Running Head: EXAM 2 !

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Exam 2

Melissa Hanson: 000810735

Drake University

Psychological Disorders: COUN 228

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Question 1: Kimberly

A. Diagnosis

Three potential disorders for Kimberly and her history would be difficult to determine

based on the information given in her case, because it is so sparse in detail. Her problems seem

to be situational, but based on the given information I would first start to look in the Trauma-and-

Stressor-Related Disorders because of her past sexual abuse.

Post Traumatic Stress Disorder

The American Psychiatric Publishing identifies Post Traumatic Stress Disorder as being a

trauma and stressor related disorder. The criteria I would identify her as having are listed below

(p 271):

A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the

following ways:

1. Directly experiencing the traumatic event(s)

Kimberly was directly sexually abused by her older brother.

4. Experiencing repeated or extreme exposure to aversive details of the traumatic event

Kimberly experienced repeated sexual abuse through out her developmental years and

her parents never did anything about it.

B. Presence of one or more of the following intrusion symptoms associated with the traumatic

event, beginning after the traumatic events occurred.

This one seemed to be a stretch for the characteristic I chose to present in Kimberly because

there is not enough information given in the synopsis.

5. Marked physiological reactions to internal or external cues that symbolize or resemble 


an aspect of the traumatic event. 


Maybe, because she is living with a man who is abusive and she is staying in the situation

which would be a physiological reaction of being “frozen” in her situation even though
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she knows it is unhealthy.

C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the

traumatic event occurred, as evidenced by one or both of the following:

Again, I had to stretch to make this category fit as well, because not enough information was

given so assumptions were made.

2. Avoidance of or efforts to avoid external reminders that arouse distressing memories, 


thoughts or feelings about or closely associated with the traumatic event.

Kimberly never went back to live with her family, but I am not sure if it was by

choice because originally her family did kick her out. She could have chose not to go

back to live with them though because she would be avoiding external reminders of those

distressing memories.

D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or

worsening after the traumatic events occurred, as evidenced by two ore more of the following:

2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the

world.

Kimberly is living with a man who is forcing her to sell drugs and is verbally abusive to

her. These choices could show that she has poor self esteem and does not feel she

deserves anyone who treats her any better then this.

5. Markedly diminished interest or participation in significant activities.

Kimberly does not have a job, although she is trying to find one, and it does not discuss

any other activities that she pursues.

6. Feelings of detachment or estrangement from others.

Kimberly only surrounds herself with her verbally abusive boyfriend. She no longer has

contact with her family either.

E. Marked alterations in arousal and reactivity associated with the traumatic event, beginning or

worsening after the traumatic event occurred, as evidenced by two or more of the following:

1. Irritable behavior and angry outburst typically expressed as verbal or physical

aggression toward people or objects.

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Kimberly was diagnosed with oppositional defiant disorder when she was in middle

school. This shows that she had very irritable and volatile behavior outbursts.

2. Reckless or self-destructive behavior.

Kimberly chose to be a prostitute to make money, and is currently living with a boyfriend

who is verbally abusive and forces her to sell drugs for him.

F. Duration of the disturbance (Criteria B, C, D, E) is more than 1 month.

Her behavior has been like this since she was 16 years old, and now she is 25.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or

other important areas of functioning.

Not enough information given to confirm this characteristic.

H. The disturbance is not attributable to the physiological effects of a substance.

Unknown, because she is exposed to drugs at her home because she is selling them for her

boyfriend.

(American Psychiatric Association, 2013)

Unspecified Trauma-and Stressor-Related Disorder

The unspecified trauma- and stressor- related disorder applies to a client who presents

symptoms of having trauma in the past, but does meet the full criteria of other trauma- and

stressor- related disorders. Kimberly’s trauma comes from the sexual abuse which was inflicted

upon her as a child. Based on her volatile choices since this trauma I feel it is still affecting her,

and because of this I would diagnosis Kimberly with unspecified trauma- and stressor- related

disorder.

