Case Study  on Abnormal Psychology

We conducted a psychological evaluation on Ms. Smith Smith, a 32-year-old biracial woman who graduated from high school and worked as a waitress. The young woman was found screaming, pacing, and weeping inconsolably outside a local apartment building on 5th Street by the local police after breaking up with her boyfriend. Having been raised in an indifferent and unloving environment, Ms. Smith struggled as a child and suffered from neglect and lack of food. Due to exposure to physical, mental, and emotional pain at an early age, Ms. Smith perceives judgment or rejection from others and becomes self-conscious and overreacts by lashing words at others.  To assess Ms. Smith, tools to be used include a clinical interview, Minnesota Multiphasic Personality Inventory (MMPI-2), and the Beck Inventories and Beck Depression Inventory. According to the DSM-5, Ms. Smith has Disruptive, Impulsive-Control, and Conduct. She is diagnosed with Intermittent Explosive Disorder. This disorder causes recurrent behavioral outbursts indicating an inability to control aggressive impulses exhibited by verbal hostility or physical injury. Possible psychosocial evidence-based treatment programs that psychologists would use on Ms. Smith include (MST), (FFT), and multidimensional treatment. The disorder appears to follow a chronic and persistent course over many years from early childhood. This makes Ms. Smith 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 with the condition.

Case Study  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. She had been 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 negligence, and 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 whom she believed had wronged her. Ms. Smith began drinking alcohol 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. She has 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

            A typical psychological assessment involves an interview and tests. In the case of Ms. Smith, I recommended using a clinical interview, which is a common assessment technique. This is where the psychologists ask the clients questions about their concerns and history, and their answers with observed data about how they interact with the environment are recorded. The psychologist is able to know Ms.Smith thought patterns, her reasoning, and how she interacts with other people. A clinical interview also helps observe 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. For instance, beliefs, moods, intellectual functioning, and awareness of surroundings will help the psychologist determine the type and nature of the client’s disorder.

I also recommend using the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Beck Inventories to conduct psychological tests. The MMPI-2 is used to measure the ailments that have characteristics of psychopathology, while Beck Inventories measure the severity of symptoms of a mental disorder (Rogers, Robinson, & Jackson, 2016). The MMPI-2 contains a scale of true and false statements for detecting ten illnesses, including depression, psychopathic deviate, hypochondriasis, schizophrenia, hypomania, social intoversion, and paranoia which might be relevant to Ms. Smith. The  Beck Anxiety Inventory measures the severity of anxiety symptoms using a self-reported test, focusing on the frequency with which a symptom has bothered a client (Celestine, 2021). Lastly, the  Beck Depression Inventory helps a psychologist ascertain whether the symptoms identified are within the normal range based on the current emotional state.

As explained, there are different resources available to conduct an assessment on Ms. Smith. Nevertheless, I recommend a holistic approach that uses more than one tool to form a valid or a “strong” hypothesis. Pyshciologitsts can use many online resources such as the online psychotherapy tool Quenza, which enables automation of the assessment and efficient collection and storage of data. Besides, the psychologist should regard both pre and post-treatment assessments using the various tools available.

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

Possible psychosocial evidence-based treatment programs that psychologists would use on Ms. Smith include multisystemic therapy (MST), functional family therapy (FFT), and multidimensional treatment (Hyatt-Burkhart et al., n.d.). The MST is a family-community-based approach that would help address Ms. Smith’s antisocial behaviors, as found by Weiss et al. (2013). The randomized controlled trial included 164 participants whose data were collected for two and half years and concluded that MST has a remarkable improvement in clients’ symptoms from family functioning and parent psychopathology measures (Weiss et al., 2013). Psychologists may also use functional family therapy (FFT), which was found to have a statistically significant reduction in recidivism, felony, violence, and an increase in positive interactions by clients and other people (Sexton & Turner, 2010). These results were consistent with Hyatt-Burkhart et al. (n.d) and Weiss et al. (2013). Lastly Sohn et al. (2014) administered an Obsessive-Compulsive Inventory Revised-Korean to 80 patients with OCD and 76 healthy control participants using the multidimensional treatment method explained by Hyatt-Burkhart et al. (n.d.). Sohn et al. (2014) found multidimensional treatment as one of the effective methods of reducing action impulsivity in OCD subjects. Therefore, multisystemic therapy (MST), functional family therapy (FFT), and multidimensional treatment are ideal evidence-based treatment programs for Ms. Smith.

Considerations

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 in terms of social issues such as losing 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 intermittent explosive disorder. 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.