Clinical disorders and medical conditions that may be a focus of clinical attention
Diagnostic code: 309.81 (F.43.10)
DSM-5 Name: Posttraumatic Stress Disorder, with delayed expression
Other condition(s) that may be a focus of clinical attention
Condition code: 278.00 (E66.9)
Name: Obesity
V62.29 (Z56.9) Other Problem Related to Employment
V15.41 (Z62.810) Personal history (past history) of physical abuse in childhood
V15.41 (Z62.810) Personal history (past history) of sexual abuse in childhood
V15.42 (Z62.811) Personal history (past history) of psychological abuse in childhood
Justification for DSM 5 Diagnosis given/conditions identified
The case notes reveal that Eleanor exhibited the essential key features of Posttraumatic Stress Disorder. Criterion A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more: The following pattern of behaviors had an early onset and long-standing course, stemming from physical, sexual, and psychological abuse from childhood; which have affected her current occupational and interpersonal functioning.
Criterion A.1. Directly experiencing the traumatic events
Eleanor Rigby states that she is not working because of emotional instability, which causes multiple and unscheduled breaks during work hours (The Case of Eleanor Rigby). These direct traumatic events show the possibility of a long-term psychological problem, which is probably due to the aftermath of her childhood experience.
Criterion B.4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolizes or resemble an aspect of the traumatic events
An in-depth analysis of the client’s mental status reveals that she has a chronic fear of people and people’s reactions towards her. It is also noted that she has experienced for more than 20 years. It is evident that she has developed a sensitivity to the behavior of others as well as the feeling of distrust of others. She often bursts into tears when anyone criticizes her even for minor issues.
Criterion C.1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events
The client tends to avoid narrating her experiences with an abusive parent. This has been observed even though she has agreed to mention that she experienced sexual, emotional and physical abuse during her childhood. However, she does not like to mention how these events happened and fears remembering them. This is a clear indication that she experienced distress, which has affected her throughout her life. In addition, it is evident that the fear of remembering the childhood events is intensive, which means that the abuse must have taken place over a longer period during childhood.
Criterion D.2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,”)
Notably, the client feels distressed in her life. She has also lost self-esteem at work and home. In addition, Eleanor tends to feel that she is not doing the right thing due to distress (American Psychiatric Association, 2013). She often cries about this feeling, which she has experienced for a long time. It is also noted that the impact of others in her life is not appreciated. She does not like working or interacting with others because she feels that they are there to distress her by interfering with her affairs.
Criterion D.4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame
As indicated above, Eleanor has a persistent negative feeling of other people (The Case of Eleanor Rigby). She feels that other people cannot appreciate her or her activities, which makes her avoid the presence of colleagues at work. Therefore, she always expects criticism from others, a clear indication that she has a chronic fear of people who are likely to harm her the same way she was harmed in her childhood (American Psychiatric Association, 2013).
Criterion E. Marked alterations in arousal and reactivity associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evidenced by
In this case, if a person attempts to make the client narrate the events in her childhood, she reacts by avoiding any further discussion. She feels disturbed. It is clear the traumatic events in her childhood caused massive distress disorder that has made her fear remembering the past events. When attempted to recall these events, she excuses herself because the arousal of the past feelings activates fearful memories. Moreover, as she remembers, her condition begins to worsen, which makes her prefer leaving out any topic likely to rekindle the bad memories.
Criterion E.2. Reckless or self-destructive behavior
Notably, Eleanor has experienced three suicide attempts in her since she was 18. In addition, criticism from others easily drives her to think about suicide. Moreover, reckless behavior is noted because she has experienced two automobile accidents in her past life, which is most likely associated with the trauma she lives with.
Criterion E.5. Problems with concentration
It is possible that the two automobile accidents could be associated with the state of poor concentration when driving, probably due to the preoccupation with fear, thought about others or remembrance of the traumatic events.
Criterion F. Duration of the disturbance (criteria B, C, D, and E) is more than one month
It is noted that the client’s disturbance is chronic in nature because she has been experiencing the problem since her childhood. For instance, the three suicide attempts in 20 years and frequent thoughts about suicide provide adequate evidence that she has a chronic psychological problem. However, she is currently facing mental problems associated with her current financial status, but the extent is critical because the problem is associated with the chronic trauma (American Psychiatric Association, 2013).
Criterion G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
It has been noted that the client has some disturbance that causes distress of clinical nature. In addition, she has some impairments of social and occupational functioning because she has a problem of dealing with her colleagues and employers, although she is able to handle disturbing customers. It is noted that she fears the people close to her because the inability to deal with others is noted when she is in physical contact with colleagues and employees. This has caused her to quite her jobs, affecting her financial status.
Criterion H: The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition
Medical conditions: 278.0 Obesity (Overweight) and 716? Arthritis (Posttraumatic, right side)
It is noted that Eleanor has no history of substance, alcohol or medical problem that may cause the disturbance. The only medical problems noted are obesity and the presence of arthritis. There is evidence that the disturbance does not affect her health, neither does it result from poor physical or physiological problem.
Specifier: With delayed expression:
Other Conditions to be considered and how they contributed to her condition
In this case, it is noted that she is mostly lonely because she lives alone and has remained single for a long time.
V62.29 (Z56.9) Other Problem Related to Unemployment
Eleanor quite her job after her wages were reduced, a factor that has contributed to the observable disturbance in the recent past.
V15.41 (Z62.810) Personal history (past history) of physical abuse in childhood
The client admits that she is a victim of childhood physical abuse. The perpetrator of this abuse was her father. She fails to come into terms with the fact that her father harmed her rather than providing protection and love.
V15.41 (Z62.810) Personal history (past history) of sexual abuse in childhood
Eleanor admits that she is a victim of childhood sexual abuse perpetrated by her father.
V15.42 (Z62.811) Personal history (past history) of psychological abuse in childhood
Eleanor admits that she is a victim of childhood emotional abuse perpetrated by her father.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DCM-5). Arlington, VA: American Psychiatric Publishing.