B. Stabilization, Sustainability, Self-Sufficiency

Stabilization

In order to stabilize Kimberly I would try to get her out of her current setting. She can

not live with her abusive boyfriend any longer, so I would present her with options of how we
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can get her into a different living situation. If she has no close relatives or support system that

she could live with I would suggest a woman’s shelter. In order for her to acquire food without

an income I would have her pursue food stamps.

Sustainability

I would start working with Kimberly on empowerment and getting her out of her current

mindset of co-dependency and abuse. I would have her start to set small goals of pursuing

activities that she enjoys so she could have success and enjoyment in things on her own without

a partner. Doing things on her own would also help her get out of the abuse cycle she has been

so used to experiencing. I would suggest a substance abuse evaluation, to make sure drugs are

not an issue, and have her follow through with any recommendations that need to take place.

During counseling I would also want to bring up past family history and work through

that situation so she can move on with her future, and not have it holding her back any longer.

I would also start focusing on strengths from her previous criminal history, and put those towards

her current employment search. I would contact Iowa Workforce Development to get her a job

that focused on the strengths we had been building upon. I would also work to get her record

expunged with a public defender or private attorney, so she might be more employable.

When starting to form neighbor networks I would have her try to branch out and meet new

people in healthy environments such as: churches, Alcoholics Anonymous meetings, or

passageways.

Self-Sufficiency

When setting priorities for Kimberly and self-sufficiency I would want her to maintain

employment and healthy relationships. I would also make sure she is drug free with a healthy
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enjoyable life. She would need to be able to maintain a connection with support networks she

has established during the sustainability period.

Another criteria I would look for from Kimberly in the self-sufficiency phase is

forgiveness and recovery from past traumas, and recognizing triggers that may set her back into a

destructive path. She would also have to understand that she has the power to choose her current

choices and deal with the consequences that comes with them.

C. Sexually Transmitted Diseases

The CDC define, sex work as “the use of sexual activity for income or employment for

non-monetary items, such as food, drugs, shelter.” It can also be defined as “survival” sex, and

when a person, such as Kimberly, is involved in survival sex they dramatically increase their risk

of becoming infected with HIV or sexually transmitted infections (STI). An example of an STI

that is common in multiple sexual partners for women in the Human papilloma virus (HPV),

which can lead to cervical cancer. I would suggest Kimberly goes into the doctor to get tested for

any STI’s or HIV. If she is diagnosed with something I would expect her to follow the guidelines

and medications the doctor suggests.

D. Expunged Record

If Kimberly went to a public defender she might not be able to get the help she needs

because her case is not an active criminal case. In an interview with Attorney, Adam Stone, he

suggested she contacted the state public defender office to give her the original case number and

ask the courts what attorney originally represented her case. They may be able to reopen the

case and get the record expunged if the case was originally deferred (Stone, A., personal

interview, May 11, 2016).

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If they did not, then Stone suggested she contact Iowa Legal Aid, but they may deny her

wishes as well because usually Iowa Legal Aid usually only works on civil cases, which hers

would not qualify under. Stone said her last choice would be to higher a private attorney who

was somewhat cheap in his expenses, like himself. This process would probably take months to

be finalized (Stone, A., personal interview, May 11, 2016).

Question 2: Gary

A. Diagnosis

The three potential disorders I would diagnosis for Gary and his history would be: Social

Anxiety Disorder, Obsessive-Compulsive Personality Disorder, and Adjustment Disorder.

Social Anxiety Disorder

The American Psychiatric Publishing identifies Social Anxiety Disorder as being an

anxiety disorder, and the criteria I would identify Gary as having are listed below (p 202-203):

A. Marked fear or anxiety about one more more social situations in which the individual is exposed to

possible scrutiny by others. 


Gary often stays in his home watching television. The only time he goes out is occasionally to

church, but does not enjoy that act because he is afraid of the church elders; probably for the fact of

suspicions and judgements they may bring upon Gary.

