DSM-5 Psychology Case History, Signs, and Symptoms

Differential Diagnoses
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Differential Diagnoses
Case History, Signs, and Symptoms
Jane is 19 years old, who is currently underweight and previously has been diagnosed with anorexia and bulimia for which she received numerous ineffectual treatments. She also has a history of sexual abuse by her cousin at the age of 2 years which had a significant effect on her. Currently, she has an erratic and agitated affect with anger outbursts and an unstable mood. She has also been self-destructive with episodes of self-harm, self-abuse and suicidal ideation. She has currently distanced herself from friends, sleeps less and is found to be talking gibberish to herself.
Potential Diagnoses and Comorbidity
Jane’s symptoms can be linked to multiple DSM-5 disorders for which a differential diagnoses are discussed below. One of the potential diagnose can be Bipolar Disorder which is characterized by a manic episode primarily distinguished through elated, irritable or expansive mood. Other symptoms include feelings of grandiosity, insomnia, talkativeness, distractibility, psychomotor agitation and indulging in harmful activities (American Psychiatric Association, 2013). Jane displays one of the major symptoms of Bipolar Disorder i.e. mood swings and an irritable mood. Her problems are related mostly related to affect which can be equalized with Bipolar Disorder as it is also a mood-related disorder. Some of her symptoms also relate to the depressive episode i.e. losing significant weight, self-harm, agitation and suicidal ideation. While some symptoms match the diagnosis a detailed history and current symptomatology have to be probed to define mood episodes, their duration, intensity and frequencies.
Some of Jane’s symptoms also point towards the diagnosis of Schizophrenia but due to slight inclination towards it, a specifier of Bipolar Disorder i.e. with a psychotic episode might be considered a better area to discuss than a full-blown schizophrenia diagnosis. A psychotic episode may accompany a bipolar episode characterized by disconnection or dissociation from reality, lack of insight, hallucinations, delusions, disorganized thought patterns, aggression, and erratic mood. Jane’s symptoms of self-talk, mood swings, temper outbursts, self-directed aggression and lack of insight corroborate with the signs of a psychotic episode but the absence of major symptoms such as delusions, hallucinations, disorganized speech or thought patterns nullify the diagnosis.
Included in Bipolar Disorder is a depressive episode as well but Jane’s symptoms also need to be ruled out from the diagnosis of Major Depressive Disorder (MDD). It is defined by a depressed mood and loss of interest in pleasurable activities (APA, 2013). Significant weight loss, insomnia, agitation, distancing from friends and family, self-harm and suicidal ideation are Jane’s symptoms which also match the diagnosis of MDD. On the contrary, major symptoms of depressed mood and anhedonia were not reported regarding Jane, hence, the diagnosis can be ruled out after more elicitation of information.
Some evidence of Post-Traumatic Stress Disorder can also be seen. Criterion A of the disorder states that the individual should have been a direct or indirect victim/witness of the trauma. In Jane’s case, she had been a victim of sexual abuse in her childhood. Though the Criterion B and C of diagnosis i.e. re-experience of trauma through thoughts, emotions or bodily symptoms and avoidance of reminders of trauma are not evidently reported in Jane, the criterion D i.e. negative changes in thoughts and mood can be vividly observed. Jane displays a negative emotional state (anger, temper outbursts, irritability), detachment from others, and loss of interest in pleasurable activities. She also fulfills Criterion E i.e. irritability, aggressive behavior and problems in sleeping. In summary, Jane does not display two significant criteria of PTSD thus, the diagnosis may not accurately justify Jane’s symptoms.
Provisional Diagnosis and Evidence
In the present case scenario, the diagnosis of Borderline Personality Disorder (BPD) can maximally validate Jane’s clinical presentation. Its Criterion A implies impairments in personality or self-functioning in the area of self-identity and self-direction. While Jane’s future plans still remain uninvestigated her low self-image can be seen in her diagnosis of anorexia and bulimia. Eating disorders may usually result when the individual remains unsatisfied by his/her body image, is self-critical of himself/herself and sometimes show dissociation from reality. These symptoms are also exhibited by Jane and thus confirms Criterion A of BPD.
The next criterion specifies if the individual shows marked impairment in interpersonal functioning. This may involve opposite polarities in intimacy i.e. sometimes being overinvolved with others while other times seeking complete withdrawal from them. Relationships may be overvalued or de-valued instantly and the distancing may be real or imagined. Jane also displays a variation in her relationship bonds which according to her mother have been recently cut off and Jane remains alienated from her friends.
Criterion B of BPD specifies pathological personality traits such as negative affectivity, disinhibition and anta...