Reference no: EM133318749

Assignment: Determine the most likely diagnosis for each case. Be prepared to substantiate your diagnosis based on the number and nature of symptoms, timeframe, and other factors. What modifications to the case would be needed in order to change the diagnosis to another disorder?

Case Study: Diagnostic Cases

Monica: A 14-year-old girl is afraid that germs are all over her clothes and body so she stands in her room for a half an hour and tries to shake them off She feels that washing her hands is not enough to get rid of the germs so she uses rubbing alcohol which often dries her hands so much that they bleed. She feels that the number 3 protects her so she does things in multiples of 3. She fears that something bad will happen to her family if she does not keep clean and do things in multiples of 3.

Nathan: A 23-year-old war veteran has recently had difficulty sleeping. Over the past 4 months, he often awakens at night in the midst of a nightmare in which he is reliving his past war experiences. His wife Linda reports that he has had flashbacks. For example, he threw himself to the ground in the backyard when a plane flew overhead, thinking it was an attacking helicopter. At times he is hyper-alert to any sign of danger. Linda states that his preoccupation with his traumatic war experience is so intense that he seems uninterested in anything else. In spite of his preoccupation, he is unwilling to discuss his military experiences with her or others. She describes Nathan as irritable, which sometimes leads to angry outbursts. She is also concerned about his detachment from her and others. Sometimes he talks as if he has no future. He also blames himself for his war injuries even though the reports indicate they were out of his control.

Rachel: A 39-year-old reporter meets with a therapist two weeks after witnessing the execution of a murderer. Since the event, she has felt very distressed, irritable, and in a daze. She has had trouble staying asleep and often has nightmares about what happened. She has intrusive thoughts about the event at least daily with vivid "snapshot" images of the moment of execution. Rachel is very reluctant to discuss what happened and avoids traveling anywhere near the jail where the execution occurred. She has had trouble concentrating on her work, is easily startled, and has had some verbal outbursts at co-workers when they have asked her how she's doing.

Vincent (DSM-5 Clinical Cases): Vincent, age 26, has been preoccupied with his "scarred" skin, "thinning" hair, and "asymmetrical" ears, since age 13. Although he has no obvious defects, he is convinced he looks "ugly and hideous." He believes others make fun of him because of his appearance. Vincent spends 5-6 hours a day checking his disliked body areas in mirrors. He excessively styles his hair "to create an illusion of fullness" and pulls on his ears to try to "even them up." He compulsively picks his skin, sometimes using razor blades, to try to improve its appearance. He almost always wears a cap to hide his hair. He has received dermatological treatment for his skin concerns but feels it had not helped. He is socially withdrawn and does not date "because no girl would want to go out with someone as ugly as me."

Rose: A 39-year-old woman reveals that the clutter in her house keeps her and her two daughters from inviting guests over. 75% of the household is difficult to access because the floors are completely covered with items. Her bedroom and kitchen are cluttered with food cans, empty boxes, little appliances, old newspapers and mail. The exterior shed and the storage space that she rents are full of other objects. The kitchen is full of miscellaneous things and her stove is covered. There is no room left in her closet. Her bed is covered with clothes that she hasn't worn in years. While her house is completely cluttered, she cannot even think about discarding anything. In fact, she often brings home things that others have discarded on the street and tries find space for them. Her landlord is now threatening eviction.