B. The individual fears that he will act in a way or show anxiety symptoms that will be negatively

evaluated.


This can be confirmed by his fear of public situations like church or talking to his sister who may try

and judge his lifestyle or choices.

C. The social situations almost always provoke fear or anxiety. 


Gary constantly stays in his home so he does not have to interact with people. He has one

relationship with his sister, and even that is still marked by a fear of judgement.
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D. The social situations are avoided or endured with intense fear or anxiety. 


Gary has avoided social situations since he was a child, often wondering in the cornfields by himself.

He still secludes himself indoors most days.

E. The fear or anxiety is out of proportion to the actual threat posed buy the social situation and to the

sociocultural context.


This can be confirmed with the fact that he gets very nervous of church elders when going to church

and often parks near the entrance if he does attend church, so he can escape immediately after the

service.

F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more. 


Gary has had these fears for the last 20 years, and one can even assume since he was a child.

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,

occupational, or other important areas of functioning. 


Gary’s social anxiety has led to avoidance in maintaining a healthy living style. He uses the same

towels, which have turned to rags, for the last 20 years. He eats the same meals every night, and does

maintenance around the house, which is now full of cobwebs.

Obsessive - Compulsive Personality Disorder


The American Psychiatric Publishing identifies Obsessive - Compulsive Personality

Disorder as being a personality disorder, and the criteria I would identify Gary as having are

listed below (p. 678-679):

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and

interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early

adulthood and present in a variety of contexts, as indicated by four or more:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the

major point of the activity is lost. 


Gary has kept the same routine and ideals for the last 20 years of his life. Ever since his wife
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left him abruptly he seems be frozen in time. He does the same routines everyday, never

wavering on his meals, clothes, schedules, or other routines of his daily life.

2. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values. 


Gary is a pristine man in the area of morals and ethics. He does not watch pornography,

expose himself to violence, abusive speech, or drugs, and often fears church elders who may

think down on him morally.

3. Is unable to discard worn-out or worthless objects even when they have no sentimental

value. 


Gary has kept the same towels for the last 20 years, even though they have transformed into

rags. He also wears the same clothes, and has driven the same car for the last 20 years.

Although, this could be because he does accept change in his life, it could also be because he

can not endure to part with it.

4. Is reluctant to delegate tasks to work with others unless they submit to exactly his way of

doing things.


One could make an assumption here. Whenever anyone threatens to change Gary’s lifestyle

and how he has been doing it for the last 20 years, he becomes very anxious and will always

give the threat of committing suicide.

5. Shows rigidity and stubbornness. 


Gary does not allow himself any grace in the area of morality and lives a rigid lifestyle with

high standards in that area.

Adjustment Disorder
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The American Psychiatric Publishing identifies Adjustment Disorder as being a trauma- and

stressor- related disorder, and the criteria I would identify Gary as having are listed below (p.

286-287):

A. The development of emotional or behavior symptoms in response to an identifiable stressor

occurring within 3 months of the onset of the stressor. 


You could conclude that Gary has been frozen in time since his wife left him 20 years ago.

Doing the same routines everyday and hardly ever (if never) wavering from that routine.

B. These symptoms or behaviors are clinically significant, as evidence by one ore both:

A. Marked distress that is out of proportion to the severity or intensity of the stressor, taking

into account the external context and the cultural factors that might influence symptom

severity and presentation.


Although, losing your significant other would be devastating at some point his distress

needs to end, and he needs to continue on with his life. 20 years is a long amount of time

for the mourning process.

B. Significant impairment in social, occupational, or other important areas of functioning. 


He has lost contact with all of his family members except one sister, and hardly ever goes

out of the house unless it is to work.

C. The symptoms do not represent normal bereavement.


As I said above, losing your significant other would be devastating, but at some point his

distress needs to end and he needs to continue on with his life. 20 years is a long amount of

time for the mourning process.

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D. Once the stressor its consequences have terminated, the symptoms do not persist for more

than additional 6 months. 


