In this assessment, I’ll be asking you to apply what you’ve learned to several brief case studies. I’d like you to identify the most likely diagnosis for each case, along with a rationale to support

For each of the following cases, answer these questions:

What is the most probable diagnosis?

Why? Which symptoms of this disorder are present? Which are absent?

What further information would help you ascertain if this were the correct diagnosis? Name at least two, and how they would help.

Would you add any specifiers? If so, which would you choose and why?

Which conditions that the DSM-5 recommends for a differential diagnosis list would you need to consider? And why?

1. Lawrence, age 43, was a native of a large urban area who was on his way home from work via the subway one evening when “the event”, as he calls it, occurred. While waiting for his train on a crowded platform, two people started arguing and pushing each other about five feet away from him. The fight escalated with punches being thrown and bystanders being pushed out of the way. One of those bystanders fell into Lawrence, knocking him to the ground and twisting his knee in the process. He was near the edge of the platform at the time, and his head and shoulders were hanging over the edge right as the train pulled into the station. Fortunately, the woman who fell into him was able to pull him back onto the platform, but for a brief moment he was staring at a train barreling towards him.

Lawrence’s knee suffered torn ligaments and required surgery. He had to take sick leave from his job to accommodate the surgery and immediate rehabilitation, and so he was at home by himself for a while. His mood deteriorated during this time alone, as he is a social person and missed seeing his friends and coworkers. Some came to visit him, which he welcomed at first but he found himself becoming irritable with them, so much so that they stopped coming. He also found his thoughts turning increasingly to the event, and the things he should have done to prevent his injury.

Lawrence reported difficulty sleeping – his pain medication helped with his knee pain, but the discomfort was always there. His fatigue seemed to darken his mood further, and the thoughts about the event became more and more intrusive. Soon his sleep was further impaired by frequent dreams of the train that had nearly killed him. These dreams were so upsetting that he would wake up in a sweat and have difficulty getting back to sleep.

When he was cleared to return to work three weeks later he found himself unable to take the train – he “wanted nothing to do with that” platform where he nearly died. Just thinking about the train causes his immense distress. He does not have a car, so he tried taking cabs to and from work, but the expense of doing so led him to abandon that strategy. He’s currently using all of his accrued vacation time so he can stay away from the train, though he knows that is soon to come to an end. Now, six weeks removed from the event, he doesn’t know what to do and is contemplating quitting his job.

2. Roberta is a female high school student in her late teens. Upon arriving at a new high school, she appears to be fairly normal in behavior. However, it is apparent from early on that she has almost no social relationships, or even more, a desire to have any. Aside from a relationship with her parents, who appear supportive and loving, she only has one other relationship which she cares about: her boyfriend Carl. Her parents say there is no past mental health history in their families, though they note that Roberta has had some periods of seeming down and withdrawn. No major drug or alcohol use is apparent. There are no outward health problems visible. She is a very intelligent girl and is described as having a “very strong-willed personality.” Unfortunately, she does not seem to care too much about asserting that intelligence towards any goals. School is in no way important to her.

Although Roberta is generally able to living and function normally, she has a past history of suicidal behavior (no attempts, but some ideation has been reported). She appears to be a fairly friendly person, but is occasionally irritable with others. At times she seems to think that she should do and be able to do whatever she wants whenever she pleases. For example, she became quite frustrated when she wanted to get ice cream at midnight one weekend, and insisted that she and Carl go to the local ice cream shop. He assured her it would be closed, but she insisted on going anyway. Once they got there it was indeed closed, and her frustration bubbled over into banging on the doors and windows, yelling to be let in. Carl was able to calm her down, but was troubled by what he saw. This went far beyond the “strong-willed” irritability he had previously seen.

Roberta stayed home from school over the next few days, calling herself in as sick without her parents’ knowledge. During this time she worked furiously in her bedroom, rarely coming out even for meals. In the few interactions her parents had with her, she seemed to be both quite happy with whatever she was doing (she kept it a secret) and annoyed at questions or efforts to draw her out. A few days later Roberta stole her parents’ credit card and ordered a dozen

refrigerators from a local appliance store. When her parents discovered this they confronted her and demanded an explanation. She excitedly told them about her own plan to develop a 24-hour ice cream shop which she would operate out of their garage, speaking in such a rapid-fire manner that she sometimes struggled to catch her breath. Throughout the conversation she was extremely animated and dismissive of the reservations and objections her parents raised, eventually becoming angered by their lack of support. When her parents informed her they were cancelling the order, she stormed off, drove to Carl’s house, and asked tomove in with him. Carl, who had only been dating Roberta for two months and was also living at home with his parents, was taken aback. This seemed like a different Roberta than the one he had been dating.

Roberta’s parents brought her home and arranged for her to see a physician, as they were now convinced something was wrong. They couldn’t get her in right away, but felt they could manage her until the next available appointment (three days later). By that time, Roberta’s mood had changed and she seemed a bit more “like her old self.” The doctor ordered some routine bloodwork and made a referral to a psychiatrist for further evaluation.

The psychiatrist was unable to see her for a month, during which time her stability wavered again. She once again withdrew into her room, but refused to come out at all. She mostly slept, and would not talk to her parents despite their best efforts to find out what was wrong. She barely ate, and would not shower or bathe. Her parents could occasionally hear her sobbing, but when asked she denied being sad. During this time she felt a constant emptiness, and this purposelessness frequently led her thoughts to ending it all.