This Chapter is on Personality Disorders Instructions: Read the case study, The

Question

This Chapter is on Personality Disorders

Instructions: Read the case study, The “Passive” Waitress, on pages 188-190 in the textbook. Then complete the following 5 sections of the diagnostic report.

1. Client strengths: All clients have strengths. What are these client’s strengths and how could they benefit his recovery and continued good mental health?

2. Client limitations: What potential limitations does this client possess in terms of his recovery and continued good mental health?

3. Differentials: List three differentials for each disorder you are considering, why you considered it, and why you rejected it. Your differentials should be rational, not random. For example, do not use Alcohol Use Disorder as a differential when the diagnosis is Major Depressive Disorder. The client should exhibit some symptoms of the disorder you use as a differential, but not enough to qualify for the diagnosis.

4. Diagnosis: List all DSM-V diagnoses and specifiers for the client in the case. Some will have only one disorder, others will have multiple diagnoses.

5. Rationale for diagnosis: Looking at the DSM-V criteria for each final diagnosis you select, provide your rationale for selecting that diagnosis.

****CASE STUDY: The “Passive” Waitress"****

Erica is a 23-year-old single Jewish Caucasian woman who says she’s “devastated” over her recent breakup with her boyfriend and her sudden relocation to Virginia from Florida two months ago. She is currently staying with her sister and her sister’s fiancé in a suburb of Washington, D.C., while she assesses her future. Their relationship is contentious; Erica feels “controlled by her sister,” who she says “nags” her to “clean” around the house and “judges” her when she spends money going clubbing with her new friends instead of on groceries for the household. Erica admits that her sister feels she abuses her hospitality.

Erica graduated from college a year ago with a degree in criminal justice, which is a field she claims to feel “passionate” about. After graduation, Erica spent June in Europe with her father. Upon returning to the United States she began an intimate relationship with a man who had recently been released from prison and needed a place to stay. She allowed him to move into her apartment and paid for his room and board over the summer, using her father’s credit card to pay for their expenses. In early September, upon realizing that the man was cheating on her, she abruptly moved out and came to Virginia because she wanted “to show him that I didn’t care” and because “I wanted to escape.” At the same time, her father cut off her access to his credit card. Currently, her mother is helping her with basic expenses but is threatening to stop supporting her as well. Her sister has given her a deadline of two months to move out on her own.

Erica details a history of unstable relationships and making “unhealthy” choices in her relationships, with men in particular. She had a boyfriend throughout high school, by whom she became pregnant twice (she aborted in each case) and comments that he was similar in character to her most recent boyfriend. She remained emotionally involved in that relationship throughout college. She is puzzled by the men she dates, stating, “I don’t know why I always like the guys that I know my father won’t approve of.” Erica remained sexually active in college, “You know, getting drunk and sleeping with guys I didn’t even know,” but did not have a monogamous relationship with anyone. She has been in “almost daily” phone contact with a young African-American man who lives in New Jersey whom she met two years ago over spring break. Despite admitting that this man “has some problems”—he still lives at home, is in debt, is a heavy drinker, dropped out of college, and never comes to see her (she always drives to see him)—she has strong feelings for him and is considering moving to New Jersey to be near him.

She now holds a part-time job waiting tables at an area bar, for which she receives no health insurance. After one week at her new job, she began dating one of the waiters, a 27-year-old African-American male who has a four-year-old daughter. Erica states that she wants to “take it slow,” yet she is already intensely emotional about the course of the relationship and had sex with him within their first week of dating. She says “she just knows” they are supposed to be together. She worries about what her family will think of these relationships, because they want her to marry a white Jewish man.

Erica grew up in Miami, Florida, the younger of two sisters. Her parents divorced when she was six years old and shared custody of her. She denies any history of sexual or physical abuse. Her father fought her mother over child support for many years, and money is a controlling force in Erica’s relationship with her father. Erica has “many issues” with her father, and her feelings about him tend to shift. When he is financing her lifestyle, he is a “good guy.” When she does something he does not approve of, he cuts off contact with her and she views him as “Castro.” She repeatedly asked the social worker if her father is to blame for her problems.

