DSM-5 Diagnosis
List: Principal DSM-5 Diagnosis (Focus of Treatment): 309.81 (F43.10) Posttraumatic Stress Disorder.
There are several criteria that can be applied to adults while diagnosing the patient. To begin with, the patients suffering from PTSD are exposed to the threat of death or a serious injury. In the case under analysis, the patient experiences “…repeated or extreme exposure to aversive details of the traumatic events”. Further, the patient experiences involuntary, recurrent, and intrusive memories of the distressing events. Third, the patients must avoid the distressing memories, feelings and thoughts of the traumatic events. There are also negative alterations of the mood and cognition associated with traumatic events, as well as low level of reactivity and concentration associated with traumatic effects. The patient is amenable to angry behavior that can be expressed in physical and verbal aggression.
Relevant Medical Diagnoses
The main feature of posttraumatic stress disorder includes the development of typical symptoms leading to the exposure of traumatic events. Emotional dimension of the traumatic events can be bound to Criterion A. In fact, the medical representation of PTSD can differ. For instance, in some patients, fear-based emotional and behavioral signs can prevail while some patients can experience dysphoric and anhedonic mood states, as well as negative, distressing conditions. There are also cases when individuals suffer from reactive-externalizing symptoms, or dissociative symptoms. Finally, there are individuals who experience the combination of all the symptoms presented above.
Measures of Symptom Severity/Disability
While evaluating the system severity, the attention should be paid to the number of systems and their intensity. Judging from the case, the patient owns almost all systems of the criteria presented in DSM-5 manual, and therefore, the exposure of the disease is evident.
Rationale for Diagnosis
The advantages and limitations of using the DSM-5 to diagnose this client. Certainly, medical diagnoses can reveal additional symptoms and signs, which are typical to the disorder. However, adhering to the information presented in DSM-5 can allow the physicians to define the leading effects and further actions for treating the patient. DSM-5 is constantly updated with new information and correction, and, therefore, using this diagnosis assessment tool can be beneficial for promoting the diagnosing and treatment. At the same time, the medical intervention can provide more details on the case. For instance, the irritated behavior, loss of memory and poor concentration could be caused by the drug abuse. In this respect, it is highly essential for the patient to go through the necessary procedures, such as blood testing.
The main symptoms a therapist might observe in a client with this mental disorder. The direct observation in combination with the client self-report can be the best option in case of mental disorder. In such a way, it is possible to establish the level of objective and define further actions, which need to be adopted for the client. In addition, the therapist can also introduce new approaches to communicating with client. Due to the fact that the patient avoids direct conversation on the topic related to the traumatic event, the task of the physician is to provide the corresponding procedure for managing this conversation and reducing the risk of complicating the psychological state of the patient.
Theoretical Model of Psychopathology
- Biological Approaches. Biological theorists define abnormal behavior as a disorder caused by the malfunctioning of the organism. They also determine the problems with brain anatomy causing serious abnormalities. In the case under analysis, the brain abnormality model suits the best for the patient because of the possible injuries received during his military service. According to Comer, “mental disorders are sometimes related to abnormal chemical activity in the body’s endocrine system”. Therefore, endocrine glands work with neutrons to take control of such important activities as reproduction, heart rate, growth, energy, body temperature, and responses to stress. As a result, glands reveal chemical substances that are called hormones, which can make other body organs act in an unexpected way.
- Psychological Approaches. The psychodynamic model is considered to be among the oldest approaches. According to this model, the attention should be paid to individual’s behavior, both normal and abnormal, which is defined by psychological factors. These internal forces are presented as dynamic factors that make people interact with the external environment creating the corresponding behavioral response. This approach to understanding the behavior presented in the case can also explain the disorder and patients’ symptoms. Specifically, PTSD is the result of the individual’s interaction with the external traumatic events.
- Social/Interpersonal Approaches. In the context of social-interpersonal approaches, the emphasis should be put upon the socio-cultural model, which explains the individual’s perspective and reaction to certain events. Specifically, the model reveals that abnormal functioning can be affected by roles and labels, which are assigned to certain people. The patient had been a soldier for a long period of time, and when he resumed a normal existence, the relationships with people were destructed because of the inadequate understanding of events. Abnormal behavior, therefore, is a defense mechanism for the new socio-cultural environment.
Describe how each model explains the etiology of this disorder. Apply each model to your own understanding of this diagnosis.
At a biological and physical level, the occurrence of the disorder is predetermined by the nerve impulses, which are stimulated by the associations with the traumatic effect. Therefore, the analysis of these disorders could be used for understanding how biological impulses react to the traumatic effect. In other words, it is a sort of a defensive mechanism of an organism in response to the situations, which might threaten its safety. Sometimes, these visual or auditory stimuli make the patient experience the sense of fear and tremble. According to Mooli and Doron, “the difference in perception singles out the PTSD client, and indicates that the recurrence of these reactions is both tiring and frustrating”. The clients also feel hopelessness and cannot control their emotions and reactions because of the failure to change anything. Therefore, physical breakout cannot be interpreted into an active reaction or right. Hence, the evident reaction to the event is to freeze, which is adaptive under certain circumstances. From the psychological viewpoint, the attention should be paid to the analysis of behavioral patterns that distinguish PTSD patients from individuals without deviations.
