Patient
Isabel, 26 years-old female from Michigan, came to a social worker feeling pain and as if she was guilty; she was anxious, sleepy, and depressed. She narrated that her problem started immediately after her parents divorced when she was only three years old. For the better part of her childhood, she lived with her father, who took charge after the court ruled that her mother was not fit to provide parental care. They migrated from Central America confounded her isolation problem as she did have a support system in her new country. Further, her dad was always angry and aggressive towards her, continuously criticized, disrespected, and undermined her. Isabel’s loneliness, lack of love, and attention from their dad aggravated when she was eight years as the father remarried and shifted all his attention to the new partner. This situation heightened her stress and depression levels, and when she was 18 years, Isabel started rebelling and stopped listening to her father.
At this time, she started to cut her arms in secret as a way of relieving all the pain and stress with which she was dealing. The pain, hopelessness, and depression lured her into smoking marijuana, drinking alcohol, and engaging in unprotected sex. The influence of drugs and alcohol got her involved in a car accident in which she broke her legs and arms. Her relationship with her father worsened after the accident, and he decided to take her back to her mother. At 26 years, Isabel already had mental issues as she was depressed, often feeling sad and hopeless, and lost interest or pleasure in most activities. She attended several counseling sessions and was treated for depression, anxiety, and nervousness. Despite being under control for many months, she was continuously in pain, anxious, sleepy, felt guilty, and depressed.
Assessment
The social worker then decided to conduct a short interview and psychological tests of about 55 minutes with Isabel to learn and get more insights about her life and conditions. The information emerging from the short interview showed that Isabel grew up in isolation (Fink, 2020). She did not have friends or family members around her except her grandmother. Additionally, she lacked parental love because her mother separated from them, and her father denied her basic emotional response. Further, her dad was always angry and aggressive towards her, continuously criticized and undermined her and her interests; he would even hurl verbal abuses at her even in the presence of other family members.
The stress, anxiety, hopelessness, and depression that affected her mental state resulted in their smoking marijuana and drinking alcohol heavily, and her sexual behavior was not safe. The effects of being an alcoholic and a drug addict were clear from the car accident she got involved in that made her break her legs and arms. Isabel looked resilient, bold, courageous, extra sensitive to their surroundings, and was able to speak her mind. However, she hardly made eye contact, was intense, and felt emotionally tormented.
Further, the interview results and psychological tests indicated that Isabel was in intense pain, anxious, lacking sleep, guilty, and depressed. It was evident from the scars on her body that she was using razors, able to cut her arms in secret to relieve all the pain and stress she was dealing with. Her fantasy included cutting her with a razor blade. This portrayed her as a patient in deep trouble who needed immediate and urgent attention, and hospitalization was the best option to manage her situation.
It was apparent that Isabel missed a lot during stages of development from infancy until she was 26. There was no social interaction with their parents, friends, and the community around her (Cherry, 2021a). The lack of clear social interactions in her early life might have created a conflict in her growth, resulting in her failure to develop a quality life psychologically (Cherry, 2021a). In addition, she lived a life full of conflicts and was not grounded in any religious or spiritual beliefs. The lack of proper spiritual guidance also played a big role in shaping Isabel’s personality. To her, life was meaningless, and everything was against her. Therefore, all interventions for Isabel must include behavioral and spiritual therapies alongside medical treatments.
Diagnosis
The social worker used mental health questionnaires alongside psychological tests and assessments to learn about the patient. This involved gathering data about her disease symptoms, life experience, and family history. Through this process, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (APADSMMD), 5th Edition (DSM-5), was used as the principal guide (Boyles, 2020). This necessitated holistic approaches to diagnosis, assessment, and intervention for the patient (Corcoran & Walsh, 2019). Considered the “Bible” of mental health specialty, it provides descriptions and classifications of mental illnesses, their symptoms, and criteria experts use when conducting mental disorder diseases.
