Discussion: Personality Disorders

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Please review “The Mr. Wilson” (no not family—Smile)  and consider your differential diagnostic process for her. Be sure to consider any past diagnoses and what influence they might have on her current diagnosis and needs. Finally, return to the Week 1 Discussion topic of stigma and reflect on stigma related to personality disorders.

By Thursday night, Please post a 300- to 500-word response in which you address the following:

  • Provide the full DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention).
  • Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis
  • Support your decision by identifying the symptoms which meet specific criteria for each diagnosis.
  • Identity any close differentials and why they were eliminated. Concisely support your decisions with the case materials and readings.
  • Explain how diagnosing a client with a personality disorder may affect their treatment.
  • Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorders.
  • Identify how trauma affects the case, either precipitating the diagnosis and/or resulting from related symptoms or treatm  

CASE OF MR. WILSON

Intake Date: May 2019

DEMOGRAPHIC DATA:

This is a voluntary intake for a 33-years-old Caucasian, Protestant male. Mr. Wilson has had several psychiatric hospitalizations in the past. He has been married for 8 years and has been separated from his wife for the past ten months. He initially moved in with his parents but recently moved to his own place for the past five months.  His wife lives two blocks from him. Mr. Wilson has had difficulty in jobs and has not been at any job longer than two years.

CHIEF COMPLAINT:

"I miss my wife and do not want to live if I have to live without her".

HISTORY OF ILLNESS:

Mr. Wilson reports first seeking psychiatric treatment when he was seventeen years old. He was prescribed anti-depressants but does not remember what kind. The anti-depressants worked well for his depressed mood, so he remained on anti-depressants for three years until he believed he did not need them anymore since things started changing for him. He was feeling much better, happier, freer, able to get out there and conquer the world. At 21, he began drinking. His chemical use increased in his early twenties when he began using cocaine and amphetamines. His use of alcohol and pills continued throughout his late twenties. At twenty-nine-years-old, he attempted suicide after his wife left for the first time. He was hospitalized in a psychiatric unit for thirty days where he was also treated for drug and alcohol addiction. At this time, he became involved with AA and NA few a short period of time. After the reconciliation with his wife, their financial difficulties, which existed from the start of the marriage, continued. At that time, Mr. Wilson was put on Depakote with continued successful results three years.

Mr. Wilson reports being in a car accident six months ago where he hurt his back and was prescribed Oxycontin. He began using the medication more often than prescribed. Shortly after the accident, he began using other medication once in a while that he would obtain from friends, such as Klonopin. He decided to return to self-help meetings to end this behavior, but it did not last long because he felt uncomfortable.

In December 2018, Mr. Wilson returned to his psychiatrist because he was becoming depressed again, feeling sad, fearful, and suicidal. He was given Luvox. Soon after, the psychiatrist did not think this was working very well and added Ritalin to augment his medication regiment. During the next three months, Mr. Wilson's mania increased. He was having angry outbursts regularly. His wife asked him to leave the home. He took an overdose of Klonopin. Mr. Wilson was hospitalized for 3 days until his mood was stabilized and then returned home. He reports feeling anger towards his wife believing she forced him to be hospitalized and started using amphetamines again. 

Mr. Wilson continued on anti-depressants and Depakote. His psychiatrist was unaware that he continued using amphetamines and other medications. Mrs. Wilson was getting continuously concerned about their financial state because Mr. Wilson would constantly buy presents for her that she did not need or want, nor that they could afford. They would have arguments about this all the time. Mr. Wilson continued his use throughout the summer and by the end of March was asked to leave his home again because he used pills as a suicidal gesture. He began drinking again to cope with the separation. This use continued up to his current presentation for intake.

PSYCHOSOCIAL HISTORY:

Mr. Wilson is the only child from his parents union. Mr. Wilson reports his growing up to be tumultuous. His mother separated from his father on several occasions and sometimes would throw Mr. Wilson out of the house with the father. His mother made all the decisions and his father played a more passive role. Both parents would often have physical fights and Mr. Wilson would try to break up the fighting from as early as he can remember. 

