Major she knew she would go to

Major
symptoms of this disorder.

Commonly patients with this
disorder show their psychiatrists multiple and repetitive suicidal thoughts and
attempts. The patients are unstable emotionally and may have trouble managing
their emotions, and when faced with stressful events they can go through a
variety of mood swings. Patients also make continuous efforts to avoid real or
imagined abandonment from others. Having Borderline Personality disorder may
cause brief psychotic episodes and the patient diagnosed would also be
extremely impulsive.

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•    Briefly outline the client’s background
(age, race, occupations, etc.).

The patient Becky a Caucasian
female is currently enrolled in college but also seems unsatisfied with her
progress she mentioned that she knew she would go to college but that she
should be on a master or doctorate program based on her plan. Becky is just 24
years old and also works at customer relations and seems to be doing good in
it.

•    Factors in background that might predispose
him or her to this disorder.

Becky mentions in the interview
that she has some concerns regarding her genetic predispositions related to her
families medical and mental history. On one side or her family, her mom’s side
they had an extreme mental illness and her father has muscular dystrophy. Also,
maybe due to the reason that she had four siblings in the household she used to
lie to get attention. Both biological and environmental factors predisposed her
to be diagnosed with this disorder.

Observations

•    Symptoms that you have observed that
support the diagnosis. You can include direct quotes or behaviors that you may
have observed.

She revealed many situations in her
life that show symptoms of borderline personality disorder.   Becky quickly dismisses her friends once she
thinks they’ve seen her true self, even though she easily becomes friends once
she built struts. She also mentions a time when she had an anxiety attack just because
she was separated from a friend. She says in the interview that “it was like being
ripped apart from the inside” (personal communication, November 12, 2014).

Also, Becky showed various sign s
or compulsiveness from the spending impulses to the cutting. She would do these
things to gain confidence and make herself feel right at least the spending.
But the cutting started since her roommate left her alone to visit family, and
she just kept doing it. All of this symptoms or factors back up the diagnosis

•    Symptoms or behaviors that are inconsistent
with the diagnosis.

One of the inconsistencies is that
Becky tends to push close friends away, which contradicts the first diagnostic
criteria of avoiding real or imagined abandonment. She also seems completely
aware of her actions, like if she enjoys the attention brought from it. Another
inconsistency is that from the interview it looks like she had a reasonably
decent childhood since there were no signs of physical or emotional abuse and
both parents were at home.

•    Provide any information that you have about
the development of this disorder.

Due to environmental factors, the
disorder usually begins during adolescence or early adulthood. Factors like the
household upbringing, number of family members at home, one or two parent homes
and many other aspects. The patient shows that environmental factors helped in
the display of her disorder. The patients that suffer from this disorder are
complex individuals and often hard to treat.    

Diagnosis

•    Did you observe any evidence of general
medical conditions that might contribute to the development of this disorder?

There hasn’t been any observation
of any medical condition that may have influenced or added to her disorder. In
the other hand, she disclosed that on her mother’s side of the family they have
mental health issues.

•    Did you observe any evidence of
psychosocial and environmental problems that might contribute to this disorder?

With the evidence, I was able to
conclude that environmental issues have contributed. I do believe that her
extreme need for attention started and is based on her being 1 of four kids in
the house. She would do it all, lie, manipulate and fight just to get
attention. It didn’t stop till she finished high school but then in college her
illness evolved.

•    As per your observations, what is the
client’s overall level of safety regarding the potential harm to self or others
(suicidality or homicidally)?

At this point suicide or homicide
is not a concern since she has control and is aware of her actions, but Becky
is a harm to herself, since “cutting” has been her compulsiveness.
Although if untreated it will escalate into harming herself more if the
attention levels she wants are not met.

•    What cross-cultural issues, if any, affect
the differential diagnosis?

Like many other disorders,
Borderline personality disorder has various overlapping symptoms which can make
it over-diagnosed or under-diagnosed. The American Psychiatric Association
mentions that borderline personality disorder “co-occurs with depressive and
bipolar disorders and is confused with other personality disorders” (American
Psychiatric Association, 2013).  The
reason for this is that both adolescents and young adult’s actions or behaviors
may be misleading in the beginning stages of the diagnosis.

Therapeutic
Intervention

•    In your opinion, what are the appropriate
short-term goals of this intervention?

The first thing is to help her in
her current situation. No one could get better until having a more stable life.
A way needs to be found to help her to stop “cutting”. Another goal is to
make her see she is I control her life and give her a sense of confidence and
that way stop her spending compulsively. And of the attention aspect, we can
just get Becky surrounded by friends and family for support as well.

•     What are the appropriate long-term goals
for this intervention?

The long-term is to help her gain
an understanding of the pattern her disorder. That way once she learns what’s
causing her instabilities and faces her past traumas or situations then start
working on the building of interpersonal relationships and put her on the right
track

•    Which is the therapeutic strategy most
appropriate in this case, Why?

In my opinion, the dialectical
behavior therapy would be the most appropriate strategy.  Since the patient has problems with managing
emotions through this method, she will be helped to learn to recall and handle
the emotional trauma. The individual and group therapy sessions will even be an
excellent way for her create and sustain interpersonal connections.

This
type of therapy “focuses on the concepts of

mindfulness,
or of being aware of current situations” (National Institute of Mental Health,

2014).

•    Which is the therapeutic modality most
appropriate in this case, Why?

