3a. Suggest another possible diagnosis for Magenta C. Identify several of Magent

Question

3a. Suggest another possible diagnosis for Magenta C. Identify several of Magenta C.’s symptoms that would lead you to this alternative diagnosis. (5 points)

3b. What are the implications of attaching a second diagnosis to the same set of symptoms using the DSM-IV? Would this be a criticism of the DSM-IV? Explain your answer. (7 points)

The Case of Magenta C Magenta C. is a 21-year-old college student studying art history at a college in a major U.S. city She had maintained an almost perfect GPA up until about 3 months ago, at which point she started to lose focus and neglect her responsibilities as a student. She sought the help of a therapist after realizing that she could no longer keep up with the demands of her schedule and, consequently, was unable to "do hat needed to be done for peace of mind. Magenta C. lived at home with her mother, and was employed at her university's bookstore as a part-time cashier. She came from a working-class family. Her parents separated when she was a child. leaving. She last saw her father at her sister's funeral. He has made little effort to contact her or her mother, and has only spoken with her once since leaving-which was on her 16th birthday. She remembers as a child how she used to convince herself that her father would return by the time she counted to 20. She used to wake up every morning and count to twenty to see if he would then return. If she didn't count in the morning, she would feel anxious and uneasy that day at school, wondering if he would have come back that day had she remembered to count. Magenta C.'s only sibling, Maria, died 5 years ago at the age of 14 after being hit by a drunk driver while riding her bike with Magenta C. on the side of the road. Magenta C. describes this incident ividly, and recalls her most recent flashback of the event with great detail and emotion. She expresses a feeling of guilt for having survived rather than her sister. Today, Magenta C. is no longer able to ride a bike anymore, and says that the flashbacks are a constant reminder that "her life could be taken at any moment" Magenta C. was extremely thin. During her intake interview she sat rigidly in her chair with her hands tightly folded, and she maintained an expressionless gaze and tone of voice. She had stated that he and her boyfriend, Kevin, had just terminated their relationship after several years of being together. The relationship was described as one with extreme emotional turmoil. Magenta C.'s mother did not seem to like Kevin, and was very cold and aloof whenever he came to the house. Whenever Magenta C. had talked about the possibility of marrying Kevin, her mother responded by saying how tired she was and how Magenta C. needed to stay at home so she could take care of her mother. Magenta C. felt torn between her mother and Kevin. She has had frequent crying spells over the last few months and has had great difficulty falling asleep at night. She feels that her lack of general interests may be contributing to her poor performance in school

Explanation / Answer

3a. The above mentioned case of Magenta C with her given symptoms suggest the possible alternate diagnosis of an acute onset of post-traumatic stress disorder since the duration of symptoms is less than 3 months. She presents with the following symptoms which are suggestive of acute post-traumatic stress disorder (PTSD):

- Magenta lost her only sibling Maria 5 years ago to an accident which she too was a part of. This is a traumatic stressor that involved a perceived threat to her life as well as her sister's.

- Magenta C can still recall the event vivdly with great detail and pain hence she has recurrent and intrusive recollection of the event.

- Magenta C describes painful guilt feelings about surviving and her sister not surviving. This is the 'survivor's guilt'. Here Magenta believes that it is unfair that she survived and her sister didn't.

- She is no longer able to ride a bike anymore because it brings back memories of the stressful event and hence she tries to avoid using any bike.

- Magenta C has difficulty falling asleep, difficulty concentrating, and lack of interest in significant activities which are symptoms of hyperarousal.

- She has just terminated her relationship with her boyfriend Ken which is describes as one with extreme emotional turmoil. This may be because of "emotional anesthesia" which began soon after the traumatic event. Magenta may be experiencing reduced ability to feel emotions especially those associated with intimacy, tenderness, and sexuality.

- Magenta is extremely thin this may be suggestive of loss of appetite which is a symptom of PTSD.

3b. Individuals suffering from post-traumatic stress disorder may also present with other mental health problems such as clinical depression, general anxiety disorder such as panic disorder, somatisation, chronic pain and poor health.

The DSM-IV diagnosis of PTSD requires that the symptoms have persisted for atleast 1 month. In the first month after the trauma, trauma survivors may be diagnosed as having acute stress disorder according to DSM-IV, which is characterised by symptoms of PTSD and dissociative symptoms such as depersonalisation, derealisation and emotional numbing.

In Magenta C's case she has already experienced multiple traumatic events such as seperation from her father at the age of 9. This has left a profound effect on her, she appeared to be very attached to him and may have become severely depressed after the incident. Since this was a stressful event during her childhood and she had trouble coping with the painful loss of her father, this must have led to depression.

Many symptoms of depression overlap with the symptoms of PTSD. For example, with both depression and PTSD, one has trouble sleeping or concentrating. One may not feel pleasure or interest in things, or may not want to be around with other people as much. Hence it is possible to have both PTSD and depression at the same time. These may be implications of attaching an alternative diagnosis in the above case.

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