FOR PROF MAURICE ONLY – THANK YOU
Anxiety Disorders The National Institute of Mental Health (NIMH) estimates that 18% of the population suffers from anxiety disorders in any given year. The following are anxiety disorders that occur in adults: Specific phobia Social anxiety disorder (social phobia) Panic disorder Agoraphobia Generalized anxiety disorder (GAD) Substance/medication-induced anxiety disorder Anxiety disorder due to a medical condition You may be familiar with some of these disorders through media accounts, such as movies or news stories. Many individuals suffer from anxiety in social settings, such as when they have to do public speaking, or have an irrational fear of things, such as a fear of snakes. GAD is a common anxiety disorder. GAD is when an individual feels an overwhelming sense of anxiety with no identified precipitant, quite frequently in such a way that some aspect of his or her life functioning is affected. Often, in a correctional setting, an offender may request a consultation with a psychiatrist in order to request antianxiety medication, which has a sedative effect. Jail and prison settings are conducive to anxiety due to being busy, crowded, noisy, uncomfortable, etc. Therefore, because the emotional response of anxiety is appropriate to the situation, it would not qualify as a disorder. Instead, it is more effective to teach offenders relaxation techniques that they can use to quell any anxious feelings. Further, offering behavioral techniques to address anxiety rather than making a referral to a psychiatrist for medications is a particularly appropriate response for offenders who might have substance abuse issues, since the goal is to try to reduce their reliance on medications to cope with their feelings. Obsessive-Compulsive Disorders With the publication of DSM-5 in 2013, obsessive-compulsive disorders (OCDs) were given their own distinct category. Previously, there was only one type of OCD, and it was included in the anxiety disorders category in DSM-IV-TR. In the current version of DSM, multiple types of OCDs are listed. Other disorders that are included in the obsessive-compulsive category are body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking disorder). However, these disorders are much less likely to be encountered by a forensic mental health professional. Also, within the Obsessive Compulsive Disorders section of DSM lies OCD. A further exploration of OCD itself can be of help in distinguishing it from its same-name category. OCD, as the name implies, involves obsessions (repeated, unwanted thoughts, such as “I’m going to be harmed”) and compulsions (repeated, unwanted behaviors, such as hand washing or excessive checking). The thoughts typically center on something bad happening if the behavior does not occur. The behavior will temporarily relieve the thoughts only for them to soon return until another repetition of the behavior occurs to again temporarily relieve them, for example, “Before I leave the house, if I don’t check twelve times that every appliance is switched off, one might be left switched on and burn down the entire house.” Treatment for OCD is usually cognitive behavioral to train the individual to replace or tolerate his or her unwanted thoughts in order to reduce the likelihood of acting on them. OCD has been portrayed in films such as The Aviator and As Good as It Gets as well as in Monk, the former television series. You may wish to view these depictions of OCD to gain a better understanding of how OCD affects people’s lives. You can also click here to go to the Faces of Abnormal Psychology website. There, you will see twelve different disorders listed. For this module, view the video on OCD, entitled “Obsessive Compulsive Disorder.” (You do not have an assignment on this video.) Obsessive Compulsive Disorder Trauma- and Stressor-Related Disorders Although a number of disorders are listed in this category, the three that are most relevant to a forensic mental health professional are posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorder. PTSD has often been highlighted in the media, especially among war veterans. There is little doubt that combat can trigger PTSD, and there has been an increased prevalence of PTSD among soldiers returning from Iraq. However, PTSD is also found among first responders, such as paramedics and rescue workers, as well as victims of violent crimes. PTSD can result from a violent crime that occurred just once, such as an assault on a stranger, or PTSD can result from violent crimes that have occurred over many years, such as abuse from a family member. As a forensic mental health professional, you will want to understand causes of and treatments for PTSD. Click here to go to the Faces of Abnormal Psychology website. There, you will see twelve different disorders listed. For this module, view the video on PTSD, entitled “Posttraumatic Stress Disorder.” (You do not have an assignment on this video.) Posttraumatic Stress Disorder Eating Disorders The two most common eating disorders are anorexia nervosa and bulimia nervosa. Let’s review them further. Click here to go to the Faces of Abnormal Psychology website. There, you will see twelve different disorders listed. For this module, view the video on bulimia nervosa. (You do not have an assignment on this video.) Bulimia Nervosa A question has recently arisen on whether obesity should be added to the DSM. Although, currently, obesity is not a diagnosis in the DSM, according to the Centers for Disease Control and Prevention (n.d.), obesity affects over 35% of the