Psychological Disorders in Context

After you read each of the following four case studies, discuss and answer the questions below the case regarding the problem(s) that may or may not be present. Feel free to use your textbook or any other notes/resources you may have.  Remember, not every case will necessarily present you with a specific disorder and some may present you with more than one disorder (what we refer to as “comorbid” disorders).

Case #1

Jim is a 31-year old successful salesman. He was referred by the nurse practitioner in his physician’s office. He complains of muscle tension, headaches, and difficulty sleeping. He worries about not having enough money for his family in the event he dies suddenly or is fired from his job. He worries about job stability and feels he would be unable to get another job that paid as well. In fact, he is extremely bothered by a constant preoccupation with the possibility that he might inadvertently start screaming at his boss for no reason. To make sure he doesn’t actually start doing this, he often goes way out of his way to avoid any contact with his boss. He even goes so far as to miss important meetings where his boss is likely to be present.

 

He has elevated blood pressure, heart palpitations, and has now missed several work deadlines because of all his worrying and preoccupations. Jim’s friends describe him as a “constant worry-wart” who is always planning for that one “disaster” that never actually comes. Jim states that he tries to stop worrying, but can’t seem to make himself stop. His worrying has begun to interfere significantly with his ability to perform his job, enjoy time with his family, or engage in any of the hobbies that he once enjoyed.

  • Based on the symptoms presented in Jim’s case and the four key criteria for determining whether behavior is abnormal, would you say that Jim has a psychological disorder?  Why or why not?

It appears to me that Jim has a disorder. Excessive worrying and difficulty sleeping seem to be signs of atypical behavior. His physiological reactions he is experiencing, muscle tension, headaches, elevated blood pressure, and heart palpitations, seem to be abnormal for a healthy person. Jim’s tendency to miss important meetings so that he will not see his boss and his fear of screaming at his boss do not seem to be very rational. Rational behavior would seek better ways to avoid such problems. The fact that his behaviors are interfering with his ability to do his job , enjoy time with his family, or engage in his regular hobbies indicate that his behavior is maladaptive. Lastly, he says that he is distressed by his behavior. When the patient or those around him are distressed by a person’s behavior, it is a good indicator that the person could have a mental disorder.

If you answered yes, what disorder (if any) should be considered? Explain why you chose this disorder.

Jim shows signs of suffering from Generalized Anxiety Disorder.  Jim worries constantly and this indicates that he suffers anxiety. His fears seem to come from many general areas and not one specific source. This indicates a more general fear which is linked to GAD. Jim cannot stop his own behavior which is a symptom of GAD.

Case #2

Martin is a 21 year-old business major at a large university. Over the past few weeks, his family and friends have noticed increasingly bizarre behaviors. On many occasions, they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a hidden microchip that he was forced to swallow.

 

His parents have tried to get him to go with them to a psychiatrist for an evaluation, but he refuses. He has accused them on several occasions of conspiring with “others” to have him killed so they can remove his brain and put it inside one of their own. He has stopped attended classes altogether. He is now so far behind in his coursework that he will fail if something doesn’t change very soon.

 

Although Martin occasionally has a few beers with his friends, he’s never been known to abuse alcohol or use drugs. He does, however, have an estranged aunt who has been in and out of psychiatric hospitals over the years due to erratic and bizarre behavior.

  • Based on the symptoms presented in Martin’s case and the four key criteria for determining whether behavior is abnormal, would you say that Martin has a psychological disorder?  Why or why not?

Yes, Martin seems to be suffering from a mental disorder. Martin is displaying atypical behavior (whispering agitatedly to himself when he is alone). His beliefs that others are conspiring against him and making him swallow microchips show that Martin is not thinking rationally. His behavior is maladaptive in the way that he has stopped attending classes. His paranoid behavior is most likely distressing his family and himself

If you answered yes, what disorder (if any) should be considered? Explain why you chose this disorder.

Martin likely suffers from Paranoid Schizophrenia. His delusions, thinking of conspiracies, and his hallucinations, hearing and talking to voices, are positive symptoms of schizophrenia. Martin most likely experiences some negative symptoms such as losing his ability to communicate very well or maintain relationships. Martin’s condition could be linked genetically to his estranged aunt with a history of mental illness.

Case #3

Lenore has been feeling very sad since her husband died 12 weeks ago. She hasn’t eaten very well, and has difficulty sleeping.  She cries most days but is usually able to “put on a happy face” when people stop by to comfort her. Lenore is preoccupied with thoughts of her husband and does not want to do much other than think about him. She has declined all invitations by friends to socialize and instead, spends most of her time alone looking through old photographs and remembrances.

  • Based on the symptoms presented in Lenore’s case and the four key criteria for determining whether behavior is abnormal, would you say that Lenore has a psychological disorder?  Why or why not?

No, it does not appear that Lenore has a disorder. Although 12 weeks is a considerable time period to mourn a person’s death, it is not atypical considering the person was her husband.  Mourning is not irrational behavior.  Her behavior is slightly maladaptive since she does not want to do anything else but think of him, but it does not seem to be extreme enough to be a mental disorder. She is distressed about her husband’s death, not her behavior towards it.