Yes, Gary’s symptoms have been going on for 20 years.

I would also add on mixed depressed mood disorder and anxiety to this diagnosis of

Adjustment disorder. He has low mood and often secludes himself inside and never goes out to

socialize. He also seems to be in a constant state of worry or nervousness especially in the area

of others judging him and or in his idea of morality.

B. Adverse Childhood Experiences and Resilience Questionnaire

ACE Score

After reviewing the ACE Survey I only found Gary to have two adverse childhood

experiences. I was convinced Gary could answer yes to a parent or adult in the household often

or very often putting Gary down or insulting him. This is confirmed with the fact that his parents

often told him that he was an accident and unwanted. It gave Gary a poor self image which later

affects his self esteem in major ways.

The second adverse childhood experience that Gary experienced was often feeling like no

one in his family loved him or thought he was important or special. This goes along with the last

one, and his family often telling him how he was not wanted and unappreciated.

Resilience Scale

When looking at the resiliency scale, I found Gary could have answered 9 out of 14 as

being “probably not true” or “definitely not true.” That is more than 50% of the questions

showing a lack of resiliency. This is confirmed with his lack of resiliency in his own life,

currently. He has a lack of motivation to move on from the fact that his wife left him 20 years
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ago. He does the same thing daily and hardly ever changes from that routine. Gary has not built

up the resiliency skills needed to move on from a devastation of this size in his life.

Question 3: Mary

A. Diagnosis

Mary had a very interesting history, because she seems to have been misdiagnosed in her

past with schizophrenia, yet she still shows similar signs of having schizophrenia because of the

hallucinations. Three potential disorders I would give Mary based on her history would be:

general anxiety disorder, somatic symptom disorder, and schizoaffective disorder.

General Anxiety Disorder

The American Psychiatric Publishing identifies Generalized Anxiety Disorder as being an

anxiety disorder, and the criteria I would identify Mary as having are listed below (p. 222):

A. Excessive anxiety and worry, occurring more days than not, for at least 6 months, about a

number of events or activities.


Mary has been known to feel very anxious and even though it does not give a selective

amount of time, I am assuming she has felt this way for a majority of her life because she has

had panic disorders in the past.

B. The individual finds it difficult to control worry. 


It is clear that Mary worries about her mental stability and medical symptoms because she is

pursing an answer to the symptoms that she is having. She also has trouble sleeping which

we can assume is due to worry.

C. The anxiety and worry are associated with three or more of the following symptoms:
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A. Restlessness or feeling keyed up or on edge.


Mary often has insomnia and could not even get herself out of bed.

B. Being easily fatigued 


Mary often has insomnia.

C. Sleep disturbance


Mary often has insomnia.

D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment

in social, occupational, or other important areas of functioning.


Mary seems to be so anxious and distressed about her physical health that it is affecting her

everyday living. She finds it difficult to get out of bed and sleep at night.

Somatic Symptom Disorder

The American Psychiatric Publishing identifies Somatic Symptom Disorder as being

somatic symptom and related disorder, and the criteria I would identify Mary as having are listed

below (p. 311):

A. One or more somatic symptoms that are distressing or results in significant disruption of

daily life. 


Mary states that she often feels depressed and has high levels of anxiety. She has symptoms

of insomnia and high levels of restlessness. She is not able to get herself out of bed, even

though she has a reason to get out of bed (two children). She also has hallucinations, which

have occurred majority of her life, and she has also been diagnosed with panic attacks in the

past.
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B. Excessive thoughts, feelings or behaviors related to the somatic symptoms or associated

health concerns as manifested by a least one of the following:

A. Disproportionate and persistent thoughts about the seriousness of ones symptoms. 


Mary has persistent thoughts about her symptoms. The symptoms that seem to cause her

the most distress are probably very scary to her because they include hallucinations of

neon Native Americans.

