Case Scenario
Jacob, a 32-year-old African American man, has just returned from his second overseas tour. Before starting a third, his commanding officer requires him to seek counseling due to “odd behaviors.” Jacob reports feeling unsafe over the past few weeks without knowing why. He repeatedly checks that doors are locked and patrols his property to ensure no one is lurking outside. He does not feel these behaviors interfere with his daily life but is attending counseling because it was mandated.
Jacob grew up in a violent neighborhood and witnessed his uncle’s shooting at age six. His parents were loving and protective, but the event was never discussed. He experienced flashbacks and nightmares as a child, which eventually subsided.
During his last military tour, he heard gunfire and cries of soldiers, triggering thoughts of his uncle’s death. He can connect his childhood trauma with his military experiences but has learned to compartmentalize them. He sees the military as his family and wants to dedicate his life to service, avoiding marriage or having children out of fear he couldn’t protect them.
Differential Diagnosis for Jacob
A differential diagnosis for Jacob will include obsessive-compulsive disorder (OCD), anxiety disorder, and schizophrenia. It is crucial to consider aspects of Jacob’s traumatic experiences of his childhood. In addition, attention will be paid to the peculiarities of the anxiety disorder in Jacob’s age, 32 years old.
Remarkably, the entire course of a person’s life is influenced by childhood trauma and negative experiences (Kuzminskaite et al., 2021). According to Kuzminskaite et al. (2021), “childhood trauma impacts the functioning of the brain, mind, and body, which together may contribute to a higher vulnerability for affective disorders” (p. 1). Additionally, factors such as cultural aspects, ethical and legal issues, and human diversity will be examined.
Another critical factor to consider is Jacob’s current occupation. Particular life experiences and actions, such as a professional occupation, can significantly impact a person’s state. Since Jacob’s negative childhood experience is connected with unsafe streets and violence, it is crucial to note that the potential aggression, deaths, and other attributes of the army and military service can increase his anxiety.
Remarkably, such factors as gun fires, roars, and different loud sounds can adversely influence Jacob’s mental health (Thorsteinsson & Brown, 2019). These actions constantly remind him of his traumas and are the causes of his unstable behavior. In addition, the uncle’s death is another vital point that should be taken into account while considering Jacob’s anxiety and high stress.
Notably, other types of comorbid disorders may also exist. Among them, one should highlight overweight and obesity, particular disorders such as anorexia nervosa and bulimia nervosa, depressive and anxiety disorders, and others (Thorsteinsson & Brown, 2019). All of them are closely connected with the main stressors of anxiety and schizophrenia disorders. To confirm the diagnostic impression, additional information from research and practical studies, as well as scientific investigations, will be necessary.
Cultural Aspect
A key aspect that warrants exploration regarding psychological disorders is the cultural component. Jacob is African-American and may experience various cultural unfairness, stereotypes, and other issues. Jacob’s unwillingness to seek help regarding his condition. The case states that Jacob consulted a specialist only because his military commander ordered him to do so. This fact is crucial because it highlights Jacob’s usual attitude toward his disorders and panic.
The American Psychological Association, as outlined in the DSM-5, emphasizes the patient’s personal willingness to resolve the situation. Their reflections on possible causes and past negative experiences can reveal a great deal about future treatment and the problem’s resolution (Cultural Formulation Interview). In the cultural context, it could be connected with social norms. In particular, the society in which Jacob grew up may perceive violence and aggression as an integral part of life. Due to this fact, Jacob could think that everything is alright and there is no need for help, which has only worsened the situation with his disorders.
Human Diversity Aspect
Human diversity is another aspect that can be considered as a cause for Jacob’s diagnosis. It is essential to consider socioeconomic and racial factors. Socioeconomic issues can be considered environmental factors that shape a person’s attitude toward life. In early childhood development, this point is significant (Ash et al., 2020). Because Jacob experienced the death of his uncle when he was six years old, one should state that the issues connected with danger on the streets create a connection with this tragedy. Therefore, aspects such as poverty or a lack of resources, for example, for quality education, are the major causes of a poor neighborhood.
Notably, although Jacob experienced traumas related to street violence, he chose military service as his profession, which may be one of the causes of a lack of choice due to poverty resulting from socioeconomic factors. The racial element is also critical because of the initial differences in attitudes towards life and the potential for bullying or discrimination. Ash et al. (2020) highlight that people with racial similarities have more opportunities and greater ease in overcoming specific difficulties related to socioeconomic factors (Ash et al., 2020). It means that, in addition to Jacob’s tragic family experiences, it was difficult for him to find support and understanding from others.
Legal and Ethical Issues
Among the legal and ethical issues surrounding the case of Jacob, it is crucial to consider the necessity of informing him about potential treatments and the specific characteristics of his disorders. Considering his childhood traumas, communication should be conducted attentively to avoid harming Jacob and worsening the situation. Moreover, due to cultural differences and possible past discrimination, it is essential to create a friendly environment for communication with Jacob to show him respect and demonstrate a willingness to help.
It is necessary to respect Jacob’s cultural differences to create a friendly, calm atmosphere and to understand the possible causes and treatment methods for him (Ash et al., 2020). Since Jacob did not have a personal desire to seek help or consultation, his willingness to receive treatment is presumed absent. Consequently, it is essential to inform him about all aspects of potential treatment and ask his permission.
