Case Study  on Abnormal Psychology

Ms. Smith’s Psychological Evaluation

Reason for Referral

Ms. Smith was referred to Dr. Liam for psychological evaluation due to immediate concerns about the risk of self-harm. After being found screaming, pacing, and weeping inconsolably outside a local apartment building on 5^th Street by the local police. Ms. Smith had multiple treats for cuts on her arms. She was taken to the hospital by the local police on 3/18/2019 for further observation.

Ms. Smith is a 32-year-old biracial woman who graduated from high school and worked as a waitress. She had relocated to town a month before, looking for a new beginning. Her family has a history of mental health disorders and anger management issues that have been linked to the use of illegal substances. She has seen several therapists over the years but has yet to find one that truly understands her and can help her change.

Background Summary

Ms. Smith was raised in an indifferent and unloving environment. Helen Taylor and Jake Smith, Ms. Smith’s parents, have a history of heroin addiction. Ms. Smith was born normal and healthy, despite the mother’s dread of doctors and lack of financial security during the pregnancy. Ms. Taylor was uninterested in being a mother, and when Ms. Smith was eight months old, she was abandoned in Mr. Smith’s care. Her father married a stepmother, and she grew up with her stepmother and father until she was 18 years old. She struggled as a child with her stepmother’s ignorance and her confusion about why her mother abandoned her. She also suffered from malnutrition due to a lack of food at home.

Ms. Smith suffered from bouts of self-loathing between 7 and 17 and wanted a permanent end to her mental, emotional, and physical pain. If she perceived judgment or rejection from others, she became self-centered and overreacted. She would lash out at anyone who she believed had wronged her. Ms. Smith began drinking to cope with the sorrow and emotional emptiness she was experiencing at the time. Her family has a history of mental health disorders and anger management issues that have been linked to the use of illegal substances. She has seen several therapists over the years but has yet to find one that truly understands her and can help her change. Ms. Smith excels in the arts, music, and writing. Her relationships have tended to be fleeting, with her idealizing the person then quickly demonizing and demanding that person.

Ms. Smith is now employed as a waitress, but she wishes to pursue a career in the music industry. She’s always had a knack for the written word. This is her fourth “remaking of herself” in 18 months.

Ms. Smith is the subject of a restraining order issued by the state of California. The order is to keep a distance of over 100 feet between you and a former romantic interest. Ms. Smith expressed her disappointment that her adoration was viewed as unduly demanding, and she blamed the relationship’s demise on the fact that the individual was married.

Ms. Smith is a 32-year-old multiracial woman with a tiny build and average height. She arrived anxiously and dressed in what appeared to be soiled clothes for the evaluation. Ms. Smith’s mental processes were linked, but the rationale she used to make decisions was not always consistent. During this examination, no signs of visual or hearing impairment were found. Ms. Smith’s walk and tempo changed throughout the session, reflecting her mood swings. She expressed suicidal thoughts but not homicidal ones. Her demeanor fluctuates quickly depending on the topic of conversation. Her thoughts were occasionally divergent.

Assessment Data

Clinical consultation

This would be a face-to-face meeting between Ms. Smith and a mental health expert. The former observes her and collects information about her actions, attitudes, current position, personality, and past life. Unstructured interviews with open-ended inquiries are possible and structured interviews with particular questions. The patient will be assessed using questions that assess his or her look and behavior.

Grooming and body posture, mental process, and content, including disorganized speech or thoughts. Others include incorrect beliefs, moods, and consequences such as feeling sad or glad, intellectual functioning, and awareness of surroundings are all aspects of appearance and behavior. This will aid the professional in determining which areas require additional investigation.

Psychological assessments and inventories

Ms. Smith’s personality, social skills, cognitive abilities, emotions, behavioral responses, and interests will be assessed with this test. The Projective and Thematic Apperception Tests are two options for the professional. The specialist can use the reaction to get insight into the patient’s concerns, needs, emotions, and conflicts.

Personality assessment

It involves asking the patient whether each phrase in a long list pertains to them, and it may include questions on feelings, behavior, or beliefs.

Neurological Examinations

The test is designed to determine whether or not a person’s cognitive abilities have been harmed by brain damage caused by tumors, infection, or changes in brain activity. These tests can detect structural abnormalities in the nervous system, such as brain and spinal cord tumors, in diseases like multiple sclerosis.

Physical examination

A physical examination is similar to a routine checkup. Type, hypertension, and tachycardia are all examined vital signs. The mental state was evaluated for signs of confusion and inattention in particular. A physical examination is essential because it can reveal whether something else, such as a thyroid disorder or a neurological issue, is at play. Detecting such diseases can help you avoid expensive therapy or surgery.

 Behavioral Assessment

The test stresses direct observation of the patient. Observing the antecedents, the relevant behaviors, and the effects of the behavior are common. This evaluation seeks to uncover as many elements as possible that could be influencing Ms. Smith’s issue behavior and develop hypotheses about which ones are the most essential and easiest to alter.

