Case Study of Mood Disorders
Case Study of Mood Disorders
In this paper, we aim to assess ourselves and study the case presented to us. By using the learned diagnosis tools, and the DSM, we shall give a diagnosis, and offer counseling tools. Maria is a 23-year-old female who came to her first psychiatric evaluation after being found wandering in the night. We shall recap the case study to have a better understanding of it, and to signal the key points that would help us in our paper. In the first place, Maria states that she has been having increased anxiety for the past three months since she broke up with her last boyfriend. After the breakup, she has been feeling “outside” of her body, and very anxious. In the same way, that feeling of depersonalization has made her feel like an “empty shell”. Also, she has felt that she cannot be content, and truly happy with herself. Maria has also lost her job, probably given to this depersonalization. She also stated that her former boss “never really liked her”. Also, her grandmother was diagnosed with schizophrenia, and her mother suffered from panic attacks.
After reviewing the case, and the available literature, we consider that Maria suffers from depersonalization syndrome. We base our consideration after reviewing the sources, and the available literature.
Discussion of the Maria’s Diagnosis
Depersonalization is defined as subjective experiences of unreality in one’s sense of self. The symptoms described were already known in the early works of psychopathology by the term autoscopia (Hoyer et al., 2012). Depersonalization occurs on a continuum that range from transient episodes in healthy individuals under specific conditions, to mental and emotional disorders. Depersonalization in its maximal expressions may include symptoms such as Emotional numbing; lack of empathy; a sense of isolation; a dream-like state; impaired concentration; “mind numbness”; memory impairments; difficulties in processing new information; dizziness and sensory distortions; and altered perceptions (American Psychiatric Association, 2002).
People who suffer depersonalization typically report as if they were spectators in their own life. When we spotted one of the first of Maria’s symptoms “Since the break-up, Maria has felt “outside” of her body and very anxious”. According to Sacco (2010) People suffering from depersonalization report feeling as spectators in their own life. They see themselves as if they were observing from the distance. Sufferers of depersonalization feel they might lose control over their thoughts, and actions. They feel as if they were going crazy. Nevertheless, when people are suffering from depersonalization, their capacity of testing the reality, remains intact. In the same way, people suffering from depersonalization report marked distress or impairment in social, occupational and other functions that require interactions with others (Hunter, Sierra & David, 2004). In the same way, according to Medford et al., (2005), depersonalization disorder involves unpleasant, chronic, and disabling alterations in the experience of self, and what surrounds us.
Depersonalization also includes alterations in the bodily sensations and the loss of emotional reactivity. The disorder has an approximately 1:1 gender ratio, with onset at around 16 years of age. In the same way, mood; anxiety, and personality disorders are comorbid with depersonalization, but none of them predict that the condition could worsen, The most common immediate precipitants of the disorder are: stress; panic; depression, and the hallucinations provoked by the ingest of a psychotropic drug (Simeon, 2004).
In another note, it is important not to forget the family factors. For instance, if her grandmother is schizophrenic, that may add a genetic risk. Also, her mother’s pain attacks give us a clue about our patient’s background. Our subject was not under the influence of any drug, and after reviewing our sources testimony, we consider that Maria is suffering from depersonalization syndrome triggered by social anxiety, caused by her break-up.
To be sure of our diagnosis, we shall consult the DSM-IV (American Psychiatry Association, 2002) to see if our patient’s diagnosis is correct.
A. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling like one is in a dream). The study made to the patient shows she is suffering from a detachment from the body.
B. During the depersonalization experience, reality testing remains intact. The patient remained in contact with the reality all the time
C. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The patient was not able neither to perform socially nor to hold her job.
D. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder,Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy). The patient does not suffer from another disorder, nor was under the influence of any drug.
After reviewing the criteria, we have enough evidence to state that our patient is suffering from depersonalization syndrome.
Discussion of the Differential Diagnosis
Since the symptoms of depersonalization are still present, we shall begin our evaluation. By checking her complete medical history and a physical exam. Although there are not lab tests that specifically diagnose dissociative disorders. However, there are tests that can be done to rule out physical illnesses or medication. If the symptoms cannot be ruled out by the tests, the patient should be directed to a psychiatrist or a psychologist. Differential diagnosis refers to the determination between two or more similar diseases and given the fact that in psychology, many diseases share common symptoms, can be quite hard to diagnose some disorders.
Maria is a young female of 23 years old, who was observed wandering aimlessly in a bridge and brought to the hospital. Upon the mental examination, her symptoms are Anxiety; the feeling of being out of her body, and emotional apathy from as long as she could remember. The anxiety has grown from the past three months, and the symptoms are getting worse. The patient has been feeling this emotional detachment, and she would go to bars and meet men, and bring them home, a situation that angered her roommates. Also, she lost her job, which did not matter much to her. After reviewing the symptoms, we consider that neither the sex nor the age has to be with what she is suffering. In the same way, it has been hard for Maria to stay in one place, as she does not feel attached and keeps drifting. After gathering the information, the patient’s history, and the relevant information, the following differential diagnosis can be posted.
1. Schizophrenia: Given her family background, we considered that schizophrenia could be a diagnosis. Besides, the patient suffered from disorganized speech and grossly disorganized behavior
2. Social Phobia: Since the symptoms observed were triggered after her break-up, we consider that social phobia could be one of the possible diagnosis.
