the information provided in the case file and on the diagnostic criteria from the current edition of the DSM, write a sentence or two to identify every plausible disorder the client might be experiencing. identify all potential disorders, including the one you think it is.

B. Differential Diagnosis: For all disorders from your list of diagnostic impressions, rule out the ones that cannot be justified by identifying the specific diagnostic criteria from the DSM that the client DOES NOT meet, which rule out the disorder

C. Full DSM Diagnosis: Identify the final diagnosis that you have selected after ruling out the other possibilities. To build an argument in support of your diagnosis, briefly describe each diagnostic criterion in the current version of the DMS for the chosen disorder in your own words, and then use specific examples from the client’s case file to demonstrate how he/she meets each one.

III. Etiology of the Problem/Disorder

A. Biological Theory: Identify ONE biological theory of causation (or maintenance), and then cite information from the case file AND at least one scholarly source to support your rationale. If you cannot justify the theory using case information, then explain what additional information you would need to support your theory for the current case.

B. Psychosocial Theory: Identify ONE psychosocial theory of causation (or maintenance), and then cite information from the case file AND at least one scholarly source to support your rationale. If you cannot justify the theory using case information, then explain what additional information you would need to support your theory for the current case.

IV. Treatment Recommendations

A. Biological Intervention: Discuss ONE biological treatment you would use to address the biological cause that you identified. When making your treatment recommendation, make sure that it: 1) directly addresses the biological causal theory presented in the Etiology section, 2) is relevant to the case, 3) is able to be implemented by the client, and 4) is supported by at least one scholarly source .

B. Psychosocial Intervention: Discuss ONE psychosocial treatment you would use to address the psychosocial cause that you identified. When making your treatment recommendation, make sure that it: 1) directly addresses the psychosocial causal theory presented in the Etiology section, 2) is relevant to the case, 3) is able to be implemented by the client, and 4) is supported by at least one scholarly source .

Formatting Specifications

· In-text citations are provided and formatted according to current APA guidelines.

· All text is typed and double-spaced in a standard, university-approved font.

· All pages utilize 1-inch margins.

· A current APA-formatted title page is provided.

· A current APA-formatted references page is included.

· Individual references on the references page are formatted according to current APA guidelines.

· Sources on the references page match sources cited in the body of the paper.

Writing and Organization

· Write in a scholarly writing style with a formal, graduate-level tone

· Be concise, not wordy

· Organize your ideas logically

· Utilize appropriate grammar, diction and punctuation

Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

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Tips for Case Presentation 3 Assignment 

· This week, you will analyze the “Sarah” case file.

· I encourage you to use the "most up to date research" to back up the arguments in your case presentation. This means that I encourage you to rely on sources that have been published within the past 5 years. Please reevaluate your chosen sources to make sure all of your sources meet this expectation.

· You should only give each client 1 diagnosis, not 2 or 3.

· Also, I encourage you to submit at least 3 diagnostic impressions before settling on the one diagnosis that you think is applicable to the specific case study. More than 3 is fine, but please propose at least 3 in this section of your analysis.

· Please make sure in the etiology and treatment sections that you tie your recommendations not only to scholarly sources but also to specifics that you know about the client’s story. You need to clearly back up all of your arguments in this conceptualization with science. Please cite journal articles and not the textbook or DSM manual here.  I want to see that you have your hands on direct research that is up to date, that you can explain how that research was done, and describe how the intervention that was studied is relevant for the particular case study.

· When proposing psychosocial and biological treatments, it is very important that they are evidenced based and that you have dug into the research to find the most up to date treatments in these different domains for the disorder you diagnosed your client with. If these sections are too vague/not specific, the grade will reflect that.  I want to see that you can locate the most up to date treatments for clients in your write up that have been published recently in the scholarly literature. For these sections, one reference is required but more are encouraged.  Also, please cite journal articles and not the textbook or DSM manual here.  I want to see that you have your hands on wdirect research that is up to date, that you can explain how that research was done, and describe how the intervention that was studied is relevant for the particular case study.

· In treatment section, please do not talk about treating potential comorbidities, but instead focus on reviewing research that has evidence of effectiveness for your given diagnosis.

· Relatedly, I encourage you to cite multiple primary scholarly sources in your conceptualizations. Different sources offer different perspectives, and learning how to think critically and write about these different perspectives is a critical professional development skill to focus on in this course. Citing the textbook is citing someone else who has read the research. You should be reading and citing the research directly yourself!

· When talking about biological treatments, make sure you consider nutritional treatments that may have evidence as opposed to only medication treatments. Also, when talking about medications, talk about how long clients should be on medicines, can they taper off, when can that happen, what are short and long term side effects etc.

· I don’t penalize students for going over the page length for the conceptualization. If you need more space to be thorough in your presentation, then that’s fine!  I’m happy to read and grade it.