Schizophrenia Disorder
The schizophrenia diagnosis was made applying to Jacob because of one fact that he describes himself. He said that he constantly worries about his family and does not want to leave them because something terrible is about to happen. Remarkably, negative thoughts about possible events in the future are one of the most defining factors of schizophrenia. As Ray (2019) states, “When individuals with schizophrenia or depression talk to themselves, they often think negative thoughts about who they are and what will happen in the future” (p. 15). Consequently, Jacob’s worries about his family can be determined as a depiction of his anxiety and schizophrenia diagnosis.
Provisional Diagnosis for Jacob
The provisional diagnosis for Jacob will be anxiety (65.1 T-score) following DSM-5 (DSM-5 Online Assessment Measures).
Diagnosis Criteria
- The feeling of fearfulness. Jacob fears many things, including the safety of his family. However, among unusual anxiety symptoms, his will to check the doors are locked three times, and his fear of the external environment are the significant indicators.
- The feeling of anxiousness. It has the exact causes of fearfulness. One should also state their experiences of violence during the second tour overseas while serving in the military.
- The level of worry. Jacob has deep concerns about his own life aof hwife’sife achildren’s livesren. He also admits that he cannot feel safe without a particular reason. Jacob says he checks to see if there is no one in the dark corners of his house.
- Struggling with focusing on something despite anxiety. No particular disorders related to Jacob’s lack of concentration were identified.
- The high nervousness symptoms are absent.
- The feeling of uneasiness is depicted through Jacob’s struggle to choose whether to devote his life to military service or to always be with family and protect it.
- Significant tension is absent. Jacob does not experience that his state is problematic. He lacked the will to seek help and consulted only because his commander had recommended it.
Treatment
Two theoretical models that may conceptualize Jacob’s clinical presentation were selected: the neurodevelopmental and cognitive-behavioral models.
Neurodevelopmental Model
This model highlights the peculiarities of schizophrenia diagnosis and allows one to determine particular causes. For example, it suggests that schizophrenia occurs due to negative early childhood development (Ray, 2019). Different traumas and negative influences can significantly impact a person’s lifespan and thought patterns. In addition, it stresses genetic and environmental symptoms common to Jacob’s case because of his adverse experience with violence on the streets (Thorsteinsson & Brown, 2019). Therefore, treatment aligned with this model is essential.
Considering the clinical treatment, on the one hand, Jacob will be placed in the clinic for a thorough evaluation of his brain. It will help to understand possible traumas and neuron issues. For example, abnormalities in specific neurotransmitters, including dopamine, serotonin, and glutamate, are connected to schizophrenia symptoms (Ray, 2019).
On the other hand, qualitative help from a psychologist will be necessary to communicate with Jacob and determine his fears and their causes. Because he lacks the desire to seek help, one can conclude that he is unaware of his traumas and their negative consequences. This treatment will help him understand them personally and recognize the need to change his behavior.
Cognitive-Behavioral Model
The cognitive-behavioral model outlines a step-by-step treatment approach that utilizes communication sessions between the patient and therapist. It was chosen to combat Jacob’s anxiety symptoms, eliminate his fear of anxiety, and reduce his worries. With his agreement, Jacob will attend these sessions regularly to set a precedent for change.
Notably, these changes should begin with his thought processes. Therefore, the therapist’s task will be to foster and develop Jacob’s self-awareness and understanding of his moral, physical, and psychological well-being. The patient should understand the necessity of changes because significant Improvements will not be possible (Thorsteinsson & Brown, 2019). It will provide a qualitative basis for future therapeutic practices based on cognitive-behavioral theory, such as communication regarding Jacob’s traumas.
Particular steps of the cognitive-behavioral model for Jacob’s treatment will include behavioral activation, relaxation and stress management, and education. Due to Jacob’s negative thoughts about potential harm to his family and the dangers posed by the external environment, behavioral activation will be crucial for promoting positive thinking. It assumes creating unique approaches while communicating with Jacob to give him a feeling of satisfaction (Ray, 2019). It will be connected with stress management practices, allowing Jacob to relax.
Finally, the educational process about anxiety, its causes, symptoms, and outcomes is crucial. It is a part of arousing Jacob’s self-consciousness and helping him to understand the importance of prompt treatment. Moreover, in the future, this approach will allow him to understand the initial symptoms of anxiety and to seek help as soon as possible.
References
Ash, A. A., Wiggan, G. A., Watson-Vandiver, M. J. (2020). Teacher education to enhance diversity in stem applying a critical postmodern science pedagogy. Taylor & Francis.
Cultural Formulation Interview. APA DSM-5.
DSM-5 Online Assessment Measures. American Psychiatric Association.
Kuzminskaite, E., Penninx, B. W., Harmelen, A. L., Elzinga, B. M., Hovens, J. G., Vinkers, C. H. (2021). Childhood Trauma in Adult Depressive and Anxiety Disorders: An Integrated Review on Psychological and Biological Mechanisms in the NESDA Cohort. Journal of Affective Disorders, 283(15), 179-191.
Ray, W. J. (2019). Abnormal psychology. SAGE Publications.
Thorsteinsson, E., & Brown, R. (2019). Comorbidity: Symptoms, conditions, behavior and treatments. Springer International Publishing.