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Major Depressive Disorder in a Pakistani Immigrant

Presenting Problem

Nadia Qadiri is seeking psychotherapy due to her apparent anxious mood and debilitating headaches. The headaches and anxious mood have increased and become more frequent within the last several months. Nadia’s presenting problems made her body extremely infirm and weak and had no physical medical explanation, which necessitated professional help. The patient first discovered the symptoms of anxiety when she was a student. She was always worried about her academic status and maintaining the charade of perfectionism. Nadia’s debilitating headaches started after moving to the United States and giving birth to her two daughters.

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Brief History

Nadia is fifty-two years old, and she migrated to the United States from Pakistan at twenty-two. Nadia was the third child in a family of four children. Nadia’s mother was a homemaker, while her father worked as a steamfitter. Her family often lived in a large Pakistan city in a neighborhood of the lower middle class. As opposed to her siblings, Nadia was an exceptional and bright student. She excelled in her elementary school and entrance examinations, which earned her a place in a prestigious high school known for academic excellence. Nadia was serious with her studies and often received the highest grades. However, she was constantly worried about the maintenance of her academic excellence. Nadia appeared to be self-confident, but she was an imposter internally. She had a critical attitude towards people who could not score high grades; nonetheless, she hated criticism. She had few friends, whom she distrusted and worried about how they were motivated to ruin her reputation.

Nadia was fourteen when her distant relative inappropriately touched her. She remained silent about the incident and talked to her mother without revealing all details. As a result of the incident, Naida became wary of men, leading to a deep distrust of men’s intentions. Her cynicism towards men made her accept the offer of a prearranged marriage. She became married to Javed, whom she loved but did not trust him to take care of her financially. She attended a two-year college program in Pakistan and arrived in the United States, where she worked in a grocery store on a part-time basis prior to her children’s birth. She was constantly stressed by her husband’s siblings, who were disrespectful and controlling about her family’s matters. Nadia’s family does not have a history of any addiction or mental health.

Overview of Symptoms

Nadia shows signs of anxiety, feelings of inadequacy, and debilitating headaches. She worries a lot about multiple things. Nadia is worried and concerned about how to maintain her academic status. She often appears to be self-confident, but she is concerned about being an imposter. Nadia preferred to work alone while studying to increase her feelings of being in control and reduce anxiety. Additionally, she continuously worries about her daughters being in different locations and their safety. Nadia has felt inadequate and worthless about many things after and before her marriage. For instance, she told her husband that she has low self-esteem and faces constant stress. Nadia often thinks that she is not a good mother and wife. She believed that she could not provide care to her daughters. Nadia has debilitating headaches which are not attributed to physical causes. Furthermore, she feels irritable even when she tries to be positive.

Nadia has experienced sleep disturbances and often feels lonely and sad. She denies her husband sex because she believes sex is only meant for procreation. Her mood has deteriorated, and she experiences aggravated patterns of social isolation. Few activities give her pleasure; however, she enjoys her phone conversations with her parents. Nadia’s capability to organize and plan daily tasks in her life and family has reduced. She feels she has lost the energy that she once had to care for her daughters. She believes she will soon have a nervous breakdown or experience an episode.

Diagnostic Formulation with Rationale

Based on her symptoms, Nadia has a major depressive disorder with anxious distress. Nadia’s symptoms satisfy the diagnostic criteria for major depressive disorder. A patient must experience at least loss of pleasure or interest or depressed mood to be diagnosed with major depressive disorder (American Psychiatric Association, 2013). According to Nadia’s symptoms, Nadia has a depressed mood and a loss of interest and pleasure. Additionally, Nadia has decreased appetite almost every day since she has based her eating habits on a starvation concept. Nadia also experiences a loss of energy, making her feel like she cannot care for her daughters. Furthermore, Nadia has become indecisive, as evidenced by her daughter wanting the parents to meet the daughter’s partner. Another possible diagnosis can be generalized anxiety disorder because Nadia faces excessive worry and anxiety associated with irritability, sleep disturbance, and restlessness. Furthermore, Nadia finds it hard to manage her worry.

Recommended Interventions

Nadia should seek psychotherapy to help with her major depressive disorder. Some types of psychotherapy, such as interpersonal therapy, cognitive behavioral therapy, or brain stimulation therapies, can be effective for treating depression. Face-to-face sessions with a therapist can help Nadia talk about her condition and learn how to cope. Medications can also be used to relieve depression symptoms. Such drugs for depression treatment can include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). The follow-up program will involve the counselor constantly monitoring their patients after treatment is offered to assess psychiatric symptoms changes, prevent relapses, and alter medication regimens if it is required (Giannelli, 2020). Nadia can join support groups that are based in her community since they can offer social support. In addition, Nadia can join online communities for mutual support from people around the world.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Pub.

Giannelli, F. R. (2020). Major depressive disorder. Journal of the American Academy of Physician Assistants, 33(4), 19–20. Web.

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