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Stress Disorder Diagnosis and Analysis of an Example

Client’s Current Life Situations

The client, Clay Jensen, perceives the problem of his friend committing suicide irrationally, and his capacity to solve this problem seems to be weak. Clay perceives it extremely emotionally, feeling guilty and sorrowful for not being able to support her. The client fails to accept the situation as his behaviors show that he tries to visit the places they were in together. The physical appearance can be characterized by a lack of eye focus, trembling hands, and overall anxiety in behaviors. Clay has a history of anxiety, which impacted his relationships with peers. There is no history of drug abuse, serious illnesses, and injuries. As for his mental status, there are disturbances in thoughts (hallucinations and obsessive ideas) and poor awareness of the problem. The client’s issues are related to his role as a teenager and school student. He lives with his father as the parents divorced, but communication with the mother is present as well.

Interpersonal family issues include antisocial and introverted behaviors that led to misunderstanding and bullying from peers. Both parents are aware of the problem and consider that professional help is needed. The quality of the family interactions is high as the family members are close and open to each other. The analysis of interpersonal work and school issues reveals that Clay is an 11th-grade student, who works as a clerk. He had only one friend, while interpersonal issues with peers significantly affected his approach to making friends. Since the client was accused of being gay, it created barriers to communication, and Clay became even more introverted.

Client’s Context and Social Support Networks

The client’s environmental resources are good as he lives in his parents’ house and has proper access to food and transportation. However, he does not know about the community supporters and adaptation opportunities. There are no evident vulnerabilities in Clay’s environment that can worsen his mental state. The ethical and cultural considerations involve his Caucasian background and the mainly White neighborhood he lives in. No discrimination based on ethnicity is reported by the client and his father.

DSM-5 Diagnosis and Rationale

Based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is possible to diagnose Clay with Posttraumatic Stress Disorder (PTSD). The key symptoms of the client are the negative impacts of his friend’s death on his mood and thinking changes in reactions and intrusion symptoms. Clay repeatedly comes back to this event and considers that he was responsible for preventing it. These thoughts uncontrollably invade his mind, causing emotional distress and unwanted memories. Since the events occurred more than one month ago, and the client experiences the mentioned symptoms for several months, it is (PTSD Pai et al., 2017). Also, the symptoms lead to social and functional impairment as the client cannot concentrate on work and education.

Biopsychosocial Model

A biopsychosocial model implies using the interconnection between psychology, biology, and social factors to understand the reasons for developing a disease (Zide & Gray, 2016). In the case of Clay, the biological dimension is represented by his Caucasian origin, proper physical health, and no disability or genetic predispositions. Being an introverted and antisocial White male promoted the fact that his peers accused him of being gay. This risk factor probably increased anxiety and depressive symptoms. Living in a single-parent family and poor relationships with peers were social stress factors. A lack of developed coping skills, low self-esteem, little experience in communicating with people, and a history of depressive episodes are psychological risk issues. Nevertheless, protective factors include good relationships with both parents, the involvement of parents in their son’s care, and timely referral to social work.

Theoretical Formulation

An emotional processing theory states that clients with more rigid attitudes to life before trauma are likely to have more serious expressions of PTSD (Kichic & D’Alessio, 2016). Such people are more vulnerable to experiencing the senses of loss and frustration as a result of perceiving themselves as incompetent (Alpert et al., 2021). At the same time, they perceive the world as a place where everything is dangerous (Pinheiro et al., 2018). As for Clay, he had a history of mistreatment from peers, which might make him feel lonely and alienated. Accordingly, his PTSD can be explained in terms of his previous emotions, and it helps to understand his depressive feelings and behaviors. After the loss of their only friend, the client probably feels that he would never have friends in the future. Nevertheless, these assumptions should be clarified while providing cognitive-behavioral therapy (CBT) (Simon et al., 2019; Zide & Gray, 2016).

Intervention

CBT can be recommended for Clay to help him in coping with stress and anxiety symptoms. According to the emotional processing theory, people who experience traumatic events build associations between safety reminders and changing them leads to psychological improvements (Guideline Development Panel for the Treatment, 2019). By understanding the client’s trauma, a professional would choose relevant narrative and behavioral strategies. The purpose of applying CBT to Clay is to return a sense of self-control and avoid obsessive thoughts. From a long-term perspective, it is expected that the client would learn self-copying methods to develop skills and knowledge to prevent PTSD symptoms in case of further traumatic events.

References

Alpert, E., Hayes, A. M., Yasinski, C., Webb, C., & Deblinger, E. (2021). Processes of change in trauma-focused cognitive behavioral therapy for youth: An emotional processing theory-informed approach. Clinical psychological science: a journal of the Association for Psychological Science, 9(2), 270-283.

Guideline Development Panel for the Treatment, G. D. P. (2019). Summary of the clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. The American Psychologist, 74(5), 596-607.

Kichic, R., & D’Alessio, N. (2016). Emotional processing theory and prolonged exposure therapy for posttraumatic stress disorder. Vertex (Buenos Aires, Argentina), 27(126), 133-141.

Pai, A., Suris, A. M., & North, C. S. (2017). Posttraumatic stress disorder in the DSM-5: Controversy, change, and conceptual considerations. Behavioral Sciences, 7(1), 1-7.

Pinheiro, P., Mendes, I., Silva, S., Gonçalves, M. M., & Salgado, J. (2018). Emotional processing and therapeutic change in depression: A case study. Psychotherapy, 55(3), 263-274.

Simon, N., McGillivray, L., Roberts, N. P., Barawi, K., Lewis, C. E., & Bisson, J. I. (2019). Acceptability of internet-based cognitive behavioral therapy (i-CBT) for post-traumatic stress disorder (PTSD): A systematic review. European Journal of Psychotraumatology, 10(1). Web.

Zide, M. R., & Gray, S. W. (2016). Psychopathology: A competency-based assessment model for social workers. Australia: Brooks/Cole.

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