adult population in the United States, which is a much higher rate than the rate for both anorexia and bulimia combined. Obesity also has a cultural component. Hundreds of years ago, in medieval times, being overweight was considered desirable because food was scarce. However, at the time, the obesity rate was much lower than it is currently, which likely reflects the fact that individuals then were not eating the types of processed foods that we eat today. Conversely, in today’s society of plentiful food in this country, being ultrathin is considered desirable, thus lending further credence to the notion that the ideal body size is the one that is the hardest to obtain. Eating disorders are relatively rare among offenders. However, when they do occur, they might go unnoticed as in a busy, crowded correctional environment, weight loss might evade detection. If a forensic mental health professional notices extreme weight loss in an incarcerated individual, he or she would need to determine whether it is due to stress of being incarcerated or the result of an attempt to exercise control in an environment where an individual has very little control, in which case, therapy and perhaps medical intervention would be warranted. Reference: Centers for Disease Control and Prevention. (n.d.). Overweight and obesity.           Retrieved from http://www.cdc.gov/obesity/index.html Sleep Disorders Nearly half of the population has at some time complained of a sleep disorder, typically insomnia. Consumers are regularly inundated with advertisements for sleep aids as well as cures for sleep apnea. In spite of what television advertisements might suggest, behavioral changes related to a bedtime routine and relaxation exercises are more effective in the long term at improving one’s ability to fall asleep than medication. Medication can be quite effective in helping a person to fall asleep. However, when the medication is stopped, often the sleep problems return, which is not the case when more permanent behavioral changes have been put in place. Often, in a correctional setting, incarcerated individuals complain of difficulty sleeping. However, in a busy, crowded, loud prison, such complaints are not surprising. Again, when the reaction is appropriate to the situation, it would not be considered a disorder. It would be more of a concern if an offender is unable to sleep for days on end since not sleeping for several days at a time could pose serious health risks. Because an incarcerated individual may attempt to malinger (feign symptoms for secondary gain) problems with sleeping in order to obtain medications that he or she can use to trade for money or food or to help him or her sleep away the prison time, a forensic mental health professional must be judicious about when to refer an offender for an evaluation by a psychiatrist for sleep issues. Adjustment Disorder Adjustment disorder is characterized by a psychological response to an identifiable stressor that results in clinically significant impairment. As the name implies, adjustment disorder refers to adjustment to a significant event, usually a major life change, such as a change of job, a change in the relationship status, and the addition or loss of a family member. All major life events involve a period of adjustment. However, the time that it takes to get used to a new life situation is not necessarily a disorder in and of itself as not everyone who experiences a major life change will develop adjustment disorder. To meet criteria for adjustment disorder, the individual must have a reaction that exceeds what would be expected for the given situation. Also, the reaction must cause some degree of impairment in an aspect of the individual’s life functioning at work, school, or home or in social activities. Adjustment disorder is unique because even though the precipitant is known, it is ongoing and usually unalterable. Therefore, instead of a treatment involving the removal of the stressor (which is very likely not possible), treatment must focus on increasing the individual’s coping mechanisms to better manage the change. Typically, talk therapy would be the most useful treatment for this disorder, with medications rarely being warranted for it. Adjustment disorder is common among offenders after they are incarcerated because the change from full freedom in society to almost no freedom while locked up can mean a significant adjustment. Adjustment disorder is generally seen more in offenders who are new to a prison or jail setting rather than in offenders who have been incarcerated a number of times previously, as repeat offenders are already all too familiar with the correctional environment. If an offender has adjustment disorder, it is important to determine whether he or she has adjustment disorder with a depressed mood type because an offender with a depressed mood type of adjustment disorder might be at risk for suicide. Dissociative Disorders Dissociative disorders are characterized by a disruption in memory or consciousness or the integration of personality. Daydreaming, which we all do, is a very mild, yet healthy form of dissociation in that it is a temporary break from consciousness. However, daydreaming is not considered a disorder by any means. Conversely, perhaps the most commonly known dissociative disorder is dissociative identity disorder (DID), formerly known as multiple personality disorder. Although some clinicians refer to DID as the unidentified flying object (UFO) of psychiatry due to its low prevalence rate, there have been several well-documented