Intelligence Tests

Ms. Smith’s cognitive functioning would be determined by this exam. The patient is asked to employ both verbal and nonverbal skills in intelligence testing.

Tentative Diagnosis

Ms. Smith has Disruptive, Impulsive-Control, and Conduct, according to the DSM-5.

Ms. Smith appears to have Intermittent Explosive Disorder, based on the diagnosis. Recurrent behavioral outbursts indicating an inability to control aggressive impulses exhibited by verbal hostility or physical injury are among the criteria for diagnosing this disease (Dziegielewski, n.d.). The intensity of the frequent outbursts of hostility is disproportional to the provision or any triggered psychological stressor. The frequent hostile outbursts are not calculated and are not directed toward a specific goal. The individual is either distressed by the recurrent aggressive outburst (Dziegielewski, n.d.). This diagnosis can be made in conjunction with ADD/ADHD, conduct disorder, oppositional defiant disorder, or autistic spectrum disorder. The condition makes the person more prone to depression, anxiety, and alcohol and drug abuse.

Ms. Smith’s inability to control impulsive aggressive behavior in reaction to negatively experienced stimuli would not normally result in an aggressive outburst (Dziegielewski, n.d.). Ms. Smith’s aggressive outburst is impulsive and anger-based rather than calculated, and it is connected with severe distress, e.g. ( after breaking up with frank, after sensing rejection or judgment from others, if a partner refuses to reply to her text as she expects)

Ms. Smith demand sustained effort and attention from her partners. She shows depressive and bipolar disorder involving negative affect and irritability if one does not reply to her text the way she wants. The disorder makes Ms. Smith react with a high rate of anger in case she senses rejection or her demands are not met (Dziegielewski, n.d.). Ms. Smith has social phobia due to fear of negative evaluation from other people associated with the disorder. Besides countering rejection emotion emptiness, M.s Smith indulges herself in alcohol as a comfort.

Treatment Recommendation

The best treatment that would be the ethical choice for Ms. Smith is going to a psychiatrist. The psychiatrist uses a variety of treatments such as psychotherapy medication, psychosocial intervention, and other treatments depending on the need of each patient.

Cognitive behavioral therapy, relaxation training, cognitive restriction, coping skills training, and medicines are the best treatments for intermittent explosive disorder.Talk therapy is a type of psychotherapy that helps people determine which conditions or behaviors cause them to become aggressive (Mayoclinic, 2022). In addition, the patient learns how to regulate improper behaviors and manage anger by adopting tactics such as relaxation training, thinking differently about the situation, and applying communication and problem-solving skills (Sherrell, 2022). Medications that can help treat Ms. Smith’s disorder include using antidepressants or other drugs if needed.

Considerations

Developmental consideration

The onset of recurrent, problematic impulsive behavior is most common in late childhood and persists and continues for many years. The disorder appears to follow a chronic and persistent course over many years. M.s Smith reports to have experienced a disturbing childhood; she is neglected and ignored and faces physical abuse from her stepmother. Besides, the family she grows up in has a history of anger problems.

Social-cultural consideration

Social issues such as loss of friends. Ms. Smith reports being left by multiple partners and cannot afford to break up with Frank as she feels empty, powerless, and worthless. Besides, she has reinstated orders against her in San Diego, CA, filed by some of her partners. This problem often develops as a result of the intermittent explosive disorder.

Ethical considerations

M.s Smith is charming and thoughtful and polite, and cooperative at one moment. However, she becomes sarcastic or argumentative. Cognitive-behavioral therapy can help her understand her anger triggers, develop and practice coping skills, and think, feel, and act differently in response to anger, allowing her to feel calmer and more in control.

Conclusion

Ms. Smith has a condition known as Intermittent Explosive Disorder (IED). This disorder causes her to have poor emotional control and disproportionately violent outbursts in response to a provocation or other psychosocial pressures. Her inability to manage aggressive impulses manifests itself in physical injury or hostility. The frequent hostile outbursts are not calculated and are not directed toward a specific goal. The disorder appears to follow a chronic and persistent course over many years from early childhood. This makes her insecure and hostile if she senses rejection from other people. Ms. Smith’s ideal treatment would be to see a psychiatrist who could help her understand her anger triggers, learn and practice coping strategies, and think, feel, and behave differently in response to anger so that she can become calmer and more in control.   

References

Dziegielewski, S. DSM-5 in action (5th ed.).

Mayoclinic. (2022). Intermittent explosive disorder – Diagnosis and treatment – Mayo Clinic. Mayoclinic.org. Retrieved 26 April 2022, from https://www.mayoclinic.org/diseases-conditions/intermittent-explosive-disorder/diagnosis-treatment/drc-20373926.

Sherrell, Z. (2022). Intermittent explosive disorder: Causes, symptoms, and treatment. Medicalnewstoday.com. Retrieved 26 April 2022, from https://www.medicalnewstoday.com/articles/intermittent-explosive-disorder.