Diagnosis Assignment Two
Diagnosis Assignment Two
He is experiencing an overwhelming sense of guilt due to the traumatic events symptoms.
He is manifesting nightmares and rumination of traumatic incident.
Peter is expressing having irrational thoughts.
He is having challenges in his daily living functions such as marital issues and job performance. Also experiences physical symptoms such as sweating.
Rational for the order in which issues were prioritized.
The rationale for this order selected was based on the severity of the challenges. This counselor’s opinion is that the most important challenges are to keep Peter cognition to differentiate rational from irrational thought after this traumatic event. Once he is able to differentiate he will be able to generalize those skills increasing his job productivity and improving family relationship.
Most important features and why?
The first three issues are the most important because Peter is having challenges in his performance at work and in his marriage due to his cognitive challenges.
Outcome of Treatment
Assist Peter in returning to the level of psychological functioning prior to exposure to the traumatic event. Also, that Peter no longer avoids persons, places or activities that are reminiscent of the traumatic event. Lastly, Assist Peter in eliminate or reduce negative impact trauma related symptoms that this event has on his occupational and family functioning. (Jongsma, Peterson, ; Bruce, 2014, p. 329).
Client’s Key Issues List
Peter order of priority might be different that the one listed in the key issues by the clinician. Peter can rearrange his priority order and provide the following list to the clinician. For instance:
Guilt he has always felt
Nightmares after the accident
Job challenges due to traumatic event
Marital challenges that arose due to the discussions.
This clinician will work in a collaborative manner with client’s priorities.
This counselor will try to obtain more information Peter’s guilt history and his family’s history. Especially, a spiritual assessment of the client will of great help to understand the client better and provide assistance.
II. Diagnostic Impressions
Based on the assessment of Mr. Peter and the information provided by him my clinical diagnosis would be that Mr. Peter is suffering from a Posttraumatic Stress disorder (F43.10). Mr. Peter exhibits features consistent with this disorder as it will be described as follows.
Our case study does not go into many details that are necessary to provide a diagnose, but reality is that clinician will not have all the details in every case.
The diagnosis criteria for Posttraumatic Stress Disorder applies to adults, adolescents and children over 6 years old.
Criteria A states that client exposure to actual or threatened death, serious injury or sexual violence in one or more of four ways. Number 1 Applies to Peter. Directly experiencing the traumatic event.
Criteria B Presence of one or mote of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: Number 2 Applies to Peter. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Criteria C Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following: Number 2 applies to Peter. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Criteria D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: Numbers 3 and 4 apply to Peter. 3. Persistent, distorted cognitions about the cause or consequences or the traumatic event(s) that lead the individual to blame himself or others. 4. Persistent negative emotional state (e.g., fear horror, anger, guilt, or shame).
Criteria E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence but two (or more) of the following: Numbers one and six apply to Peter. 1. Irritable behavior and angry outburst (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 6. Sleep disturbance.
Criteria F. Duration of disturbance (Criteria B, C, D, and E) is more than a month. Peter has been experiencing all of these for over six weeks.
In addition, Z-codes: Z63.0 Relationship distress with spouse or intimate partner. Z56.9 Other problem related to employment.
Other Co-occurring disorders
Even though as stated in the American Psychiatric Association, (2013) “individuals with PTSD are 80% more likely that those without PTSD to have symptoms that meet criteria for at least one other mental disorder” (p. 280). This clinician cannot find another diagnosis that applies to Peter at this time. Clinician reviewed all differential diagnosis listed and do not count with enough information to add another diagnosis to Peter’s case.
Rationale for diagnostic impressions.
The rationale for this diagnostic impression was based on the thorough review that this counselor did of the DSM 5 in which client meets criteria explained before.
Establish rapport with Peter towards building a therapeutic alliance (Jongsma, et al., 2014, p. 329).
Administer or refer Peter for administration of psychological testing or objective measures of the PTSD symptoms and/or other comorbidity such as Minnesota Multiphasic Personality Inventory – 2. (Jongsma, et al., 2014, p. 330).
Assess Peter for the presence and degree of substance abuse or dependence and depth of depression and suicide potential and treat appropriately (Jongsma, et al., 2014, p. 330).
Refer Peter for psychiatric evaluation to assess the need for psychotropic medication.
Discuss with Peter how PTSD results from exposure to trauma; results in intrusive recollection, unwarranted fears, anxiety, and a vulnerability to other negative emotions such as shame, anger, and guilt; and results in avoidance of thoughts, feelings, and activities associated with the trauma (Jongsma, et al., 2014, p. 332).
Teach Peter calming skills such as breathing, relaxation and calming self-talk.
Peter will participate in cognitive processing therapy to process the trauma and reduce its impact. In which, Peter will be taught about the relationship between thoughts, behavior, and emotions associated with the trauma (Jongsma, et al., 2014, p. 333).
Peter and his wife will participate in conjoint and/or family therapy to facilitate healing of hurt caused by Peter’s symptoms of PTSD (Jongsma, et al., 2014, p. 338).
Peter will participate in a support group for trauma at church or lay counseling that will support him and his family during this time of crisis (Clinton ; Hawkins, 2011).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Clinton, T. E., ; Hawkins, R. E. (2011). The popular encyclopedia of Christian counseling. Eugene, OR: Harvest House Publishers.
Jongsma, A. E., Peterson, L. M., ; Bruce, T. J. (2014). The complete adult psychotherapy treatment planner. Hoboken, NJ: Wiley; Sons, Inc.