Comprehensive paper Amanda is 22-years-old and was just recently admitted to a p

Question

Comprehensive paper

Amanda is 22-years-old and was just recently admitted to a psychiatric hospital due to self-destructive behaviors. She’s has been cutting herself for the past couple of years, and most recently had another suicide attempt. Her psychiatrist has put her on various anti-depressants and anti-anxiety medications, although there’s been limited success. During the psychiatric interview, Amanda denied any self-destructive behaviors but after the anger dissolved, she soon recounted her fears that she would ever have a stable relationship in tears. At times during her stay, staff would note that she behaved in a flirtatious way and would ask personal questions to the staff. The psychiatrist at the hospital noted that she looked to be appropriate weight for her height and age. One day Amanda’s roommate was talking to the hallway staff and said that she likes Amanda but doesn’t like to listen to her throw up all the time. The staff began to pay attention to this behavior and noticed that Amanda would always go to the bathroom after mealtimes.

            There were many times that she would protest loudly, use obscene and abuse language when the nurses or staff would ask her to wait a moment or couldn’t get to her needs at the very second she requested. These impulsive outbursts were characteristic of Amanda. She would often express anger at an intensity level that was out of proportion. She would late regret what she did, such as yelling at staff or friends (when she wasn’t in the hospital). Despite the negative consequences of these actions and Amanda’s ensuing guilt and regret, she was unable to stop losing control of her anger. Usually after these incidents happen, Amanda would engage in self-harming behaviors.

Amanda became particularly attached to several staff members and arranged one-to-one talks with them as often as possible. She used these talks to flatter and compliment the staff members and tell them that they were one of the few who truly understood her and could help her, and she also complained to them about alleged incompetence and lack of professionalism among other staff members. Some of these staff members Amanda was attached to had trouble confronting her when she broke the rules. For example, when she was late returning from a pass off grounds, it was often overlooked. If she was confronted, especially by someone with whom she felt she had a special relationship, she would feel betrayed and, as if an emotional switch had flipped, would lash out angrily and accuse that person of being “just like the rest of them.”

When Amanda was 4-years-old, her mother and her father divorced. Her father rarely paid child support so her mother had to start waitressing. Although some neighbors occasionally checked in on Amanda and her siblings, they were largely left alone. When Amanda was 13-years-old, her mother remarried a man who had a 14-year-old son, Mike. Because Amanda still secretly hoped that her parents would remarry, she resented the intrusion of her stepfather and stepbrother into the household and was upset when her mother changed their last name. This is when Amanda began to engage in aberrant eating patterns. She went through periods of not eating food, to the point that she would lose significant weight. This only lasted a few years, and then she began getting too much attention for it so she started eating more and then purging her food. This happens in periods of stress.

Soon after her mother and stepfather married, Mike bean sexually abusing Amanda. Mike told her that it was important for her to learn about sex and, after raping her, threated that if she ever told anyone, he would tell all her friends that she was a “slut.” When tis occurred, she had not been sexually active with anyone. This pattern of abuse whenever Mike was living with his father. Even though Amanda was traumatized by the abuse, she felt unable to refuse or tell anyone what was happening.

Amanda’s behavior began to deteriorate. She had been doing well academically but then began to skip classes. Her grades fell precipitously over the course of a semester, and she began spending time with peers who were experimenting with alcohol and street drugs, primarily heroin and cocaine. Amanda became a frequent user of these drugs, even though she experienced some frightening symptoms after taking them. She preferred to use the heroin to help her come down from the cocaine. By the end of the next school year, Amanda’s grades were so poor and her school attendance so erratic that she was recommended for a psychological evaluation to see if she should be help back for a year. Amanda’s IQ was extremely high and did well on all of the other intellectual and achievement tests.

The abuse continued until she was 16-years-old, when her mother divorced her step-father. Right after he left, she had frequent flashbacks and worked to avoid anything that reminded her of Mike. Today she will say that it’s “no big deal” and “she got over it.” She never had any treatment. Amanda also began a pattern of promiscuous sexual activity. She felt guilty for engaging in sex, but, as happened when she was being abused by her step-brother, she was unable to refuse sexual advances, from either men or women. She was particularly vulnerable when under the influence of drugs and would, under some circumstances, participate in sadomasochistic sexual activities. For example, Amanda was sometimes physically abused, such as being punched in the face, by her sexual partners while having sex. She didn’t protest and, after a wile, expected such violence. Even though these activities left Amanda with a sense of shame and guilt, she felt unable either to set limits or break off these relationships.

By the time Amanda was 16-years-old, she never wanted to be alone. She was often bored and depressed, particularly if she had no plans for spending time with anyone else. An important incident occurred at this time, she was cruising in a car with friends, they were pulled over by the police because the car had been stolen by one of her friends. Street drugs were also found in the car. Amanda claimed that she had not known that the car was stolen. The judge who heard the case was concerned about the progressive deterioration in Amanda’s academic performance and social functioning. Amanda was offered a deal; she could either be prosecuted for the charges or go to an inpatient hospital. This was her first hospitalization of many. She showed signs of depression, such as insomnia, psychomotor retardation, sadness, anhedonia, and her purging behavior got worse. She was given antidepressant medication, but as mentioned earlier, this was ineffective. She spent most of her time in the hospital with a male patient. To any observer, their relationship would not have seemed to have a romatic component. They watched TV together, ate together, and played various games that were available on the ward. After only a couple of meetings with him, Amanda had revealed the most intimate details of her life. There was no physical contact or romantic talk. Nonetheless, Amanda idealized him and had fantasies of marrying him. When he was discharged from the hospital and had fantasies of marrying him. When he was discharged from the hospital and broke off the relationship, Amanda grabbed a kitchen knife and began cutting herself. She would make suicide threats over the phone to the former patient and say that if he did not take her back, she would kill herself.

Amanda began individual therapy for the first time, which she thought were helpful, and that the therapist “finally understood her,” until the therapist suggested that her drug abuse, promiscuity, depression, episodes of intense anger, suicide threats, and self-injurious behavior were a function of the sexual abuse she endured as a child. At this time, Amanda became outraged at the therapist and said that the therapist was trying to shame her for her experiences.

What is the presenting problem (i.e., Why is Damion seeking treatment?) 2-3 sentences double spaced.

What is Amanda diagnosis/diagnoses?

Describe the rationale for the diagnosis/diagnoses? (i.e., which symptoms did you identify in the case?) 1-2 paragraphs

What other diagnoses did you consider? What are the reasons you decided against them? 1-2 paragraphs

What other information would you like to know? 1 paragraph

Explanation / Answer

Answer:

The present problem is very major for Amanda and she require proper treatment otherwise she would be in much more trouble, even she may loss her life too.

Amanda is suffering under major depression problem as she faced many tragedy in her life since childhood.

This depression was started since the childhood of Amanda, as she was only 4 years old when her parents got divorced. The episodic depression replay in her life via many situations such as when she raped by her step brother, her mother again divorced by her step father, she took support by heavy dose of drugs, she again hurted by the incident which happened in hospital by the male patient, attempts of self harm in many ways etc.

These are the symptoms which indicates clearly that she is suffering from heavy depression problem.

Now there should be a close watch on her every activity, and try to make her happy and satisfy in every possible way to save her life and regain her from this web.

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