The Impact and Effects of Psychopathology on Family Functioning
Along with the consideration of the traumatic event issue, there are also other symptoms of the disorder, such as re-experiencing symptom, avoidance symptom, and hyper arousal symptom. In regard with the avoidance symptoms, patients suffering from PTSD used to avoiding feelings, thoughts, and conservations related to trauma, which is logical because these associative thoughts can cause the breakouts. Recollection of events also provokes distressing feelings, as well as difficulties with falling asleep. As a result, patients experience problems with sleeping and controlling their emotions. In turn, lack of sleep causes constant fatigue and exhaust.
From the social and cultural perspectives, the attention has been focused on the external environment, which affects the patient. In case of the presence of associative stimuli, the individual can display a specific defensive behavior provoking the symptoms. In fact, the social background plays an important role in shaping the individual’s diagnosis.
Impact of Social Contexts
The influence of social context is evident in the situation with the former soldier because of traumatic events the male experienced while conducting a military service. A social environment can provoke unpredicted reactions of the individual and run the corresponding defensive mechanism, which deviates from the normally accepted behavior. Therefore, the task of the nurses and health care professional is to prevent any contact with the external social stimuli, which can generate recurrence of the distressing situations.
Treatment Plan
The treatment plan for this particular patient should be premised on the combination of medical and psychological interventions, as well as support from the family members who should make everything possible to make the patient avoid stressful situations. Due to the symptoms and signs of the disease described, the patient has a great intensive of the traumatic event occurrence. Additionally, it is highly essential to introduce new schemes of intervention.
Focus of Therapy
There are three major issues that should be addressed in the treatment plan. At the beginning, it is essential to choose the psychological therapy, which would suit the needs and concerns of the patient. The second step will be the choice of medication that would allow the patient to enhance the concentration and solve the problem with sleep and memory. The third step will be the development of new algorithm of behavior in stressful situation, which could reduce significantly the occurrence of the disease recovery.
Long-Term Goals
Improve the overall biological and psychological state of a patient through regular therapeutic sessions, during which the patient should learn to behave adequately and adjust to stressful situations. It should reduce the signs of the disease, which were previously defined. The dynamic psychological support should rely on the consideration of emotional conflicts that emerge as a result of the stressful situation, particularly when it is related to the patient’s past.
Short-Term Goals
The short-term goals could be achieved by pharmacological interventions to reduce the intensive of the systems, including depression, sleep problems, and anxiety. The stress anxiety and emotional numbness could also be alleviated by means of medications administered for the treatment of posttraumatic stress disorder. Such medications as Paroxitine and Setraline can be used to alleviate the symptoms.
Theory (or Theories) to Guide Treatment
The prevailing theories guiding the treatment process rely on the psychological dynamic theory, according to which the attention should be given to the analysis of the psychological and behavioral patterns caused by specific external stimuli. The behavioral patterns could be changed by introducing psychological sessions and consulting, as well as the support from the family members who should encourage the patient and take control of the regular therapeutic meetings and medical interventions. The healthcare professionals should also be more collaborative and ensure a holistic care taking into consideration psychological, social, and cultural background of the individual.
- Specific Interventions You Will Use in Counseling to Help the Client Meet the Treatment Goals
The advances in treatment can also relate to the counselling of PTSD patients, which is premised on constant control and communication with patients, including their major concerns, their progress, and their emotional state. Additionally, there should be constant tackling of the flashbacks: therefore, the task of the family members is to reduce the impact of the traumatic situations related to the events in the past. Counselling is part of a cognitive-behavioral approach which can contribute to the improvement of the patient’s psychological state and his adjustment to a social and cultural environment. Counselling sessions are as important as medical interventions.
- Larger Environments and Social Systems Impacting Diagnosis and Treatment Plan
Larger environments and social systems considered when diagnosing this client should be taken into account while formulating a treatment plan. There are many approaches for managing care companies, such as school systems, the health care system, and the policies within the patient’s agency, or other social, political, or economic systems might impact the diagnosis and treatment planning process with this client. This is of particular concern to the family environment, the working environment, and the cultural environment. The principles of intercultural communication should also be reconsidered to define further problems and gaps associated with the disease. Further, the introduction of the cognitive-contextual technique can be viewed by the philosophy that considers major elements of human experience, such as cognition, behavior, emotions, and physiology. Hence, the concept of physiology is also associated with cognition. In the context of traditional cognitive theory, the emphasis should be placed on reducing the negative association through cognitive and behavioral channels. The dimensions of the cognitive treatment could be viewed through the cognitive scale, while estimating common therapeutic skills. The task of the counsellor or therapist is to predict the complications and take a deeper understanding of the patent’s difficulties. The introduction of cognitive-behavioral model can be efficient to predict the cognition of new levels of emotional and psychological state. In such a manner, it will be possible to ensure progress and give an emotional insight into the necessary experiences of the patient.
In general, the treatment should be combined and the ratio of medical and psychological intervention should vary with regard to the shifts in the patient’s emotional and psychological states. However, the first stages of treatment should be carried out with medical intervention to create a solid foundation for further therapeutic sessions. The control of emotional reaction and overall behavior of the patient should not be oppressive for the patient so that he could feel that his progress has been done independently from the counselors.