Based
on current readings the most successful treatment would be Dialectical behavior
therapy. Because Becky’s environment helped manifest her illness, this type of
treatment is based on invalidating environment which would be perfect for this
scenario. She could also benefit from options like individual and group therapy
and be on track to recover

 

References

 

American Psychiatric Association,
(2013). Diagnostic and Statistical Manual of Mental       Disorders (5th ed.). Washington, DC.

 

Faces of Abnormal Psychology
Interactive (2014). (personal communication, November 12,           2014).

 

N.I.M.H. (2014). Borderline
personality disorder. Retrieved from national institute of mental          health: http://www.nimh.nih.gov/health/topics/borderline-personality-          disorder/index.shtml#part6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

•    Outline the major symptoms of this disorder.

Symptoms could range from avoiding
responsibilities, building a tolerance for the substance, using in a risky way,
losing control of the substance use, using the substance to avoid or relieve
withdrawal symptoms.

•    Briefly outline the client’s background
(age, race, occupations, etc.).

Bobby currently resides with her
son and boyfriend in a small home. Her childhood was filled with many
challenges since very young. Her mother wasn’t present, and she was also
sexually abused by men in the household when she was only nine years old. She
started drinking and smoking cigarettes and later marihuana by the age of 12.
She mentions that she was just a little girl wanting to get attention. By only
sixteen years old Bobby had already experimented with multiple substances and
was just on a downward spiral.

•    Describe any factors in the client’s
background that might predispose him or her to this disorder.

 
Clearly, her childhood environment was the primary predisposing factor.
She was just a young kid without a mother who was on heroin and on top of that
she was sexually assaulted since being only a young child. Apparently, there
was an absence of positive reinforcement from the adult figures in her life
which caused her choices and actions. As a young girl she just wanted
attention, but what she got was a bad kind of attention.    

Observations

•    Describe any symptoms that you have
observed that support the diagnosis. You can include direct quotes or behaviors
that you may have observed.

In the interview, Bobby expressed
that she had been sober for ten years. She also disclosed smoking marijuana to
take her medicine. Bobby said during the interview that she does have alcoholic
beverages but just minimally. From my observation, I think she is still an
addict, and we can see by her demeanor that it is a daily struggle. During the interview,
an observation I made is that she couldn’t stay still, she continuously moved
around multiple times. Due to this behavior, I suspect that there may be some
prescription abuse as well.

•    Symptoms or behaviors that are inconsistent
with the diagnosis.

In this case, Bobby’s symptoms and
behaviors are consistent with her diagnosis. The attributes of an individual
with substance abuse problems are all showed and displayed on her.   

•    Provide any information that you have about
the development of this disorder.

In this case, Bobby’s abused
started at a young age. The American Psychiatric Association mentions that
“ages 18-24 years, have higher rates to use every substance known” (American
Psychiatric Association, 2013). Still, it could happen in other stages of
development depending on the environment. In Bobby’s case, it was her early
childhood environment which was the developmental factor to her diagnosis.  She may have a less frequent occurrence
regarding age rates of substance abuse but still is consistent with the
diagnosis as well. 

Diagnosis

•    Did you observe any evidence of general
medical conditions that might contribute to the development of this disorder?

There are no previous medical
conditions present that could’ve contributed to this disorder. During the
interview process, she did not mention family medical or mental history
conditions.  

•    Did you observe any evidence of
psychosocial and environmental problems that might contribute to this disorder?

Environmental issues undoubtedly
contributed to this disorder. Bobby came from a broken and dysfunctional
family, and the adults failed to provide the proper care and protection she
should’ve been given. Since her family did not provide a loving environment,
then Bobby sough love and attention from others. Psychosocial contributed to
her attention seeking.    

•    As per your observations, what is the
client’s overall level of safety regarding the potential harm to self or others
(suicidality or homicidally)?

At the moment, I don’t consider
Bobby harm to herself and others. She looks aware and clear of the past and
present, not so much about the future but I feel its due to her HIV status.

•    What cross-cultural issues, if any, affect
the differential diagnosis?

In this case, no cross-cultural
issues are influencing the differential diagnosis.

Therapeutic
Intervention

•    In your opinion, what are the appropriate
short-term goals of this intervention?

For short term, I think that having
positive reinforcement and individual therapy will be sufficient. She seems to
have an obvious idea of what the day holds, so especially in times where family
and friends aren’t around, I think this would be the best short-term approach.

•     What are the appropriate long-term goals
for this intervention?

In the long term, it would be good
for Bobby to attend group therapy sessions. The group support will be of great
help and benefit for Bobby in times of need

•    Which is the therapeutic strategy most
appropriate in this case, Why?

The best strategy would be the harm
reduction model. This approach is a nonjudgmental approach which helps those
involved in substance abuse. Inside this model, it is assumed that the
addiction is a pattern and through this method, it helps the patient gain back
control of their lives. Since Bobby currently is involved in multiple
substances both prescription and illegal, this strategy will help her with both
aspects.

•    Which is the therapeutic modality most
appropriate in this case, Why?

For her I think the best option
would be individual therapy since she needs to meet privately with a counselor
to discuss personal issues, this would be the best approach. The reason for
this approach is because of her other health issues. She probably wouldn’t feel
comfortable expressing her HIV status in a group therapy session for example.

 

References

 

American Psychiatric Association,
(2013). Diagnostic and Statistical Manual of Mental       Disorders (5th ed.). Washington, DC.

 

Faces of Abnormal Psychology
Interactive (2014). (personal communication, November 12,           2014). 

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