Diagnosis of a Psychology - Case Study Example

After carefully reviewing the diagnostic criteria, I have concluded that Amy possibly suffers from an Axis II personality disorder known as Avoidant Personality Disorder (301.82). The following represent the reasons why it seems likely that Amy is suffering from this disorder, and why the other diagnoses were considered and rejected. A person suffering from Avoidant Personality Disorder is marked by at least four of the following characteristics: 1) Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection; 2) Unwilling to get socially involved unless certain of being liked; 3) Restrained in intimate relationships because of fear of being shamed or ridiculed; 4) Preoccupied with being criticized or rejected in social situations; 5) Inhibited in novel social situations because of feelings of inadequacy; 6) Views self as inept, unappealing or inferior to others; 7) Unusually reluctant to take personal risks or engage in new activities because they may prove embarrassing. (American Psychiatric Association, 2000, p. 718). Amy exhibits at least four of these characteristics. She is restrained in her intimate relationships with her husband and her mother because of her fear of being shamed or ridiculed. This is particularly true with her mother, as her mother seems to be the cause of Amy’s insecurities and problems. It states that Amy does not share decisions with her mother anymore. As far as her intimate relationship with her husband, it is restrained in that she does not deflect his criticisms towards their children, and she appears to avoid conflict with him. It states that her restraint in her relationships with her husband and mother stem from a need to avoid shame and ridicule, as evidenced by her anxious thoughts that she has with her husband and that she does not share decisions with her mother because her mother made her feel wrong when she disregarded her mother’s advice in the past. Amy also seems to be preoccupied with being criticized or rejected in social situations. She states that she is desperate for acceptance by people, becomes friends then rejects them. It states that she builds things up in her mind. Although this is an ambiguous statement – what does she build up in her mind? – it sounds as if she might believe that the other people do not accept her somehow. From the way the case study is worded, it is difficult to ascertain exactly what happened between Amy and her new social friends, but it does sound as if Amy does not keep these friends for long, as it states that she made friends “initially.” The case study also states that she possibly socializes with the minister at her church, to whom she is attracted, but that she feels inferior, stupid and nervous around the minister and wants to leave the church because of it. This shows that she is preoccupied with maybe being criticized or rejected by the minister, and this would also fulfill this characteristic of the DSM-IV. There is also indication that Amy is inhibited in novel social situations because of her feelings of inadequacy. Again, the fact that she appears not to have friends because she “built things up in [her] mind” shows that she is inhibited in these social situations because she feels inadequate in some way to these other individuals. It also states that she did not really date at all before marrying at the age of 22. This seems unusual, in that most people start dating well before the age of 22, and Amy did not. This would seem to indicate that she was hesitant to date, as this is a novel social situation, and this is probably because of her feelings of inadequacy, as the fact that Amy feels inadequate is very prevalent in this case study. The case study also indicated that Amy was isolated when she worked as a nurse. This seems unusual, as nursing is a very people oriented job and socializing is presumably common among nurses, especially in a hospital. This fact would seem to indicate that Amy did not socialize with other nurses or with other medical personnel, and this gives credence to the theory that Amy is inhibited in novel social situations because she felt inferior and inadequate. Also, the fact she felt that she would kill a patient because of her negligence shows that she felt inadequate at that job, so this would further lend credence to the theory that Amy did not socialize when she was a nurse because of her inadequacy. The fourth characteristic that Amy displays is that she views self as inept, unappealing or inferior to others. This is a definite characteristic that she displays. She compares herself to others in the church, and feels that if she is not praised, she has failed. She feels inferior to her minister, and, seemingly, to her husband, as she is always viewing herself as a failure around him. Amy also stated that she felt inferiority in general, and that she “learned” this characteristic from her mother. As far as disorders that were rejected, nothing else seemed to fit. There was no indication of mania, so bi-polar is not indicated. I considered major depressive disorder, but Amy would have to present with either a depressed mood or loss of interest or pleasure in nearly all activities, in addition to four of the following: changes in appetite or weight, sleep or psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating or making decisions; or recurrent thoughts of death or suicidal ideation, plans or attempts.(American Psychiatric Association, 2000, p. 349). As there is no indication of a depressed mood or loss of interest in nearly all activities, as she does at least go to church on a regular basis, Amy does not fit this description. Moreover, she does not present with most of the other characteristics, except for the feeling of worthlessness or guilt. There are some indications that Amy might be suffering from Dysthmic Disorder, as she has low self-esteem and feelings of hopelessness, and there is a great deal of self-criticism. (American Psychiatric Association, 2000, p. 377). However, there is little indication of a depressed mood, as she does not necessarily describe herself as sad so much as anxious. Still, this diagnosis should be ruled out and considered a potential differential diagnosis. Another diagnosis to rule out is obsessive-compulsive disorder. (American Psychiatric Association, 2000, p. 456) Amy does seem to suffer from obsessive thoughts that center around her possible failure and inadequacies, and she did display compulsive behavior at her nurse’s job. However, she was not experiencing compulsive behavior at the time of this case study, and her thoughts may not be obsessive – this is unclear whether she ruminates constantly about her feelings of inadequacy and doubt. Yet another diagnosis that was considered, but ultimately rejected, was Generalized Anxiety Disorder. Although Amy did present with significant anxiety, she does not display three of the following characteristics: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep. (American Psychiatric Association, 2000, p. 472). In fact, she did not complain of any of these symptoms, therefore Generalized Anxiety Disorder can be ruled out. Amy does not display any Axis III or IV complications – no underlying medical problems, nor significant psychosocial or environmental problems. Multi-Axial Evaluation: Axis I – 300.4 Possible Dysthmic Disorder Axis II - 301.82 Avoidant Personality Disorder .300.3 Possible Obsessive-Compulsive Disorder Axis III - None Axis IV - None Axis V - GAF=55. Amy gets a 55 on the Axis V rating, because she shows moderate difficulty in social, occupational or school functioning, as she has few friends and conflicts with her peers. BIBLIOGRAPHY American Psychiatric Association (2000). DSM-IV TR. Washington, D.C.: American Psychiatric Association. Read More