B. Persistently high level of anxiety about healthy or symptoms.


Mary said herself she is having high levels of anxiety and depression. She seems to have

been symptomatic her entire life though, always has something wrong with herself.

C. Although any one somatic symptom may not be continuously present, the state of being

symptomatic is persistent (typically more than 6 months) 


It is clear that Mary has had some sort of symptom her whole life, with the history of

diagnosis’ of schizophrenia and panic disorders. Now we can add depression and anxiety the

list. I can’t help but wonder if her constant state of symptoms is from never properly being

diagnosed by the medical field.

Schizoaffectice Disorder

The American Psychiatric Publishing identifies Schizoaffective Disorder as being

schizophrenia spectrum and other psychotic disorders, and the criteria I would identify Mary as

having are listed below (p. 105-106):

A. An uninterrupted period of illness during which there is a major mood episode concurrent

with Criterion A of schizophrenia.

A. Mary has delusions and hallucinations.

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B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode

during the lifetime duration of the illness.


It seems that Mary has had delusions or hallucinations on and off throughout her lifetime

because she has been diagnosed with Schizophrenia in her past.

C. Symptoms that meet criteria for a major mood episode are present for the majority of the

total duration of the active and residual portions of the illness


Mary has said she has major feelings of depression and can barely get herself out of bed, and

then can not fall asleep at night. Insomnia is another symptom of depression.

B. Counseling Plan

Stabilization

The first thing I would suggest Mary do is go to the doctor to get a full physical, and get a

second opinion on her EEG results. I would want to discuss with her any medication she is

taking, because sedatives could have been the cause of the abnormal beta waves results on the

EEG (Healthgrades Operating Company, 2016). After health needs were figured out I would

move on to a safety plan for the children as well as herself. We would want ensure the safety of

her children and that may entail having the children go to a support network, like a family

member, until Mary can become a fully functioning parent.

Sustainability

Next I would start to try and empower Mary to see a possible happy future. I would work

with her on her depression, and set small goals to help her work through that sadness. I would

also look into stabilization of any medical diagnosis that she may have. I would also encourage

her to start advocating for herself and the medical diagnosis's she has been misdiagnosed with,
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schizophrenia. I would push her to see that she knows her body more than any physician and her

opinions and feelings matter.

I would also encourage her to start making a network of friends that she could rely on.

Maybe setting a goal of attending a mom’s group where she could have play dates with her

children, and make connections with other families in her neighborhood. She could also start to

get involved in her child’s lives by coaching or having them join a organization of some sort.

Self-Sufficiency


In order for Mary to hit self-sufficiency I would want her to have her medical issues

under control. I would hope that she would have a plan that she could rely on, WRAP plan,

where she could recognize triggers that she had and identify support systems she could go to if

she was feeling the onsite of those trigger. I would want her to have a positive plan for her future

where she is providing a healthy upbringing for her children. Maybe even start saving for her

children’s future endeavors including college.

C. Medical Model

So far the medical model has not treated Mary well. They have misdiagnosed her several

times with schizophrenia and have even made her go through electro convulsive therapy as well

as uncomfortable sleep treatments. The medical model may have even given her a pill or

medication that could cause negative symptoms to her body. A common drug given to people

with schizophrenia is Seroquel. Seroquel can cause trouble sleeping, nausea, headaches, diarrhea

and irritability (Web MD, 2016) which Mary had the very first symptom. A common drug to treat

panic disorders is Paxil. Paxil has many side effects including the following: mood or behavior
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changes, anxiety, panic attacks, trouble sleeping, impulsive feelings, irritability, hostility,

aggressiveness, restlessness, hyperactive depression and thoughts of suicide (Drugs, 2016).

Question 4: Anna

Genetic and Epigenetic Factors

The University of Leicester discusses how epigenetic factors are largely the result of

environment cues such as: smoking, stress, diet, pollution, and alcohol. If we assume what toxins

Anna was exposed to growing up we can identify all of these are being issues for both her up

bringing and her children’s. Anna was the ninth out of ten children, so we can assume resources

were scarce, so her diet probably was not the healthiest because healthy foods usually are more

expensive. We can also assume there was a lot of stress, especially since she left home before

she was technically an adult. So her DNA was affected by epigenetic factors, but we can also

assume her children’s DNA was affected by epigenetic factors.

