Differential Diagnosis Using DSM5 and ICD 10 Codes

Purpose:	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.
Questions:	Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 1.      Describe the presenting problems. 2.      Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes. 3.      Discuss which cluster the primary diagnosis belongs to. 4.      Formulate and prioritize a treatment plan.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

1. Describe the Presenting Problems

Vee, a 26-year-old African-American woman, presents with several significant mental health issues. She has a history of non-suicidal self-injury (NSSI), specifically cutting her arms and legs, which began during her teenage years. Vee has attempted suicide twice by overdosing on prescribed medications, once as a teenager and once six months ago. She reports chronic suicidal ideation, stating that it provides her with relief to consider suicide as a “way out.”

Additionally, Vee experiences dissociative episodes, describing instances of “zoning out” during conversations or at work when stressed. She expresses a lack of stable self-identity, frequently changing her hobbies, style, and job based on her social group. Her interpersonal relationships are characterized by instability, with fluctuating perceptions of her partner, ranging from idealization to devaluation. She exhibits impulsive behaviors, such as lavish gift-giving, followed by aggressive outbursts and subsequent feelings of regret and panic. Prior to her current relationship, Vee engaged in promiscuous sexual behavior, often with partners she did not know well.

2. Generate a Primary and Differential Diagnosis Using the DSM-5 and ICD-10 Codes

Primary Diagnosis:

• Borderline Personality Disorder (BPD)
  • DSM-5 Code: 301.83
  • ICD-10 Code: F60.3

Rationale: Vee’s symptoms, including chronic feelings of emptiness, identity disturbance, impulsivity in areas that are potentially self-damaging (e.g., spending, sexual behavior), recurrent suicidal behavior, affective instability, and intense, unstable relationships, align with the criteria for Borderline Personality Disorder (BPD).

Differential Diagnoses:

• Major Depressive Disorder (MDD)
  • DSM-5 Code: 296.33 (Recurrent, Severe without Psychotic Features)
  • ICD-10 Code: F33.2

  Rationale: Vee’s chronic suicidal ideation and previous suicide attempts could suggest MDD. However, the pervasive pattern of interpersonal and self-identity disturbances, along with impulsivity, points more towards BPD.

• Post-Traumatic Stress Disorder (PTSD)
  • DSM-5 Code: 309.81
  • ICD-10 Code: F43.10

  Rationale: Dissociative episodes and self-injurious behavior might be indicative of PTSD, especially if there is a history of trauma. Further assessment would be required to confirm or rule out PTSD.

• Dissociative Identity Disorder (DID)
  • DSM-5 Code: 300.14
  • ICD-10 Code: F44.81

  Rationale: Vee’s dissociative episodes and identity disturbances may suggest DID. However, her symptoms are more consistent with BPD, as DID involves distinct identities or personality states, which Vee does not report.

3. Discuss Which Cluster the Primary Diagnosis Belongs To

Borderline Personality Disorder (BPD) belongs to Cluster B of personality disorders in the DSM-5. Cluster B disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior and include antisocial, borderline, histrionic, and narcissistic personality disorders.

4. Formulate and Prioritize a Treatment Plan

Treatment Goals:

1. Ensure Safety and Stability: Address suicidal ideation and self-injurious behaviors to prevent harm.
2. Develop Emotional Regulation Skills: Help Vee manage her intense emotions and reduce impulsive behaviors.
3. Improve Interpersonal Relationships: Enhance Vee’s ability to maintain stable and healthy relationships.
4. Strengthen Sense of Self: Assist Vee in developing a more stable and coherent sense of identity.

Treatment Plan:

1. Crisis Intervention and Safety Planning:
   • Conduct a thorough risk assessment to determine the immediacy of suicidal ideation.
   • Develop a safety plan, including emergency contacts, coping strategies, and a list of triggers.
   • Consider hospitalization if there is an imminent risk of suicide.
2. Dialectical Behavior Therapy (DBT):
   • Implement DBT, which is specifically designed for BPD, to help Vee develop skills in emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
   • Engage Vee in individual therapy sessions and DBT skills training groups.
3. Pharmacotherapy:
   • Prescribe medication for comorbid conditions if present, such as SSRIs for depressive symptoms or mood stabilizers for affective instability.
   • Monitor and adjust medications as necessary, considering Vee’s history of overdose.
4. Psychoeducation:
   • Educate Vee about BPD and its symptoms to enhance her understanding and engagement in treatment.
   • Provide resources and support for her partner to improve their relationship dynamics.
5. Long-Term Therapy:
   • Focus on developing a stable sense of self and identity through ongoing therapeutic work.
   • Address underlying trauma if PTSD is diagnosed, potentially incorporating trauma-focused therapies.

Conclusion:

Vee’s complex presentation requires a comprehensive, multidisciplinary approach to treatment. By prioritizing safety, implementing evidence-based therapies like DBT, and addressing comorbid conditions, Vee can work towards greater stability and improved quality of life.

References

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

World Health Organization. (2019). International Classification of Diseases for Mortality and Morbidity Statistics (11th Revision). Retrieved from https://icd.who.int/