CASE OF CAROL
Carol (age 49) lived in a midsize city, and her husband of 24 years had passed away two years ago after a long battle with cancer. She has one child, a daughter (age 22), who recently moved out of state for a job after living at home while attending college. Carol decided to start a new job, because she had been feeling lonely due to still finding it hard to make new friends after becoming a widow and because she needed the income. She obtained a job as a receptionist in a real estate office. She enjoyed being around the realtors and meeting all the many clients who came to the door.
After short time of working there, Carol had some flowers delivered to spruce up the front office area. A few of the realtors noticed them and asked what the occasion was. Carol blurted out that a friend sent them to her due her recent cancer diagnosis, even though that wasn’t true. The concerned realtors gave her many hugs and words of support. Over the next few days and weeks many of the staff members in the office flooded her with well wishes, cards, and flowers. She also told her daughter the lie about having cancer to maintain the rouse, and her daughter found the news devastating, especially after losing her father to cancer a few years earlier. Carol felt somewhat bad about making her daughter so sad.
As the weeks and months went on, Carol would talk with everyone in the office about her “cancer” and her struggles with chemotherapy. She was able to draw from her husband’s experiences with cancer years earlier to sound believable. She even lost a little weight to make herself look thinner and cut some parts of her hair towards the scalp to make it look as though she was really physically suffering due to the chemotherapy. She also began leaving the office early some afternoons under the pretense of attending medical appointments, but she would sometimes go shopping or to the movies. Other times she would just go home and become bored.
Over time, some of the realtors at Carol’s work began to tire of hearing her long drawn out discussions of her ailing health each time they walked by her desk. They asked her how much longer she would be on chemotherapy, and she gave vague answers along the lines of “as long as it takes.” The realtors also became frustrated by her frequent absences and significantly reduced her hours, which substantially decreased her income.
Even though Carol’s lie resulted in her being resented at work, losing some much needed income, and guilt about her daughter’s sadness, she still pretended to have cancer.
CASE OF ED
Ed (age 38) had lived in multiple states as an adult. He had few connections with family, and found moving to a new state to be beneficial, because a new residence made it harder to track his prior criminal record, which was extensive. He had two criminal convictions for physical assault during his early 20’s, for which he received four months and six months non-consecutively in prison. He described those incidents to the social worker in prison as “bar fights.” His other criminal charges included two DUI’s, two petty thefts, one grand larceny theft of jewelry, and one for domestic violence. For the first DUI he was mandated to pay a fine and undergo treatment, and for the second DUI’s license was revoked for a year, but he continued to drive. The grand larceny charge was dropped due to questions regarding evidence tampering, and for the domestic violence charge, he pled guilty to a lesser offense in exchange for treatment instead of prison time. Plus, Ed typically worked as a mover, which made it easy for him to find jobs wherever he lived.
However, Ed’s most recent charge was for vehicular homicide after running over his girlfriend with his car in a grocery store parking lot in the midst of a heated argument. They had been fighting in his car, and he struck her with his car after she got out and began walking away. The incident left his girlfriend in a coma until she died three days later. He sustained no injuries in the incident. He attempted to drive away and flee the scene, but he was caught and stopped by police.
Ed was held in jail due to not having the $50,000 bond, and he became irate when his court-appointed attorney informed him that his girlfriend had died of her injuries. He knew that he was facing serious prison time of up to 30 years if he was found guilty of vehicular homicide. Ed then punched the wall so hard that he had to receive medical care at the jail for his bruised and bleeding hand. During his next visit with his lawyer, he explained that he was not responsible for his actions, because a voice had told him to run over his girlfriend. The social worker at the jail later went to check on Ed due to his injured hand and observed that he put his foot in the toilet bowl and began talking to no one.
A psychological evaluation was ordered, and Ed’s presentation was confounding. He gave incorrect answers to very basic questions. For example, when asked the name of the first president of the United States, he stated, “Mark Twain.” When asked to add 3+5, he said, “four.” He claimed to have visions of gigantic flying rats sometimes. When asked about the voice that he said had told him to run over his girlfriend with his car, he stated, “The voice is named 2-Z, and it tells me to hurt people, like my girlfriend.” He then went on to inquire about his girlfriend’s whereabouts and when she would come to visit him. When the psychologist asked him how he had injured his hand, he stated that it happened during a fight with another inmate. At the conclusion of the interview, he asked the psychologist what she would write about him in her report.
CASE DISCUSSION QUESTIONS
Use the DSM-5TR and information from the case studies to respond to the following questions on somatic symptom disorders and malingering.
Formulate a diagnostic impression for Carol with coding and specifiers from the DSM-5TR. Explain your answer in terms of how she meets diagnostic criteria for factitious disorder.
Formulate a diagnostic impression for Ed with coding and specifiers from the DSM-5TR. Explain your answer in terms of how he meets diagnostic criteria for the disorder or disorders that you gave. As you do so, pay close attention to whether a V code instead of a diagnosis is warranted.
What were your differential diagnoses for Carol and Ed, and what was your reasoning for ruling them out?
What are the similarities and differences between Carol and Ed’s disorders?
Discuss at least two important reasons to assess for malingering when working with forensic populations.
If you were a therapist in these cases, what therapeutic modality/modalities would you use to treat Carol and Ed’s conditions? Use 1-2 scholarly sources to support your answer. You may choose theories such as cognitive-behavioral, person centered, family systems or any others you are familiar with. If you have not taken a theories course, please choose one from the above list.
Paper Requirements
3-4 pages of content (not including title page and reference page)
Double-spaced, 12-point font, 1-inch margins
Citations and a list of references
APA format throughout
