Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
Vee is a 26-year-old African-American woman who presents with a history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.”
When she is stressed, Vee says that she often “zones out,” even in the middle of conversations or while at work. She states, “I don’t know who Vee really is,” and describes a longstanding pattern of changing her hobbies, style of clothing, and sometimes even her job based on who is in her social group. At times, she thinks that her partner is “the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at the thought of him leaving her. Vee reports that, before she began dating her current partner, she sometimes engaged in sexual activity with multiple people per week, often with partners whom she did not know.
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
- Describe the presenting problems.
- Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
- Discuss which cluster the primary diagnosis belongs to.
- Formulate and prioritize a treatment plan.
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
- You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
- All replies must be constructive and use literature where possible.
Vee presents with a complex array of mental health issues that require careful assessment and intervention. Her presenting problems can be summarized as follows:
- Non-Suicidal Self-Injury (NSSI): Vee has a history of cutting her arms and legs as a means of coping with emotional distress since her teenage years. This behavior is indicative of her inability to effectively regulate her emotions.
- Suicidal Behavior: She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago. Additionally, she reports chronic suicidal ideation, using it as a coping mechanism.
- Identity Disturbance: Vee describes feeling disconnected from her true self and has a pattern of frequently changing her hobbies, clothing style, and even her job based on her social group. This suggests identity instability and an unstable self-concept.
- Impulsivity: She exhibits impulsivity in her romantic relationship, swinging between intense affection and anger towards her partner. Her impulsive spending on lavish gifts and emotional swings are concerning.
- Impulsive Sexual Behavior: Vee reports engaging in sexual activity with multiple partners, often without knowing them well. This behavior may have implications for her physical and emotional health.
Primary and Differential Diagnosis:
Primary Diagnosis: Borderline Personality Disorder (BPD)
- DSM-5 Code: 301.83
- ICD-10 Code: F60.3
The primary diagnosis for Vee appears to be Borderline Personality Disorder, which is characterized by unstable relationships, self-image, and affect, along with impulsivity. Her history of self-harm, suicidal behavior, identity disturbance, and impulsivity align with the diagnostic criteria for BPD. Additionally, her chronic suicidal ideation is a concerning feature often seen in individuals with BPD.
- Major Depressive Disorder (MDD) (DSM-5: 296.20, ICD-10: F32.9): Vee’s history of suicide attempts and chronic suicidal ideation may suggest comorbid MDD. However, her identity disturbance and impulsivity are less characteristic of MDD.
- Impulse Control Disorder (DSM-5: 312.30, ICD-10: F63.8): Her impulsive behaviors in various aspects of life, including relationships and sexual activity, may also indicate the presence of an impulse control disorder. However, these behaviors are better explained by BPD.
- Post-Traumatic Stress Disorder (PTSD) (DSM-5: 309.81, ICD-10: F43.10): Trauma history should be explored as it can manifest in self-injury and suicidal behaviors. However, her identity disturbance and relationship instability are not well explained solely by PTSD.
The primary diagnosis of Borderline Personality Disorder belongs to Cluster B of personality disorders in the DSM-5. Cluster B includes disorders characterized by dramatic, emotional, or erratic behavior, which aligns with Vee’s symptoms of emotional dysregulation, impulsivity, and unstable relationships.
- Safety Assessment: Given Vee’s history of suicide attempts and chronic suicidal ideation, her immediate safety is paramount. A safety plan should be established, involving regular check-ins and crisis intervention strategies.
- Psychotherapy: The mainstay of treatment for BPD is dialectical behavior therapy (DBT). DBT can help Vee learn emotion regulation, interpersonal effectiveness, distress tolerance, and mindfulness skills. It should be prioritized.
- Medication: Medication, such as antidepressants or mood stabilizers, may be considered to address co-occurring mood disorders like depression, but it should be used cautiously alongside psychotherapy.
- Self-Harm Reduction: Cognitive-behavioral strategies can be employed to address self-harming behaviors. Identifying triggers, developing coping skills, and implementing alternatives to self-harm are crucial.
- Addressing Impulsivity: Vee’s impulsivity requires management through therapy to help her develop better impulse control and decision-making skills.
- Identity Work: Psychotherapy should focus on helping Vee develop a stable sense of identity and self-concept. Exploring her past and understanding contributing factors can aid in this process.
- Relationship Skills: Vee’s relationship instability should be addressed through therapy to improve her interpersonal skills and communication.
- Sexual Health Education: Given her history of impulsive sexual behavior, providing education on safe sex, healthy boundaries, and the potential consequences of risky behavior is essential.
This treatment plan should be individualized and adjusted based on Vee’s progress and specific needs. Collaboration with mental health professionals and potentially involving family and support networks is crucial for her long-term well-being. Regular assessments of her risk of self-harm and suicide should be conducted throughout the treatment process.