DSM-5 Diagnosis for Depressive Disorder: The Case of Mrs. X

Midterm Paper- Mrs. X’s Case
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Midterm Paper- Mrs. X’s Case
Question 1
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Mrs. X is suffering from a major depressive disorder because she exhibits symptoms of the disorder as outlined in DSM-5.
Diagnosis justifications/ symptoms present for depressive disorder
According to DSM-5, a patient suffers from the depressive disorder if they exhibit various symptoms that have been exhibited in Mrs. X’s clinical case. Mrs. X feels worthless and experiences inappropriate and excessive guilt. She feels completely worthless compared to other people, especially her family members. The extent of this feeling is so great that she never spends her money on herself. Regarding inappropriate guilt, she feels that she is to blame for the sexual abuse she experienced from her father during childhood. The guilt is entirely inappropriate, and it is a characteristic of her depressive disorder. She fails to realize that she did her best by letting her mother know of the abuse, yet she did nothing. Other symptoms experienced by Mrs. X that are characteristic of the depressive disorder include; thoughts of death, depressed mood, fatigue, sleep disturbance, weight gain, loss of interest in activities, and excessive worry concerning her family’s future (Regier et al., 2013).
Mrs. X experiences depressive symptoms than dissociative symptoms. The rationale for this diagnosis is that according to DSM-5, for a patient to be diagnosed with a dissociative disorder, two or more personality states or identities must exist within the patient, with each personality having its unique enduring pattern of perception, thinking, and relating to its surroundings and itself (Regier et al., 2013). In Mrs. X’s case, the two personality states are absent. In dissociative disorder, severe amnesia that causes gaps in the recall of life’s events must occur (Vaillant, 1992). Even though Mrs. X claims to have missed her third appointment because she forgot, she may have done it intentionally because she did not want to show up at the hospital. She lacks severe amnesia to qualify her condition to be a dissociative disorder.
Question 2
The primary defense that the therapist should focus on while dealing with Mrs. X is the immature defense. Mrs. X uses the immature defense of somatization. Under the immature defense of somatization, patients transform negative feelings towards others into bad feelings towards themselves (Shpancer, 2018). In Mrs. X’s clinical case, she transforms her negative feelings towards her father, who sexually molested her during childhood, into negative feelings towards herself. The truth is that she has no reason to feel nasty towards herself because of what her father did to her because she never approved him to continue molesting her sexually. To show her disapproval, she reported the issue to her mother, who did nothing about the issue. Not only does Mrs. X have a negative feeling towards her father, but she also has a negative feeling towards her mother for not helping her after she reported her father’s behaviors to her. However, due to the immature defense of somatization, she redirects her negative feelings and hatred towards her parents to herself.
The primary effect that Mrs. X is trying to deal with is fear. She fears that if her husband knows about her horrendous childhood, he may get upset and leave her because she has never opened up about the issue to him. She also fears how people will react if they know what happened to her during childhood, yet she has never disclosed it to anyone. She is worried that they will presume she consented to her father’s abuse, and that is why she has kept it a secret in her entire life. Her mother taught her that her father’s abuse was not good and she should keep quiet about it. Since then, Mrs. X knows and believes that what happened to her was not good, and as such, she is cautious not to let anyone know about it in obedience to her mother’s directive that she should never let anyone know about it.
Question 3
According to Herman (1994), it is difficult for therapists to be neutral when handling trauma patients. The argument is that trauma results from the evilness of human nature and not from natural disasters. Only the victim group exists in natural disasters since the perpetrator is mother nature or “God’s acts” and cannot be blamed. On the other hand, Human designed traumatic events create two groups composed of the perpetrator and the victim. The existence of the two groups warrants the therapist, who is a bystander, to morally incline and support one of the two groups (Herman, 1994). The traumatic event perpetrator approaches the therapist with a notion that there is justification to the actions and the need to forget the events. On the contrary, the victim demands the therapist to trigger actions against remembrance, engagement, and sharing the burden. Therefore, it is up to the therapist to choose the next course of action based on the conditions imposed by the perpetrators and the victims, a decision the therapist cannot escape.
In the case of Mrs. X, Herman (1994) instigates that the therapist shouldn’t urge her to share her dad’s and her previous husband’s abuses with others. According to Herman (1994), society tends to devalue the traumatic events of children and women. Therefore, society and the authority will challenge whether Mrs. X’s story is fabricated, maliciously imagined, the genuineness of her suffering and whether she is just malingering. The scrutiny is likely to occur because the event took place a long time ago and was not reported. In the end, she is likely to be discredited by the authorities and others. The outcome might frustrate her further and deteriorate her condition, especially if she is optimistic about society’s support.
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