AnnaTruttier_u05a1_DiagnosticSkillApplication

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1 Diagnostic Skill Application Anna Truttier School of Counseling; Capella University COUN5107 Principles of Psychopathology Dr. Thomas February 12, 2023

2 Unit 5 Diagnostic Skill Application Throughout this paper, two cases will be presented; Jenny and Marisol. Each of these women is experiencing debilitating symptoms that interfere with their daily lives. Jenny parted ways with her boyfriend and moved back in with her mother. She is presenting issues of having low energy, loss of interest in things that she once loved, lack of motivation, feelings of hopelessness, and like there is a dark cloud hanging over her, and she feels like no matter what she does, it is never enough. Marisol’s presenting issue is panic, especially when in large crowds. It feels as if everyone is judging her. She fears what people think of her, gets anxious and excited, and can not seem to think straight. She passed up on a promotion because she feared what her colleagues would say. To begin treatment for Jenny and Marisol, a few things must occur. Identifying both Jenny and Marisols presenting concerns, including biological and neurological impact, examining methods used for their differential diagnoses, identifying assessments that correspond best with them, relating to the DSM and ICD codes to support their findings, and a medical referral if necessary. Presenting Concerns: Case of Jenny Jenny is experiencing many abnormalities that would qualify as dysfunction. According to Nolen-Hoeksema (2019), the four D’s explain a person’s abnormalities; dysfunction, distress, deviance, and dangerousness. This means that when a person’s thoughts and feelings begin to interfere with their daily life and are debilitating from completing mundane tasks, the term dysfunction begins to arise. In Jenny’s case, she presents many symptoms that would concern any professional counselor. Throughout Jenny’s first session, she used the terms “what is the point,” “why even bother,” and “hopelessness.” These three words might seem minor, but they provide much

3 insight into a person's mental health. Jenny tries many things to feel better about herself, but nothing seems to work for her. She once enjoyed being outside and enjoying the sunshine, but that even feels useless. Jenny recently amicably parted ways with her partner and moved back into her mother’s home. She sleeps a lot, thinks that there is a dark cloud hanging over her head, and everything goes wrong no matter what she does; she has no energy, lacks the motivation to interact with friends, and tries to eat but lacks an appetite. As mentioned above, dysfunction is identified when the person’s symptoms impede their life. Jenny’s symptoms are doing just that. Many contributing factors could help understand Jenny’s symptoms. Two leading proponents could be Biological and Neurological causes. Biologically it is known that those with a family history of depression puts them at a higher predisposition. According to Nolen-Hoeksema (2019), family history studies find that the first- degree relatives of people with a major depressive disorder are two to three times more likely to have depression than the first-degree relatives of people without the condition. However, we do not have enough information to ultimately say that Jenny’s first-degree family has a history of mood disorders. Although it is essential to keep this in mind as the therapeutic process continues. With this knowledge, it is also critical to look at our brain and its functions. It is safe to say that multiple genetic abnormalities play a role in a person’s depression. Several studies suggest that abnormalities in the serotonin transporter gene could lead to dysfunction in the regulation of serotonin, which contributes to a person’s mood stability (Nolen- Hoeksema, 2019). Jenny’s presenting symptoms could explain her feelings of “hopelessness” and the fact that she feels like “always a dark cloud” is hanging over her head. Mood disorders are complex and need appropriate tools to help proceed. Tools like the DSM-5 and the Differential diagnosis by the Trees are used to help make concrete decisions on a person’s diagnosis.

4 Differential Diagnosis: Case of Jenny Using the Differential diagnosis by the Trees helps to identify treatment plans and the foundation of any clinical process. For Jenny, it is essential to rule out and understand leading candidates, eliminate others, and not jump to any hasty diagnoses. According to recent research, clinicians conclude in the first five minutes of interacting with a client. Then they spend the remainder trying to justify their diagnoses (Differential Diagnosis by the Trees, 2013). That is why using the differential diagnosis by the Trees is essential. To provide accurate and appropriate care for her needs, examine her presenting symptoms and work backward. The appropriate decision tree in Jenny’s case is using the decision tree for depressed mood. This tree was chosen not on a whim but with thought, Jenny’s symptoms and well-being in mind. Understand that her symptoms do show signs of being depressed, but it is also essential to know and recognize that these symptoms could be a result of a period in Jenny’s life that she is struggling to regulate. Using the differential diagnosis tree will flow through the chart to understand it more clearly. She is starting with the symptoms assessing that Jenny’s presenting issues do not stem from any form of medications or medical conditions. Confirming that her symptoms are not contingent on these, continuing to flow through the chart next, we observe that for at least two weeks, Jenny has experienced a depressed mood and diminished interest in weight loss and gain. Jenny also does not meet the requirements for manic episodes. So progressing and flowing through the chart, the following symptom to observe on the tree is a depressed mood, more days than not, for at least two years with associated symptoms. Moving along the chart, it is not conclusive that these symptoms have been going on for an extended time. Jenny states it has been going on for “awhile” If these symptoms have been going on for more than two weeks of depressed mood or diminished interest plus symptoms

5 associated with loss of appetite, changes in sleep behavior, fatigue, etc. (Differential Diagnosis by the Trees, 2013) then the flow chart would bring us to “Major Depressive Disorder.” Different checklists and assessments of Jenny will allow for a more conclusive understanding. Symptom Checklists: Case of Jenny The Beck Depression Inventory-Second Edition is a twenty-one self-report item constructed to quantify a person’s depressive symptoms. While this is a widely used assessment, it is essential to denounce that this checklist is primarily used as a baseline or a screening instrument. According to Erford et al. (2016), the BDI-II is a depression screening instrument and should not be used alone to diagnose depression. The reason for choosing BDI-II is that it has significant signs of validity across the board for those that show symptoms of depression. Multiple studies have found an 80% accuracy rate in assisting in diagnosis and treatment (Erford et al., 2016). As stated above, BDI-II is a twenty-one self-reported item assessment. Jenny and her counselor can do this together. This scale is set on a four-point scale from 0(not at all) to 3(severely). This assessment will help further focus on issues that Jenny has presented, such as loss of interest, “hopelessness,” “what is the point,” and “why even bother,” which can be interpreted as symptoms of depression. Furthermore, administering this assessment to Jenny will help her counselor with a proper treatment plan, give Jenny a baseline, and see if further or additional interventions are necessary. Systemic Assessments: Case of Jenny A person’s family system plays an essential role in an individual’s life. The family is a framework of how individuals see the world. A person can learn how to trust others, how to form bonds and friendships, how to socialize, how to cope, how to build emotional skills, etc. If these foundational blocks are damaged, it can emotionally damage the family system. Family

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