cases of the disorder. One of the first examples was made known through a book by two psychiatrists, The Three Faces of Eve. This book, which was later made into a popular film, depicted the development of three different personalities in Christine Sizemore. Ms. Sizemore later reported that she developed 20 different personalities, who had different allergies and physiological measures, such as blood pressure and heart rate. She had the personality of a ten-year-old boy, and some personalities had skills that she did not otherwise possess. Another interesting dissociative disorder is dissociative fugue. This disorder involves travel away from one’s home along with the inability to recall parts of one’s past. Sometimes, these individuals are found wandering on the streets with no recollection of their personal identity. The face of such a person may appear on the news, referred to as “Jane Doe” or “John Doe,” with a request that anybody who knows of the individual’s identity should contact the authorities. Conclusion Eating, sleeping, and anxiety are all part of every human being’s neurological and biological functioning. When a disruption occurs in one of these areas, it can have a substantial impact on an individual. Eating disorders such as anorexia can be fatal. Sleep disorders are of concern due to the addictive properties of the medications that are often taken to attempt to resolve them. Anxiety disorders can be biological in origin, or sometimes their etiology is related to a severe external stressor. While one’s anxiety level can impact eating and sleep habits, anxiety disorders do not necessarily co-occur with eating and sleep disorders, nor are they necessarily a cause of them. However, the treatment for both sleep disorders and anxiety disorders is often similar in that it involves relaxation training. The treatment for eating disorders can vary but is generally cognitive in nature since self-starvation or binging reflects a complex decision to override our biological instincts to eat for survival.
FOR PROF MAURICE ONLY – THANK YOU
Assignment 2: RA: Diagnostic Formulation Review the case given below case study (Psychological Evaluation for Jessica E. Smith) for this required assignment (RA). On the basis of the information in the case study, provide a principal (primary) and a secondary diagnosis for the person using the most recent DSM codes. You will also discuss your diagnoses in narrative (paragraph) form. Then, identify and discuss at least one differential (possible alternate) diagnosis for the principal diagnosis and at least one differential (possible alternate) diagnosis for the secondary diagnosis that you gave. Lastly, discuss whether a diagnosis from other conditions that may be a focus of clinical attention is warranted. While you are welcome to list medical conditions that might be a concern, your primary and secondary diagnoses should be psychological conditions listed in DSM-5. Your paper should have separate sections for: Principal and secondary diagnoses The reasons for selecting the principal and secondary diagnoses Social and cultural factors that may influence the principal and secondary diagnoses Differential diagnoses, including a consideration of whether a diagnosis from other conditions are applicable The reasons for selecting the differential diagnoses Your rationale and justification for why your actual diagnoses are a better fit than your differential diagnoses Include citations and references in APA style. Your paper should be 5–7 pages in length. Click here to read the case study (Psychological Evaluation for Jessica E. Smith). Submission Details: By Wednesday, March 29, 2017, save your report as M3_A2_Lastname_Firstname.doc and submit the document to the M3 Assignment 2 RA Dropbox. Assignment 2 Grading Criteria Assignment Component Proficient Maximum Points Provide a principal diagnosis for the selected case study. At least one principal diagnosis was provided. 20 Provide a secondary diagnosis for the selected case study. At least one secondary diagnosis was provided. 20 Discuss the rationale for the principal and secondary diagnoses in narrative form. Discussed clear reasons for the principal and secondary diagnoses based on the DSM criteria. 24 Discuss social and cultural factors that may influence the principal and secondary diagnoses Provided a thorough discussion on social and cultural factors that may influence the principal and secondary diagnoses 24 Identify at least one differential (alternate) diagnosis for the principal diagnosis. Provided a plausible differential diagnoses for the principal diagnosis, including a consideration of whether a diagnosis from other conditions are applicable 20 Identify at least one differential (alternate) diagnosis for the secondary diagnosis. Provided a plausible differential diagnoses for the secondary diagnosis, including a consideration of whether a diagnosis from other conditions are applicable. 20 Discuss the reasons for your differential diagnoses. Gave a clear rationale for each of the differential diagnoses based on the DSM criteria. 32 Justify why your initial diagnoses are a better fit than the differential diagnoses. Clarified why your actual diagnoses are better suited for the person in the vignette than any of the differential diagnoses. 24 Writes in a clear, concise, and organized manner; demonstrates ethical scholarship in accurate representation and attribution of sources (i.e., APA); and displays accurate spelling, grammar, and punctuation. Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation. 16 Total:   200