In the case study under consideration, there is a man with evident sexual dysfunctional problems. The beginning of the conversation is unclear and pointless because truth can hardly be identified. The client admits that his GP and urologist have not discovered any physical problems. Still, his wife notices his computer dependence and the inability to avoid its usage every night. In a short time, the client confesses to his dependence on regular masturbation (even at work where he was punished because he visited porn sites). A DSM diagnosis for this client is an erectile disorder (302.72 – F52.21) with marked difficulty in obtaining an erection during sexual activity and, as a result, maintaining an erection at the end of the sexual activity (American Psychiatric Association, 2013).
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The rationale for such diagnosis can be the following factors: the erectile dysfunction may not be dependent on the hormone levels or other outside sources but some personal male characteristics (Wallen & Graves, 2007). Many psychologists conclude if there are no physical explanations of the problem, and there are frequent cases of men climax during viewing porn, it is necessary to search for some psychological problems in such inabilities.
To introduce an accurate diagnosis, it is possible to find the answers to such questions as if the client tries to combine viewing pornography and having sex with his wife, if the client attempts to avoid masturbating, or what kind of pornography sites he prefers to watch. This additional information should help to clarify the reasons why sexual affairs with his wife cannot satisfy him and what the wife can do to change the situation.
In the current assessment, it is possible to include several individuals. If there are any, it is possible to ask an ex of the client to share her experience with him and clarify if the same problems took place before. Besides, it is possible to address a co-worker and share his opinion about the picture observed at the working place. Such information can deprive the client of the desire to use porn again and focus more on his wife.
The most comfortable environment that can lead the client to discuss his issue is a private conversation with his wife (Wincze & Carey, 2012). The psychologist should never try to divide the couple but educate them to discuss their sexual problems together. The husband should stop hiding something from his wife, and the wife should learn how to understand and interpret the behavior of her husband. The couple should be offered to use some sexual advertising or watch porn together. The client has to be provided with an environment where he can learn how to discuss his sexual preferences with his wife.
There is a 13-year-old female patient, whose parents bring her to a psychologist because of their anxiety about her unhappiness of being a girl. She faces numerous problems and misunderstandings at school caused by her looks and the desire to behave like a boy. She does like her breasts and wants to be a boy. Regarding such a situation, the girl can be diagnosed with gender dysphoria (302.6 – F64.2) with a strong dislike of female sexual anatomy and preference to wear typical masculine clothing (American Psychiatric Association, 2013). Gender Identity Disorder is a frequent problem of many children that has to be solved in a short period of time by means of providing appropriate care and explanations (Giordano, 2013).
There are many reasons for such diagnose. First, the girl demonstrates her intention to change her gender openly. In addition to her desire to have male-like clothing, she tries to participate in male contact kinds of sport and use any possible means to underline her intention to deprive herself of any male characteristics. Finally, her desire to remove breasts should be considered as one of the main signs of gender dysphoria. All these symptoms and observations help to diagnose the girl as the client with Gender Identity Disorder with a more than six-month duration.
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To prove the chosen diagnosis, it is also possible to gather more information about the client. For example, it is necessary to learn the circle of her friends, identify if there are more male or female friends, and clarify the level of the relations that take place between them. According to Drescher (2013), it is wrong to identify the problems of the girl as a mental disorder based on label variations of gender expression. Besides, the young age of clients should be considered when attempts to diagnose people are made. Paris (2015) suggests paying more attention to the connection between gender and culture to interpret the behavior of the girl properly.
To understand the reasons why the 13-year-old girl prefers to be a boy, more information can be gathered using additional sources. For example, teachers and fellows of the girl may be involved in conversations. They may be asked about the conditions under which the girl should study and cooperate with her mates and the reaction she demonstrates to different events in the school.
The courses taken with a psychologist should aim at the identification of the reasons for why the girl decided to neglect her female nature and be attracted by male characteristics. The girl should be treated during private conversations with an expert. It is also possible to provide the girl with some video presentations where the peculiarities of a transformation process are described.
Psychosis-Related Symptoms in Schizophrenia
To comprehend if psychosis-related symptoms are always indicative of a diagnosis of schizophrenia, it is necessary to understand what schizophrenia is, and what its main symptoms are. Schizophrenia is a serious mental disorder that affects the ways of how a person can think, feel, and acts (Mental Health America, n.d.). People, who suffer from schizophrenia, maybe at a loss while making attempts to comprehend if everything around is real or imaginary. Besides, it is hard for schizophrenics to express their emotions in different social situations. In brief, the main symptoms of schizophrenia are delusions, hallucinations, disordered speech, apathy, and a kind of emotional unresponsiveness (Mental Health America, n.d). In other words, schizophrenia is a mental disorder that usually causes psychosis. However, schizophrenia may have other symptoms except the already psychosis-related symptoms mentioned. That is why it is not correct to define all psychosis-related symptoms as the indicative symptoms for the diagnosis of schizophrenia.
Alternative Diagnoses for Psychosis-Related Symptoms
Psychosis is defined as a syndrome that consists of a group of symptoms inherent to such diagnoses as bipolar disorder, personality disorder, depression, etc. Therefore, some possible alternative diagnoses may be offered for psychosis-related symptoms. People with such psychotic-related symptoms as loss of appetite and social withdrawal may suffer from depression. People, who have catatonia or sleep paralysis, may be diagnosed with narcolepsy.HIV infections may be also present with psychosis and have to be treated properly as soon as they are discovered. Brain problems may also be caused by some psychosis-related symptoms. Sometimes, Alzheimer’s disease is confused with psychosis when it is correct to consider psychosis as a part of the disease.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Drescher, J. (2013). Gender identify diagnoses: History and controversies. In B.P.C. Kreutels, T.D. Biteensma, & A.L.C. de Vries (Eds.). Gender dysphoria and disorders of sex development: Progress in care and knowledge (pp. 137-150). New York, NY: Springer.
Giordano, S. (2013). Children with gender identify disorder: A clinical, ethical, and legal analysis. New York, NY: Routledge.
Mental Health America. (n.d.). Schizophrenia. Web.
Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press.
Wallen, K. & Graves, F.C. (2007). Sex hormones and male sexual behaviour. In F.R. Kandeel (Ed.) Male sexual dysfunction: Pathophysiology and treatment (pp.69-78). Boca Raton, FL: Taylor & Francis Group.
Wincze, J.P. & Carey, M.P. (2012). Sexual dysfunction (2nd ed.). New York, NY: Guilford Press.