3. Depersonalization Syndrome: The patient suffered from a sense of isolation; suffered from impaired concentration, and the feeling of being away from her body.
Discuss the Contributing Factors Leading to the Development of this Issue.
The onset of the typical case of depersonalization is acute and insidious. When the illness is acute, the individuals recall the exact moment, setting and circumstance that triggered the disorder. In the same way, after a prolonged period of time, another mental conditions, such as panic attacks, or depression can turn into depersonalization syndrome. The illness can be gradual, and become more pronounced. (Simeon, 2004). In a third of the individuals, the syndrome is episodical, with each episode lasting from hours to days. Also, the feeling of detachment from the people can contribute to the development of this issue. Regarding environmental factors that could have triggered the symptoms, we found that the successive break-ups with different men might have triggered anxiety that led to the eventual depersonalization.
Describe a treatment plan for the Patient.
Most people who seek treatment are concerned about symptoms such as depression, or anxiety, instead of the actual disorder. In many cases, the symptoms will go away over time. Treatment is only needed when the symptoms are severe, lasting, or recurrent. Psychodynamic psychotherapy, cognitive-behavioral therapy have been effective to some people, to others psychoanalysis have been useful. On the other hand, there are pharmacological treatments that can be used. In the psychotherapeutically side, we find cognitive therapies that can help blocking obsessive thinking about the state of being. Behavioral techniques engage in repetitive activities that distract people from depersonalization. Finally, psychodynamic techniques can be used to focus on helping people working through their intolerable conflicts, which are not part of the consciousness. However, psychotherapeutic treatments have not shown proved efficacy toward our depersonalization syndrome (Simeon, 2004). There are also pharmacological methods that can be used. Among them, we have found that the usage of antidepressants or anti-anxiety drugs has helped in relieving the symptoms associated with depersonalization. In the same light, barbituric and antipsychotics can be used if the depersonalization is in its acute phase. (Simeon, 2004)
Discuss Prognosis for Individuals Living with the Disorder
In the existent literature, we have found that the depersonalization syndrome can either disappear by its own means or stay and become a chronic illness. (Sacco, 2010). In cases where the syndrome disappears, the patients are expected to live a complete, and fulfilling life. On the other hand it is possible that the syndrome becomes chronical, and stays with the patient. To assess ourselves in the particular, we found an interview done in Psychology Today in the year of 2012. The interviewee said that the most important part was accepting the syndrome and understanding that it might be a life condition. The hardest part is learning to cope with the moments of depersonalization where the person feels it is not her body what is touching things, and that the person doing the actions does not feel like her. People suffering from depersonalization act normal and normally talk, but the feeling of estrangement is intense. (Bezzubova, 2012). In the same way, it might be frightening to feel like an outsider in your own body, that is why sufferers have to find methods to cope with their anxiety so they can return to their normal self. Likewise, through counseling, and medical treatment, a significant improvement can occur.
After ruling out the other possible syndromes and illnesses, we consider that Maria is suffering from depersonalization syndrome. The symptoms are clear, and despite not knowing if the depersonalization moments are recurrent, we advise that she is treated accordingly. It is possible that this was just an episode, triggered by the anxiety suffered, but since she has been feeling increasingly bad with the time, we consider that she might have another episode. However, since her cognitive responses seem to be fine, we expect that she recovers and seeks counseling. Nevertheless, since she has not done it so far, it is possible that she does not do it. In her situation, and with the background she presents, we consider that the best way to treat her would be with psychodynamic therapy, so she understands the roots of the syndrome, and how to deal with it, and the emotions that might trigger it. On the other hand, if Maria suffers chronic episodes of the disease, the practitioner would have to find a way to stop the episodes from happening, without lessening the patient’s life quality. That is why we consider that therapy and coping mechanisms can be better than pharmacological methods, in help with the syndrome.
Hoyer, J., Braeuer, D., Crawcour, S., Klumbies, E., &Kirschbaum, C. (2012). Depersonalization/ derealization during acute social stress in social phobia. Journal of Anxiety Disorders, 27, 178-187. Retrieved from http://p113367.typo3server.info/uploads/media/Hoyer_Klumbies_Kirschbaum_2013_Depersonalization_derealization_during_actue_social_stress_in_social_phobia.pdf
Hunter, E. C. M., Sierra, M. & David, A. S. (2004). The epidemiology of depersonalisation and derealisation: A Systematic Review. Social Psychiatry and Psychiatric Epidemiology, 39, 9–18.
Medford, N. (2005). Understanding And Treating Depersonalisation Disorder. Advances in Psychiatric Treatment, 92-100. Retrieved April 29, 2015.
Sacco, R. (2010). The Circumplex Structure of Depersonalization/Derealization. International Journal of Psychological Studies, 2(2), 1-40. Retrieved from http://www.ccsenet.org/journal/index.php/ijps/article/viewFile/6837/6422
Simeon, D. (2004). Depersonalisation Disorder. CNS Drugs, 18(6), 343-354. Retrieved from http://depersonalizace.info/file/2004.pdf
Spitzer, R. (2002). DSM-IV-TR casebook: A learning companion to the Diagnostic and statistical manual of mental disorders, Fourth edition, text revision. Washington, DC: American Psychiatric Pub.