Vignette Analysis: Differential and Provisional Diagnosis and Theoretical Models
Please see attached example
Assignment should be 6 pages plus a title and reference page
Please integrate a Cultural Formulation Interview
Please integrate the DSM-5 Level 2 Assessment Measure(s)
Please keep responses focused on what is presented in the vignette
Jane is a 19-year old women. She presents as markedly underweight, with significant agitation. Both of her parents are present for the intake session. Her mother is an attractive Japanese woman of slight build. Her father is a Latino who appears deeply concerned about his daughter. Jane is their only child.
The parents report that when Jane was 2-years old, she was sexually abused by an older cousin that was diagnosed with autism. While this cousin has not been part of Jane’s life since, this remains a family secret and no legal action was ever taken due to the cousin’s mental illness. The parents do believe this affected Jane and are hoping to approach this issue and find resolution and healing. They have approached their family doctor who has known Jane all of her life. He suggested that the family seek counseling and consider hospitalization for Jane.
Reportedly, Jane has been erratic, impulsive and self-destructive throughout much of her life. Her parents report that Jane suffers from mood swings, angry outbursts and has alienated most of her friends. She has a history of self-abuse and suicidal ideation. While Jane has reportedly never made an attempt on her life, her parents have always been cautious and concerned. Jane has a history of cutting her wrists, but the parents report this was superficial and did not require medical attention. Jane denies doing this at present.
Jane has also been struggling with anorexia and bulimia since age 12. They have taken her to doctors and therapists with no success. In the past few months, Jane has lost a significant amount of weight, is not sleeping and is “talking crazy”. The parents often find Jane up all night having conversations with herself that make no sense. Jane’s mother begins to cry as she expresses a fear that her daughter is using drugs and worries that she will overdose and die. At this point, Jane starts wringing her hands and looking around the room and asks if she can be excused to use the restroom.
1. Formulate a Differential Diagnosis for Jane. Consider what comorbid disorders may exist and what additional information you may need to confirm your diagnostic impression.
2. Choose one provisional diagnosis for Jane. Support your diagnostic impressions by walking thru the DSM-5 diagnostic criteria (letter by letter) for the proposed diagnosis and match each DSM-5 criterion with vignette content.
3. Choose two (2) theoretical models (Dialectical Behavioral Therapy (DBT) and Person Centered Therapy (Carl Rogers) and explain how each may conceptualize Jane’s clinical presentation. From the perspective of each theoretical model, discuss how you would provide clinical treatment. Integrate vignette content to illuminate your treatment approach.
4. Discuss legal, ethical, and cultural considerations related to your diagnostics and treatment.
Title
Name
Subject and Section
Professor’s name
Date
Jane’s Case Analysis
Differential Diagnosis
Based on the vignette, there are several potential diagnoses to consider. Jane’s history of mood swings, self-destructive behaviors, and suicidal ideation suggests the possibility of a mood disorder, such as bipolar disorder or major depressive disorder, specifically, major depressive disorder, recurrent, severe, with psychotic features (American Psychiatric Association & American Psychiatric Association, 2013). Her history of self-harm also suggests borderline personality disorder as a possible diagnosis. Additionally, her struggles with anorexia and bulimia indicate the possibility of an eating disorder, specifically anorexia nervosa or bulimia nervosa. Her erratic behavior, agitation, and apparent delusions suggest the case of a psychotic disorder, such as schizophrenia or schizoaffective disorder. It is important to note that comorbidity among these disorders is common, and Jane may be experiencing more than one disorder simultaneously. Additional information about Jane’s symptoms, medical history, and family history may be necessary to confirm the diagnosis. Furthermore, it would be essential to explore Jane’s trauma history and the impact of sexual abuse on her mental health.
Provisional Diagnosis
Based on the information in the vignette, one possible provisional diagnosis for Jane is Major Depressive Disorder, Recurrent, Severe, with Psychotic Features (American Psychiatric Association & American Psychiatric Association, 2013). Here is a walk-through of the DSM-5 diagnostic criteria for this disorder, matched with relevant vignette content:
* The individual has experienced at least two major depressive episodes.
Jane has a history of self-abuse and suicidal ideation, mood swings, angry outbursts, and erratic, impulsive, and self-destructive behavior throughout her life.
* The individual’s current episode is characterized by either a depressed mood or loss of interest or pleasure in nearly all activities and four (or more) additional symptoms of depression.
Jane has been struggling with anorexia and bulimia since age 12, has lost significant weight, is not sleeping, and has been “talking crazy.” Her parents often find her up all night having conversations with herself that make no sense. These symptoms suggest a loss of interest or pleasure in activities, disturbed sleep, and psychotic symptoms.
* The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Jane has alienated most of her friends and has been struggling with anorexia and bulimia for years, despite treatment. Her symptoms are causing significant distress to both her and her parents.
* The episode is not attributable to a substance’s physiological effects or another medical condition.
There is no mention in the vignette of Jane using drugs or having a medical condition that could account for her symptoms.
* Another mental disorder does not better explain the episode.
While limited information is provided about other possible mental disorders, the psychotic symptoms, for instance, talking to oneself, suggest that a psychotic disorder may not be a better explanation for Jane’s presentation.
* A manic or hypomanic episode does not better account for the symptoms.
There is no mention of manic or hypomanic symptoms in the vignette.
Overall, the symptoms described in the vignette are consistent with a diagnosis of Major Depressive Disorder, Recurrent, Severe, with Psychotic Features. Jane has a history of self-abuse, suicidal ideation, mood swings, and angry outbursts, as well as the recent onset of psychotic symptoms, including disordered thinking and disturbed sleep. These symptoms are causing significant distress and impairment in social and occupational functioning.
Theoretical Models
From a Dialectical Behavioral Therapy (DBT) perspective, Jane’s clinical presentation may stem from her inability to regulate her emotions. DBT focuses on developing skills to manage difficult emotions, improve interpersonal effectiveness, and increase mindfulness (Saito et al., 2020). Integrating vignette content, a DBT therapist may work with Jane to develop strategies for managing her self-harm behavior, such as using distraction techniques and developing a safety plan. The therapist may also work with Jane’s parents to develop a family intervention plan, including psychoeducation on DBT skills and strategies for improving communication and conflict resolution within the family system.
In working with Jane, a DBT therapist would begin by conducting a behavioral assessment to identify specific areas of dysfunction, such as self-injury and mood instability. The therapist would then work with Jane to develop skills to address these areas, such as distress tolerance, emotion regulation, and interpersonal effectiveness skills. In terms of specific interventions, DBT uses various techniques such as mindfulness, emotion regulation, and distress tolerance exercises. For example, Jane might be taught mindfulness exercises to help her become more aware of her emotions and increase her ability to regulate them. Emotion regulation exercises focus on helping Jane to identify and label her emotions, challenge negative beliefs, and develop coping strategies. Interpersonal effectiveness skills could help Jane to improve her communication and conflict resolution skills.
Meanwhile, from a Person-Centered Therapy (PCT) perspective, Jane’s clinical presentation may be conceptualized as a result of her not receiving unconditional positive regard, empathy, and congruence in her early childhood experiences. PCT emphasizes the therapeutic relationship’s importance and creates a supportive and empathic environment for the client (Kelly, 2020). A PCT ...