Reference no: EM133257180

Name: Carmen

Age: 20

Sex: Female

Family: In a relationship with live-in girlfriend

Occupation: College Student

Presenting problem: Hospitalization, potential overdose

Carmen had always been a good student, but her grades had fallen recently, and she was struggling in other areas of her life. Her issues in school, coupled with some relationship and sleep issues, led Carmen to schedule an appointment with a therapist in her community. Although she normally preferred to be around others, she had no interest in spending time with her girlfriend or social circle. She told her therapist that recently, she had been frequently overcome by vivid images of being in a severe car accident. Her symptoms always came on suddenly, and over time, they had made her afraid that she wouldn't be able to control her reaction to the next episode.

Carmen's symptoms began about four months before she visited the university's counseling service. Since then, she had been having nightmares at least twice a week about paramedics and totaled cars stranded on the side of the road. Her nightmares were so extreme that, over time, she began attempting to stay awake to avoid them. During the day, if she heard sirens while walking to class, she would become extremely anxious. When she was alone in her dorm, mental visions of injured or dead bodies would intrude on her thoughts. These images often distracted her throughout the day and made it nearly impossible for her to focus on her studies.

Carmen also reported issues in her relationships with others. She and her girlfriend had been arguing more often in recent months; they always seemed to fight about nothing important. Her girlfriend occasionally remarked that she seemed less invested in the relationship, to which Carmen retorted that her girlfriend must want to see someone else, which her girlfriend denied. These problems had opened up distance between Carmen and her girlfriend, especially over the past month, leading Carmen to feel hurt and neglected.

Carmen was afraid to go driving or use public transportation. She also could not bring herself to get a ride with anyone because she didn't know if she could trust their driving skills. Her unwillingness to drive or take the bus made it harder for her to get to class on time, run errands, or meet up with friends. Carmen's friends also had become concerned that she would sometimes burst into tears at the slightest provocation.

Carmen's therapist started by inquiring about Carmen's life just before she started therapy. Because the symptoms had come on suddenly, her therapist was looking for a specific event that might have led to them. Eventually, Carmen shared that she had been in a major car accident near the end of the summer just before returning to college. She had been on a trip with her family when another driver suddenly swerved to avoid a pedestrian, crashing into their car. Although most members of her family escaped with only scratches and light bruises, the passenger in the other driver's car had been severely injured and needed to be hospitalized. During the accident, Carmen said she felt like everything had happened in slow motion, yet now, she couldn't remember key details about the event, such as what street it had occurred on or the time of day at which it had happened. More than anything, she remembered the intense surge of fear she had felt during the accident, not only for her life, but the lives of her family members who were with her at the time.

After the accident, Carmen tried to push down memories of what had happened, but the more she suppressed her memories, the more they manifested as flashbacks. Her tendency to startle also became a major issue, leading her friends to become worried about her intense reactions to otherwise benign suggestions or situations. Her weekly nightmares had disrupted her sleeping patterns as well, and she could no longer perform at the level she was accustomed to performing in school. All of these issues led Carmen to feel that she was losing control of herself, and she had become scared that additional symptoms might emerge in the future.

1. Diagnostic criteria checklist: Symptoms of Trauma and Stressor-Related Disorders

One of the key features listed below relates to experiences of trauma that might cause post-traumatic stress disorder. Indicate which features are clearly present in Carmen's case.

a. Experiencing repeated or extreme exposure to aversive details of the traumatic event

b. Hearing about the trauma from an acquaintance

c. Reporting the event in great detail

d. Watching the trauma occur on television or the internet

2. Diagnostic criteria checklist: Symptoms of Post-traumatic Stress Disorder.

One of the symptoms listed below is associated with post-traumatic stress disorder. Indicate which symptoms are clearly present in Carmen's case.

a. Using a substance in greater amounts or for longer than intended.

b. Changes in appetite.

c. Recurrent, involuntary, and intrusive distressing memories of the traumatic event.

d. Exhibitionistic behaviors.

3. According to the full diagnostic criteria listed by the DSM-5 for trauma and stressor-related disorders (not just the symptoms highlighted in the previous questions), Carmen appears to meet the criteria for a diagnosis of _____.

a. neither post-traumatic stress disorder nor acute stress disorder.

b. post-traumatic stress disorder only.

c. post-traumatic stress disorder and acute stress disorder.

d. acute stress disorder only.

4. Which of Carmen's symptoms best reflects the arousal category of post-traumatic stress disorder symptoms?

a. Her difficulties in her personal relationships.

b. Struggling with flashbacks of the accident.

c. Becoming anxious when she hears sirens on her way to class.

d. Her challenges with remembering key aspects of the accident.