Mr. Wilson had very few friends growing up. He learned to be nasty from his home life and would bully and intimidate his peers. He always knew he was better than them anyway. Sometimes he would actually initiate physical fights with his peers.

Mr. Wilson was considered an underachiever in the early years of school. He went on to college and graduated with a bachelor's in science with a major in computer science. 

Mr. Wilson denies any legal history.

Mr. Wilson worked for many years in the family business right after college. Although the customers liked him, he was asked to leave because of money always missing from the day’s sales. After his addiction recovery, he entered the computer business and was a salesperson for a major company. Mr. Wilson stayed at his first job six months but did not like the company and left. He then became a director in another company. He was asked to leave because printers were missing from his area. He had several jobs for a while but would not stay long at the job. He became a district coordinator at his next job. He stayed there three years. He had several meetings with his supervisors because of many indications of unethical behavior. He hated this since it reminded him of childhood when he had to do whatever he needed to obtain favors from his peers and be able to manipulate them for things they had. For example, he would charge vacations for his friends and himself off as a business expense. Although the administration could not prove any illegal activity there was always speculation.

MEDICAL HISTORY:

Mr. Wilson states he currently takes Synthroid (which he convinced his primary care physician to give him) for a thyroid problem and this helps him keep his weight down. 

FAMILY ISSUES AND DYNAMICS:

Mr. Wilson was first married at age twenty. He reports not loving his first wife but liked the stability of her family and asked her to marry him. They spent two years together. He physically abused her from the beginning of their marriage. Mr. Wilson had several affairs that ended the marriage. They had no children.

Mr. Wilson married again at twenty five. He reports not loving his second wife but thought he should be married. He pursued the second wife right from the beginning of their relationship to marry him. 

The first four years of their marriage Mr. Wilson reported physically abusing his wife. He stopped the physical abuse when he became sober. Over the past several years, he believed his wife was becoming more distant from him, which angered him. Their fighting increased, although he would not become physical with her now.

Mr. Wilson has few friends. 

MENTAL STATUS EXAM:

Mr. Wilson presents as a neatly dressed male who appears younger than his stated age. His hair is a bit disheveled, although he continuously takes a brush out to fix it. He discusses his weight and body image stating he wants to be thinner and return to weightlifting to build up his muscles again because at one point in his life he looked like an "Adonis". His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Mr. Wilson admits to a history of suicidal ideation. Mr. Wilson has some manic like symptoms, i.e. getting up, going to the men's room, talking fast during the interview. Mr. Wilson is oriented to time, place, and person. His intelligence appears normal. ent of diagnosis.




 

equired Readings

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 16, “Diagnosing Personality and Relationship Problems” (pp. 251–270)
American Psychiatric Association. (2013m). Personality disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm18
Cicchetti, D. (2014). Illustrative developmental psychopathology perspectives on precursors and pathways to personality disorder: Commentary on the special issue. Journal of Personality Disorders, 28(1), 172–179. doi:10.1521/pedi.2014.28.1.172
Ferguson, A. (2016). Borderline personality disorder and access to services: A crucial social justice issue. Australian Social Work, 69(2), 206–214. doi:10.1080/0312407X.2015.1054296

Required Media

Accessible player --Downloads--Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018e). Psychopathology and diagnosis for social work practice podcast: Personality disorders [Audio podcast]. Baltimore, MD: Author.

Optional Resources

Howard, R., & Khalifa, N. (2016). Is emotional impulsiveness (urgency) a core feature of severe personality disorder? Personality and Individual Differences, 92, 29–32. doi:10.1016/j.paid.2015.12.017
Donatone, B. (2016). The Coraline effect: The misdiagnosis of personality disorders in college students who grew up with a personality disordered parent. Journal of College Student Psychotherapy, 30(3), 187–196. doi:10.1080/87568225.2016.1177432

 





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