Respond to at least two colleagues in the following ways:
Explain whether you agree with your colleague about the potential effects of labeling an individual with a personality disorder.
Explain how to engage in trauma-informed treatment with this client given the effects of trauma identified by your colleague.
Katie Paro
Week 11 Case Diagnosis: Case of Cathy
COLLAPSE
F60.3 Borderline Personality Disorder
F14.10 Stimulant use disorder, mild, cocaine
Z62.810 Personal history (past history) of sexual abuse in childhood
Z62.820 Parent-child relational problem, parent-biological child
Cathy has a history of unstable and intense personal relationships (A2) that fluctuate from positive to negative. She expresses love for her siblings, with simultaneous frustration and anger toward them. She has unstable self-image or sense of self (A3) as she states she has never felt as important as her siblings. Cathy demonstrates self-damaging impulsivity (A4) including promiscuous sex, substance use, and spending money. Cathy demonstrates affective instability (A6) as she presents as dysphoric, also having ongoing feelings of anxiety and depression. Cathy has had chronic feelings of emptiness (A7) and recurring suicidal threats (A5). Cathy’s behaviors are aligned with six of the symptoms for borderline personality disorder, which meets the five-symptom diagnostic criteria (American Psychiatric Association, 2022a).
Cathy uses cocaine in larger amounts (A1), craving or strong desires to use cocaine (A4), and recurrent stimulant use in situations in which it is physically hazardous (A8), as she uses it to enhance work performance and during caretaking for her mother. Cathy shows three symptoms which constitute a mild cocaine use diagnosis (American Psychiatric Association, 2022b).
Differential Diagnosis
Initially I considered F07.0 personality change due to another medical condition due to Cathy’s herpes but eliminated this, as this diagnosis requires evidence of a direct pathophysiological impact from a previous condition (American Psychiatric Association, 2022a) which was not evident. Cathy was showing symptoms of personality disorder before her herpes diagnosis during adolescence, which is often when personality disorders begin to develop (Morrison, 2014). I also considered major depressive disorder but ruled this out because, while Cathy says she feels depressed and always felt empty as a teenager, there are not enough evidence to suggest her depressive symptoms are not related to substance use (Morrison, 2014).
Diagnosing Personality Disorders – Impact on Treatment
Ferguson (2016) suggests that borderline personality disorder can often lead to barriers to treatment given the nature of interpersonal challenges. Stigmas, fragmented services due to comorbidities, and presence of trauma can also impact one’s treatment (Ferguson, 2016). Interventions would better serve individuals with personality disorders if variations in developmental levels were considered, as this is often overlooked in treatment (Cicchetti, 2014).
Power and Privilege Influencing Personality Disorder Diagnoses
Even when the symptoms of trauma or documentation of resulting conditions are present, the systems have the power to dismiss or silence the individual (Ferguson, 2016). Gender power may also be relevant, as women are more likely to be diagnosed with borderline personality disorder (Ferguson, 2016) even though the DSM-5-TR does not indicate that there is a major difference in prevalence between men and women (American Psychiatric Association, 2022a).
Trauma Impact
Complex trauma often accompanies personality disorders, and early abuse can lead to the development of borderline personality disorder later in life (Ferguson, 2016). Cathy was sexually abused by her father as a child. This may have contributed to her borderline personality disorder development (Ferguson, 2016).
References:
American Psychiatric Association. (2022a). Personality disorders. Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
American Psychiatric Association. (2022b). Substance-related and addictive disorders. Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Cicchetti, D. (2014). Illustrative developmental psychopathology perspectives on precursors and pathways to personality disorder: Commentary on the special issue. Journal of Personality Disorders, 28(1), 172–179. doi:10.1521/pedi.2014.28.1.172
Ferguson, A. (2016). Borderline Personality Disorder and Access to Services: A Crucial Social Justice Issue. Australian Social Work, 69(2), 206–214. https://doi.org/10.1080/0312407X.2015.1054296
Morrison, J. (2014) Diagnosis made easier: Principles and techniques for mental health clinicians (2nd ed.), New York, NY: Guilford Press.
Brandon Thornton
Week 11
COLLAPSE
Diagnosis
(F60) Paranoid Personality Disorder
(F43.8) Other Specified Trauma- and Stressor-Related Disorder
Cathy has a very complicated case, and there I spent hours trying to determine her diagnosis. I chose Unspecified Personality Disorder as Cathy’s first diagnosis. I will explain later how I was able to rule out other potential diagnoses. Unspecified Personality Disorder applies to a diagnosis which causes clinically significant distress, but does not meet the full criteria for any of the disorders in the personality disorders diagnostic class (APA, 2022). I had trouble classifying any of the diagnoses in the DSM-5 TR, but still recognize enough symptoms for the Unspecified Diagnosis. I also chose the diagnosis of Other specified Trauma and stressor-related disorders. This disorder applies to presentations in which symptoms of trauma and stressor-related disorders that cause clinical significant distress but do not meet the criteria for any other traumatic disorder (APA, 2022).
Differential Diagnosis:
I considered Paranoid Personality Disorder because Cathy seemed to meet the criteria. She met criteria A, which is having pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent (APA, 2022). Cathy has suspicion, without good reason, that others are exploiting her. Cathy seems to think that her siblings are not helping with the care of her mother because they all have children. This seems to be her own assumption, and there is little evidence that this is their true intention. Cathy also holds personal grudges towards her roommate and her siblings, which meets criteria for PPD (APA, 2022). Other than these two criteria, I could not justify the diagnosis. She does not report unjustified doubts of loyalty, or trustworthiness. She does not describe any attacks on her reputation. I also considered the diagnosis of PTSD due to her past sexual assault. Cathy was directly affected by a sexual assault when she was a child. She has also had recent memories of her traumatic event. Outside of these two diagnoses, I could not justify this as a diagnosis. She did not meet any criteria for C, or D.
