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ChiefRook3281
Review the case study of Alice and ask the bullet points. Be sure…
Review the case study of Alice and ask the bullet points. Be sure to provide research citations to support answers.
What differential diagnostic possibilities does Alice’s case suggest, and what are your choices of DSM-5 and ICD-9-CM (or ICD-10) diagnoses?
Justify the reasons for your choice of diagnosis or diagnoses, including the final selection(s).
Evaluate the effects of client data sources on the diagnostic reliability and validity.
Assess the role of family determinants in Alice’s presentation using the theoretical orientation of your choice.
Argue the pros and cons of keeping the selected diagnosis in an upcoming DSM.
Case Study:
Alice, an 18-year old college freshman, is accompanied to your office by her worried working-class parents who were verbally coerced into bringing her by their oldest son “who is a college graduate and knows stuff.” Alice is quite thin and at five-foot-six she weighs only about 110 pounds. She has dropped out of school because she is confused by two voices who have been talking about her behind her back for the past six weeks. They sound like “parents” but not her own “because they both sound female.” The voices comment critically on her performance in almost everything she does, “good or bad,” but particularly when she is around males who look as if they may be interested in dating her. You learn that she has never been on a date because her parents wanted her to be an adult before she “even thought about it.” Alice cannot identify who is talking. The voices are clearly not internal thought processes; she hears them even when there is no one near. This is the second period of time she has heard the voices, and the fact that they have returned frightens her most of all.
Alice is aware that she was depressed for at least the month prior to the onset of the voices and probably for at least the last few years “in some fashion or other.” Remarkably, she lost fifteen pounds between six and eight weeks ago, and started sleeping about fifteen hours a day, much as she had done five months earlier during the summer. Usually, seven hours of sleep is typical for her. Her sleep has again returned to “normal.” Her parents, though, are particularly worried because prior to hearing the voices Alice had been highly fatigued and very slowed down in everything thing she did, “in her thoughts, the way she walked, and even in her speech.” They wondered for awhile if she had suffered a stroke, but the slowness disappeared about a month ago and her energy level returned to normal “just before the voices started talking to her again.” The first time Alice heard the voices and thought her mother wanted to kill her was about six months earlier, as she was finishing high school. This was followed by a summer of depression before Alice started college. During that last summer, about six months earlier, she could barely get out of bed, could not concentrate, always felt tired, and had begun thinking about suicide, although she insists she would never do that because of her faith.
While hesitant to mention it, Alice’s mother eventually asks if you think Alice could be possessed. You learn that the family belongs to a small evangelical church, and that their pastor recently wanted to exorcise Alice. It was only at the very adamant insistence of this couple’s son that they have come for this psychological assessment, “before we turn this over to the Lord.” But Alice’s father is not so sure if even that is the right course “because Alice has been carrying her Bible everywhere and Satan would not let her do that.” He thinks something else may be going on, which is why he finally agreed to see you, but he is still unsure. The couple argue gently about the meaning of Alice’s voices, and you learn they are torn about being here today because their pastor has told them that “the ways of Satan are seductive” and forcefully tried to talk them out of coming to see a psychologist “who does not know the ways of God and who might make things worse with his false science.” The family would like you to interview their pastor to help clarify these issues.
When you speak to Alice alone she tells you that she is certain her mother wants her dead or locked up, and that the voices have been whispering, cajoling, telling her that she should strike first before her mother harms her. She vows that she will not harm her mother and indicates that she knows her mother only wants the best for her. “But maybe I should be locked up,” she explains, “because of the thoughts I have been having. At night, I feel hands on me and I get . . . you know . . . turned on the way good girls should notnot even when they are married.” You learn that her parents believe that sex is evil and should only be used for procreation. Alice then tells you that she was hospitalized for depression when she was sixteen, but that her parents took her out of the psychiatric unit at the urging of their pastor and against the psychiatrist’s advice before she was stabilized her on medication. She smiles weakly, and says, “Everyone prayed and I got betterkind of.”
Developmental signs all fall within the norm. A thorough medical evaluation completed just two weeks earlier by the family doctor indicates that Alice has no medical concerns. She takes no medications, does not drink or use street drugs, and has no recollection of any head injuries or exposures to toxic substances. Family history is remarkable for a paternal uncle who died in a state hospital where he had lived for years because he believed the FBI was after him and because he could not stop getting in fights with people he “knew” were following him. One of her mother’s sisters “who does not belong to the same church” has been treated for depression, and another uncle, as well.
