A highly-detailed and clinically complex vignette will be distributed around the middle of the semester. Read the vignette thoroughly, multiple times, and identify what you believe is the clinically relevant information. Highlight what seems central to the individual's difficulties.

In a 12-15 page, double-spaced paper, discuss your diagnostic and clinical impressions by addressing points presented below. You must cite at least 3 articles in your paper, with at least one of those articles being unique from any article presented in class. Use APA style. (You do not need to use citations for the DSM). This exercise is similar to the vignettes; however, it will be much more complex.

1. Provide a DSM-V diagnosis, including code, R/O, and all relevant specifiers.

2. Explain your reasoning for each element of the diagnosis. In discussing your diagnosis, identify the data provided in the vignette that supports each of the criteria that you are using to make the diagnosis. (For example, "This individual's [fill in the behavior/data] fits criterion 1a of the diagnosis because ...).

3. Identify other diagnoses you considered and present your reasoning for choosing the diagnosis you did and for ruling out other diagnoses.

4. Assess and describe the individual's character structure. This should include a biopsychosocial formulation. This semester will spend a great deal of time discussing the elements of character structure, including defensive structures, object relations and relatedness, and transference/countertransference implications. Make working hypotheses with the information that you have available. Be mindful of possible biological contributors, psychological dimensions, and sociological influences on the person's psychopathology. Remember that the vignette may provide you with limited information in some circumstances. Be careful to write in a non-definitive way if you feel that you do not have enough information. (For example, "Due to [fill in the appropriate data], it is possible that this individual ...). Cite relevant literature when appropriate.

5. Describe any treatment recommendations. What do you feel would be particularly helpful for this individual? How might various psychosocial and medical factors play a role? What do you believe the challenges or limitations to treatment may be?