Posted: July 17th, 2022

discussion

  
Week 11 6090 
Personality Disorders 
Readings
• Morrison, J. (2014) Diagnosis made easier: Principles and techniques for mental health clinicians (2nd ed.), New York, NY: Guilford Press.
o Chapter 16, “Diagnosing Personality and Relationship Problems” (pp. 251–270)
• American Psychiatric Association. (2013m). Personality disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm18
• Cicchetti, D. (2014). Illustrative developmental psychopathology perspectives on precursors and pathways to 
  
• personality   disorder: Commentary on the special issue. Journal of Personality   Disorders, 28(1), 172–179. doi:10.1521/pedi.2014.28.1.172 
• • Ferguson, A.   (2016). Borderline personality disorder and access to services: A crucial   social justice issue. Australian Social Work, 69(2), 206–214.   doi:10.1080/0312407X.2015.1054296 
• • Document: The   Case of Cathy (PDF) 
The Case of Cathy
Cathy is a   32-year-old, divorced, heterosexual African American female. She came to her   first initial intake session with complaints of depression with passive   suicidal thoughts, anxiousness, and trouble sleeping. She presented as   casually groomed, coherent, and goal directed. Cathy’s primary concern was   the added stress in helping her mother with her illness. Cathy reports a   history of threatening suicide since she was a teenager. Her family thought   she was just trying to get attention. Cathy states that she was suicidal   because she always felt empty, and sometimes she just felt so overwhelmed   that she didn’t know how else to cope with these emotions. She denies any   suicide attempts. The following is a summary of the initial appointment and   assessment for Cathy. Cathy is the oldest of four children (two brothers and   one sister), all of whom are married and live in the same community. Cathy   believes she is close with all her siblings but sometimes gets so frustrated   with them she “can’t stand them”. Cathy works in a doctor’s office and lives   in a one-bedroom apartment where she often “isolates.” She is the primary   caretaker of her mother, who was involved in a car accident 20 years ago and   was left a quadriplegic. Cathy goes to her home daily to help with her   personal hygiene. Cathy has an arrest history and was incarcerated for 3   years for drug-related charges. She was charged with possession and intent to   distribute. Cathy stated that at that time she was addicted to heroin and   using daily. Cathy reports that she began using marijuana at 14 years old. As   she entered high school she began experimenting with many different kinds of   drugs. Her heroin use began when she was 21 years old. When she completed her   prison sentence, she was paroled and mandated to attend a 1-year outpatient   drug treatment program, which she successfully completed. Cathy reported that   she returned to using cocaine 2 years ago, stating that it helps her do her   fast-paced job better and it keeps her energy up so she can help her mother   early in the morning and late at night. Cathy believes the cocaine use is   just an added stress reliever as well as “retail” therapy. She reports   shopping has been a great relief from the time she was working full time. She   said no one in her family or at her job knows that she has been doing drugs.   Cathy also takes numerous medications prescribed to her by her primary care   doctor, including an antidepressant and pain medication. As we discussed her   presenting concerns, multiple issues came up. Cathy shared her feelings about   being her mother’s primary caretaker, stating, “I love my mom, but everyone   expects me to care for her. It feels so unfair, but it’s because I am not   married and don’t have any children, this is when I really hate my siblings.”   Cathy reports never feeling as important as her siblings and believes that is   why she is the only one helping her mom now. She believes they look at her   differently since she has a criminal history. She said her father does not help   with the care of her mother and that all he does is “hang out.” She reported   feeling increasingly frustrated with this added responsibility and resentful   that her father and siblings have relegated this job to her. She sometimes   resents her mother for her being in this situation. She was dysphoric as she   shared this content and described being “stuck.” She described her father as   a “manipulative loser.” She also stated that she recently allowed one of her   brother’s friends to move in with her as a favor because he was homeless and   had nowhere to go. She said she believed he was a sweet person who just has   had a hard time in life, and she wanted to help him. She had been supporting   him financially over the last month, and was concerned because it appears that   he has not made any effort to get a job. She feared she made a mistake   allowing him into her home and has thrown him out several times. Cathy then   felt bad and allowed him back in. Cathy stated that this has been a pattern   in her relationships her entire life. When she first meets someone, she   idolizes them and believes that they can do nothing wrong, then something   always happens and they end up hurting her. Cathy said that she and this new   roommate had sex one time when he first moved in. She said they both got very   intoxicated, and she is not sure exactly what happened, but she blacked out   and found him in her bed, undressed. She then told him she had herpes, and he   responded that it had been a “mistake” and that he did not want to have sex   with her again because he was afraid of getting infected. Cathy became angry   with him at this. Cathy explained that her promiscuity through her twenties   had resulted in this lifelong disease, and she expressed anger and resentment   toward some men she had sex with. She said even though the herpes is   controlled with medication, she feels embarrassed and fears she will never   have another healthy relationship. She said she feels used, slighted, and   humiliated by the man now living in her home. Cathy then shared that when she   was 12 years old her father molested her. She stated that she tried to forget   what happened to her, but this recent incident with her new roommate brought   it up again. Cathy complained of recent nightmares related to the abuse and   exaggerated startle reactions to other people’s movements. Adapted from:   Plummer, S.-B., Makris, S., & Brocksen, S. (2013). Social work case   studies: Concentration year. Baltimore, MD: Laureate Publishing.
Media 
• • Laureate   Education (Producer). (2018e). Psychopathology and diagnosis for social   work practice podcast: Personality disorders [Audio podcast]. Baltimore,   MD: Author. 
• • Osmosis.   (2016a, August 15). Cluster A personality disorders (paranoid, schizoid,   schizotypal)—causes & symptoms [Video file]. Retrieved from   https://youtu.be/9BqaHfJI1Z4 
• • Osmosis.   (2016b, August 17). Cluster B personality disorders (antisocial,   borderline, histrionic, narcissistic) [Video file]. Retrieved from   https://youtu.be/2XZ9cLJd5Gc 
• • Osmosis.   (2016c, August 24). Cluster C personality disorders (avoidant,   obsessive-compulsive, dependent) [Video file]. Retrieved from   https://youtu.be/_n2YUhNg41M 
 
Personality disorders can   arise through trauma, and they often carry added stigma. In this Discussion,   you analyze a case study focused on a personality disorder while also   reflecting on how power, privilege, and stigma affect such diagnoses.
To prepare: Review “The Case of   Cathy” and consider your differential diagnostic process for her. Be sure to   consider any past diagnoses and what influence they might have on her current   diagnosis and needs. Finally, return to the Week 1 Discussion topic of stigma   and reflect on stigma related to personality disorders.
Discussion

Personality Disorders
Post by Day 4 a 300- to 500-word response in which you address the following:
• Provide the full DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
• Support your decision by identifying the symptoms which meet specific criteria for each diagnosis. 
• Identify any close differentials and why they were eliminated. Concisely support your decisions with the case materials and readings. 
• Explain how diagnosing a client with a personality disorder may affect their treatment. 
•  Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorders. 
• Identify how trauma affects the case, either precipitating the diagnosis and/or resulting from related symptoms or treatment of diagnosis. 

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