Anna was living in a trailer with her fiancé when she had her children. She did have a

job and what seemed to be a bright future with two cars and a retirement savings account. I

assume that there were some environmental factors going on for the birth of all three of her

children as well. Especially when she moved back to Oklahoma after the divorce from her

husband. Anna’s life would spiral back into what she grew up with; poverty, alcohol abuse, and a

feeling of hopelessness.

Resiliency & Future Diseases of Anna’s children

Tiffany


Tiffany is married with two children. She is known as the care provider by her siblings

and husband because everyone looks to her for help or answers. This burden of caring for
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everyone and being “responsible” stresses her out especially because I believe she, out of all the

children, has the most realistic attitude about her current situation. I assume that this will

eventually lead to depression and alcohol abuse.

Tiffany continues to show resiliency throughout her struggles because she has a full time

job and did not drink or smoke while pregnant with her children. She also preservers with one

child who is disabled and another who is 4 years old. There are many things in need of repair in

her trailer, but Tiffany never complains and always stays somewhat positive even though the

stress is clearly getting to her.

Maryann

Maryann has a laissez faire attitude for her life. Although it may be frowned upon, I see

it as a form of resiliency for the life that she currently lives, which is full of stress, poverty, and

substance abuse. Maryann is also very resourceful; despite not having a means of transportation

she still was able to find a way to make it to her mother’s funeral. I assume Maryann will also

deal with depression at some point in her life as well as exhibit substance abuse like the

generations that have come before her if she stays in her current environment.

Davey

Davey was considered his mother’s most loyal caretaker. He showed resiliency in many

ways; His largest in the form of hospitality. He let Anna Marrie live with him and did all the

shopping for them, using his mother’s disability check. He also tried to reason with his mother

in the area of her drinking, but would seldom win. His kindness would cave in and he would

allow her small amounts of alcohol which I think he regrets at times. He also moved in with

Tiffany after his mother’s death to help with her household and children’s needs. There is a
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strong family bond between all three siblings and they all look after and care for each other. I

believe Davey already has a drinking problem and can foresee it turning into Alcohol abuse in

his future, along with depression as I had thought for the other siblings as well.

!
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Resources

ACE and Resiliency Questionnaire: (2016). Retrieved May 9, 2016, from http://

formedfamiliesforward.org/images/Trauma-informed-care-information-from-Allison-

Sampson-Jackson.pdf

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: American Pyschiatric Publishing.

Center for Disease Control and Prevention, (2016). HIV risk among adult sex workers in the

United States. Retrieved May 9, 2016, from http://www.cdc.gov/hiv/group/

sexworkers.html

Drugs.com.(2016). Paxil. Retrieved on May 13, 2016, from http://www.drugs.com/paxil.html

HealthGrades Operating Company. (2016). Understanding your EEG results. Retrieved on May

9, 2016, from https://www.healthgrades.com/procedures/understanding-your-eeg-results

Saslow, E. (2016, April 8).”We don't know why it came to this." Washington Post. Retrieved

May 13, 2016, from: http://www.washingtonpost.com/sf/national/2016/04/08/we-dont-

know-why-it-came-to-this/?wpmm=1&wpisrc=nl_evening

University of Leicester. (2016). Epigenetics, diet and pregnancy: Learning outcomes. Retrieved

May 9, 2016, from http://www2.le.ac.uk/departments/genetics/vgec/schoolscolleges/

epigenetics_ethics/case-studies/epigenetics-diet-and-pregnancy

Web MD (2016). Seroquel. Retrieved on May 13, 2016, from http://www.webmd.com/drugs/2/

drug-4718/seroquel-oral/details