Based on the criteria set by APADSMMD, the patient exhibited all nine symptoms during the diagnosis procedure, which necessitated the conclusion that she was suffering from a borderline personality disorder (Kivi, 2020). The patient’s symptoms were evident: an intense fear of abandonment, a pattern of unstable relationships with the mother, and an unstable self-image (Kivi, 2020). In addition, Isabel was impulsive, excessively abused alcohol, self-harmed her body so many times, attempted suicide, and had frequent and dramatic mood swings (Kivi, 2020). Lastly, she demonstrated chronic feelings of emptiness and uncontrolled anger and always had paranoid thoughts and delusions or felt temporarily disconnected from reality (Kivi, 2020). These provided clear evidence for the social worker to recommend the following medication and interventions for Isabel.
Interventions
The interview results, psychological tests, and assessment pointed to a severe mental disorder. The patient lacked both parental and societal love; she had poor psychological development at the early stages of her life. Spiritually, Isabel was not herself because she was not seeing any value in life and could not connect with the reality of her life. Upon reflection of these assessment and diagnosis results, the following interventions were prescribed for the patient.
Spiritual Therapy
First and foremost, Isabel needed a proper connection with her spiritual self. Serious mental counseling was required to help the patient rediscover her religious beliefs is key in supporting her mental and emotional healing. Greater spiritual health is very important in positively impacting Isabel’s overall mental wellness. The patient must be assisted to come back to the reality that God has good plans to heal, prosper, give hope and a future, and not to harm her (NIV, 1983, Jer. 29: 11). This counseling will help treat Isabel’s soul and mind by changing her belief system and helping her rediscover the realities of life. It will make the patient achieve a deeper connection with the spiritual power and disengage from self-sabotage acts.
Cognitive Behavioral Therapy
This will be necessary for Isabel to assist her in learning how to identify and change disturbing thought patterns that have had a negative influence on her behavior and emotions. The treatment will aim to eliminate negative thoughts that have contributed to and worsened her emotional difficulties, depression, and anxiety in the past (Cherry, 2021b). Through this, other different but interconnected modalities like behavior, sensation, imagery, cognition, interpersonal factors, and alcohol abuse in her will be eliminated (Cherry, 2021b). Cognitive therapy is very effective and has been used elsewhere to treat addictions to drugs, depression, personality disorders, relationship problems, and anger issues.
Medication
The patient should undergo psychotherapy as the main treatment measure to help her learn skills to manage and cope with his condition. This must be accompanied by medical treatment for other mental illnesses that are already occurring along with borderline personality disorder, like depression or alcohol abuse. Dialectical behavioral therapy (DBT) is recommended to teach Isabel how to manage emotions, tolerate distress, and improve relationships through communication (Kivi, 2020). Schema-focused therapy (SFT) will enable her to get her needs met in a healthy manner to promote positive life patterns in the patient (Kivi, 2020). Mentalization-based therapy (MBT) is prescribed to help the patient know her own thoughts and feelings and enable her to create an alternative perspective on her situation (Kivi, 2020). For symptoms like depression, impulsiveness, aggression, and anxiety, medications like antidepressants, antipsychotics, or mood-stabilizing drugs are necessary (Kivi, 2020). These procedures must be done within the psychiatric hospital to keep and monitor her safe from self-injury.
References
Boyles, C. (2020). What are the new classifications in the DSM-5? Behavioral Health HER. Web.
Cherry, K. (2021a). Erikson’s stages of psychological development. Verywellmind. Web.
Cherry, K. (2021b). What is cognitive-behavioral therapy? Verywellmind. Web.
Corcoran, J. & Walsh, J. M. (2019). Mental health in social work: A casebook on diagnosis and strengths-based assessment. Pearson.
Kivi, R. (2020). Borderline Personality Disorder. Health Line. Web.
New International Version. (1983). New International Version (NIV). Bible Study Tools. Web.