How PD may Affect Treatment:
When treating a client with PD, there are two main treatments. The first is psychosocial treatment and pharmacotherapy. Psychosocial treatment is recommended as the primary treatment for personality disorders. The reason for a psychosocial approach before a medication approach is because PD form from a complex interaction between genetic determinants and developmental processes. The pharmacological approach in treating personality disorders is that behavioral traits associated with personality disorders might be associated with neurochemical abnormalities (Bateman et al., 2015).
Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorders:
Personality Disorders come with a certain level of stigma. Some PD’s such as antisocial personality disorder, are more frequently diagnosed in men. Others such as borderline, histrionic, and dependent personality disorders are diagnosed more frequently in women. Women may be more likely to seek clinical assistance than men, which may be why they are more likely to be diagnosed by PD, but there is no real clinical evidence (APA, 2022).
Trauma in the case:
Trauma is a recurrent theme in Cathy’s case. She admits that she was sexually assaulted when she was young, and has been feeling triggered sense her recent situation with her roommate. This is the reason I gave her the diagnosis of Other Specified Trauma. I do not think there is enough evidence at this point to give her a diagnosis of PTSD, as I stated above, but it is still relevant to her case.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr. American Psychiatric Association Publishing.
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735–743. https://doi.org/10.1016/s0140-6736(14)61394-5
Katie Paro
Week 11 Case Diagnosis: Case of Cathy
COLLAPSE
F60.3 Borderline Personality Disorder
F14.10 Stimulant use disorder, mild, cocaine
Z62.810 Personal history (past history) of sexual abuse in childhood
Z62.820 Parent-child relational problem, parent-biological child
Cathy has a history of unstable and intense personal relationships (A2) that fluctuate from positive to negative. She expresses love for her siblings, with simultaneous frustration and anger toward them. She has unstable self-image or sense of self (A3) as she states she has never felt as important as her siblings. Cathy demonstrates self-damaging impulsivity (A4) including promiscuous sex, substance use, and spending money. Cathy demonstrates affective instability (A6) as she presents as dysphoric, also having ongoing feelings of anxiety and depression. Cathy has had chronic feelings of emptiness (A7) and recurring suicidal threats (A5). Cathy’s behaviors are aligned with six of the symptoms for borderline personality disorder, which meets the five-symptom diagnostic criteria (American Psychiatric Association, 2022a).
Cathy uses cocaine in larger amounts (A1), craving or strong desires to use cocaine (A4), and recurrent stimulant use in situations in which it is physically hazardous (A8), as she uses it to enhance work performance and during caretaking for her mother. Cathy shows three symptoms which constitute a mild cocaine use diagnosis (American Psychiatric Association, 2022b).
Differential Diagnosis
Initially I considered F07.0 personality change due to another medical condition due to Cathy’s herpes but eliminated this, as this diagnosis requires evidence of a direct pathophysiological impact from a previous condition (American Psychiatric Association, 2022a) which was not evident. Cathy was showing symptoms of personality disorder before her herpes diagnosis during adolescence, which is often when personality disorders begin to develop (Morrison, 2014). I also considered major depressive disorder but ruled this out because, while Cathy says she feels depressed and always felt empty as a teenager, there are not enough evidence to suggest her depressive symptoms are not related to substance use (Morrison, 2014).
Diagnosing Personality Disorders – Impact on Treatment
Ferguson (2016) suggests that borderline personality disorder can often lead to barriers to treatment given the nature of interpersonal challenges. Stigmas, fragmented services due to comorbidities, and presence of trauma can also impact one’s treatment (Ferguson, 2016). Interventions would better serve individuals with personality disorders if variations in developmental levels were considered, as this is often overlooked in treatment (Cicchetti, 2014).
Power and Privilege Influencing Personality Disorder Diagnoses
Even when the symptoms of trauma or documentation of resulting conditions are present, the systems have the power to dismiss or silence the individual (Ferguson, 2016). Gender power may also be relevant, as women are more likely to be diagnosed with borderline personality disorder (Ferguson, 2016) even though the DSM-5-TR does not indicate that there is a major difference in prevalence between men and women (American Psychiatric Association, 2022a).
Trauma Impact
Complex trauma often accompanies personality disorders, and early abuse can lead to the development of borderline personality disorder later in life (Ferguson, 2016). Cathy was sexually abused by her father as a child. This may have contributed to her borderline personality disorder development (Ferguson, 2016).
References:
American Psychiatric Association. (2022a). Personality disorders. Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
American Psychiatric Association. (2022b). Substance-related and addictive disorders. Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Cicchetti, D. (2014). Illustrative developmental psychopathology perspectives on precursors and pathways to personality disorder: Commentary on the special issue. Journal of Personality Disorders, 28(1), 172–179. doi:10.1521/pedi.2014.28.1.172
Ferguson, A. (2016). Borderline Personality Disorder and Access to Services: A Crucial Social Justice Issue. Australian Social Work, 69(2), 206–214. https://doi.org/10.1080/0312407X.2015.1054296
Morrison, J. (2014) Diagnosis made easier: Principles and techniques for mental health clinicians (2nd ed.), New York, NY: Guilford Press.