Erica chose to live with her father and his new wife and stepchildren through most of her high school years, because his rules and supervision were much more lax than those of her mother. She used marijuana heavily throughout high school and began using other drugs (alcohol, ecstasy, cocaine, acid) extensively in college. In her junior year in college Erica started experiencing panic attacks and was unable to attend classes. She was given paroxetine, which she took for six months, and her symptoms alleviated. She said her doctor told her the panic attacks could have been caused by her recreational drug use. She denies current drug use at this time and continues to drink socially. She is no longer taking any psychoactive medications and stated a strong aversion to taking any at this time. She declined to see the staff psychiatrist for a consultation.

Erica describes a close and supportive relationship with her mother. She says she has a similar personality to her mother and that they are both “passive,” although she wasn’t able to provide any details about what this meant. She believes her father resents her because she is so much like her mother. Erica reports that her mother suffered from major depression for over two years after breaking up with a long-term boyfriend and was finally helped through therapy. Her mother is currently remarried and has stepchildren much younger than Erica.

Erica’s mother sent her to therapy numerous times when she was growing up, blaming Erica’s problems on the divorce. Erica has little recollection of the therapy and usually stopped attending after only a few visits. She reports several traumatic events in her life thus far: having a driver on her street pull out a gun at her and her mother while at a stop sign when she was in the fifth grade; allowing gang members to come to a party held at her mother’s house (while her mother was away), which resulted in the house being robbed; and undergoing two abortions while in high school.

Erica says she doesn’t think about these past events in more than fleeting ways, and she doesn’t have bad dreams about them. She recounted the events in detail and did not, in session, seem to be avoiding memories of them. Erica states that while she has thought about “what it would be like if I was no longer here,” she has never had suicidal ideation with a plan or intent to carry it out.

Erica is an intelligent young woman with an engaging and outgoing personality and a good sense of humor. When asked how these traits were “passive,” as she had described herself earlier, Erica wasn’t able to reconcile these aspects of herself. Erica admits to having very low self-esteem and no sense of “who I am” beyond what others identify for her. Her values and goals change from day to day depending on whom she is talking to. She describes herself as “too generous and kind,” but has strong expectations about what she must get in return for her nurturance of others.

Erica states that she has a group of close friends in Florida with whom she maintains contact, but she is reluctant to move back to Florida because of their negative influence on her life (excessive partying). Still, she is bored in Virginia and “just wants to go out and have fun.” She says she goes clubbing with her coworkers most nights after work and likes the restaurant trade for that reason; there is typically an instant social life attached to it. She says she feels bored and empty when she stays home at night and then usually spends her time talking on the phone to the young man in New Jersey or her friends in Florida. She says she feels restless, tense, and “empty” when there is no one in the house and she is alone. Because she doesn’t like feeling this way, she says that she avoids the feelings by being with other people as much as possible and talks on the phone almost constantly when she is by herself. She states that one of the reasons she moved to Virginia is that she didn’t want to live by herself in the apartment after she broke up with her boyfriend.

Erica believes that money would answer all of her problems and yearns for life in college when she could do whatever she wanted and her father paid her expenses. She has little insight into her pattern of behaviors in relationships and seeks therapy hoping that the social worker can advise her “what to do.” Erica identifies “figuring out what I want to do with my life” as her major goal and is also interested in having a “healthy relationship.” Erica has committed to only eight therapy sessions because of her financial situation, and since beginning therapy two months ago she has either missed or rescheduled half her appointments, allegedly due to work conflicts.

Erica completed a Beck’s Assessment for depression and scored a 19 out of 60, putting her in the low-depression range. She denied insomnia, decreased or increased appetite, lack of energy, an inability to concentrate, or recurrent thoughts of death. When asked about episodes of major depression in the past, she said she has sometimes “felt depressed” but can “snap out of it” if she talks to a boyfriend or meets someone new.

Explanation / Answer

1. Clients strengths : In this scenario erica is positive in mind and in the stage of life where she understands her problems. She considers her mother to be similar to her in terms of nature which will help her to come of the depressed situation. Being able to work part time gives her some financial assistance. She understamds her problems and just requires proper therapy.

2. Client Limitations : Unable to concentrate on the aspect of life. Repeating the same mistake again and again after facing social and psychological problems from the men. Having to trust the friends who are not reliable to her is dangerous. Unable to have proper social and financial life mental stability causes to depression in erica.

3. Mood disorder can be seen in client as she is attrached to partying and getting attrached to all kinds of men. Alcohol and drugs also has effet on her personality. Bipolar disorder is seen in erica as she uses alcohol and had taken drugs before. Social anxiety is another disorder in erica, with mental illeness and having to detached from the friends and family.

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