If you answered yes, what disorder (if any) should be considered? Explain why you chose this disorder.

Although I find it unlikely that Lenore has a mental disorder, it is possible that she has a major depressive disorder. She matches some symptoms of major depressive disorder by displaying irregular sleeping and eating patterns as well as losing interest in her family and social life.

 

Case #4

Sister Margaret has been a member of her congregation for 20 years. She is 45 years old and the Director of Religious Education for a large suburban parish. She seems to be the perfect fit for the job. Her high energy, her overflowing enthusiasm, talkativeness, and engaging personality make her a favorite of the staff and parishioners. In particular, she seems to connect emotionally with adolescents who enjoy her enthusiasm. Everyone marvels at her ability to do so much with as little as two to three hours of sleep each night.

 

Prior to entering religious life, Sr. Margaret had abused alcohol and had incurred some significant credit card debt. After entering her community, she seemed to channel her energies into her ministry. Although she continuously overworked, she did not appear to be having other significant life problems. In the last several years, however, she has taken on more and more responsibility at work and is more stressed. A few months ago, she began to act out sexually with another sister in her community. Currently, she finds herself depressed; she is struggling to keep up with her many ministerial commitments. The sisters living with Sr. Margaret are experiencing many forms of distress. Some feel angry because their routines are often disrupted and others feel anxious. because they continuously anticipate a change in her mood, going from highs to lows almost weekly. With her mind racing at night, her increased inability to sleep and the increasing distress in her local community, Sr. Margaret decided to talk with someone on her leadership team. After an assessment, she was admitted to a local treatment facility.

  • Based on the symptoms presented in Sr. Margaret’s case and the four key criteria for determining whether behavior is abnormal, would you say that Sr. Margaret has a psychological disorder?  Why or why not?

Sister Margaret appears to be exhibiting atypical behavior in her sleeping patterns, sleeping two or three hours a night. Overworking, feeling depressed, and acting out sexually can also be seen as atypical behaviors. Sister Margaret seems to be acting slightly irrationally by taking on more responsibility when she is already struggling to keep up with her ministerial duty which is also a sign of her behavior being maladaptive. Her sudden mood changes are deeply distressing the sisters living with Sister Margaret and the local community. Sister Margaret most likely has a psychological disorder.

If you answered yes, what disorder (if any) should be considered? Explain why you chose this disorder.

It appears that Sister Margaret suffers from bipolar disorder. Her behaviors such as incurring credit card debt, displaying high energy, enthusiasm, talkativeness, and taking on many responsibilities are comparable to manic episodes patients with bipolar disorder exhibit. Her depression, lack of sleep, and inability to keep up with her responsibilities could be seen as depressive episodes. Her drastic low to high mood swings are consistent with bipolar disorder.

 

Case #5

Elise is a 35-year-old architect. She comes to you in great distress, feeling that she is unable to work, and generally unable to function. She says that she feels tired all the time, to the point of feeling completely exhausted. She says that she cries easily, and almost every day, is having difficulty sleeping, and has lost 20 pounds in the last 2 months without trying.  She also describes herself as a “worrier” and tells you that she constantly feels restless, irritable and has difficulty concentrating.  She can’t let her husband or children leave the house without making them call her regularly to reassure her that they are okay. Her husband is growing weary of her constant worry and distressed mood.  Her children can’t understand what all the fuss is about. Their impatience with her only makes her feel worse.

 

She says that things have been “real bad” for the last 2 months; she doesn’t enjoy doing anything and thinks frequently of suicide. However, she also says that she has never been a very happy person. She says that things rarely go right for her, and she has given up on expecting good things to happen for her.

  • Based on the symptoms presented in Elise’s case and the four key criteria for determining whether behavior is abnormal, would you say that Elise has a psychological disorder?  Why or why not?

Elise is exhibiting atypical behavior by crying every day, feeling tired all the time, and losing 20 pounds in two months. Other behaviors she is displaying that appear to be atypical are her feelings of restlessness and irritability. Elise is acting irrationally by calling her husband or children very often and constantly worrying about them.  Her behavior is maladaptive in the way that she cannot work or function regularly. Her husband and children are likely very distressed by her behavior which is a good indicator that she is unwell. It is likely that Elise has a psychological disorder.

If you answered yes, what disorder(s) (if any) should be considered? Explain why you chose this disorder.

Elise seems to be suffering a comorbid mental disorder. She seems to have a major depressive disorder and a generalized anxiety disorder. Extreme weight loss and lack of sleep are major symptoms of MDD and so is feeling tired and weak. Elise exhibits both of these symptoms along with extremely sad thoughts such as thinking that she does not enjoy anything and thoughts of suicide. These symptoms indicate her major depressive disorder. Excessive worrying and feelings of restlessness and irritability are not symptoms of MDD and indicate that she is simultaneously suffering from generalized anxiety disorder. This is supported by her distressing moods.

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One comment

  1. This is very interesting. I’d disagree with you about case #3 though. Lenore could well be suffering from ordinary unhappiness, a perfectly healthy reaction to a loss. But she could also have an “adjustment disorder”… (which I didn’t even know existed until a few months ago, but apparently it means “mild” depression as a reaction to some loss…)… what do you think?

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