Step1: Read Case

Case

Joan is a 23 year old female. Joan was raised by her maternal grandparents who she describes as caring and supportive. Joan has not met her father as he moved across the country when Joan's mother was pregnant with her. After Joan was born, her mother struggled with chemical dependency. Joan's mother has a long history of chemical addiction, specifically alcohol and cocaine, which is the primary reason Joan was raised by her grandparents. Joan's mother has been an unstable presence in her life, depending on her sobriety. Joan reports that her life is less stressful when her mother is absent from her life, yet she also feels guilty for feeling this way because knows that this means that her mother is using and abusing drugs.

Joan has been in a long-term romantic relationship for 6 months. Her relationship has been turbulent at times. One of the main reasons is that Joan is fearful of being left by her boyfriend. Her fear has caused Joan significant distress and is also creating conflict in their relationship as Joan is constantly questioning her boyfriend's love and faithfulness, especially when she does not see him for several days or when he does not respond to her messages immediately. After not hear from him for 24 hours, Joan became so distraught that she felt an overwhelming urge to cut herself. Joan notes that when her boyfriend did finally call her, she yelled at him for not returning her call, which led to an argument where her boyfriend indicated that she was suffocating him with her insecurity. This led to even more emotional upset for Joan. She describes feeling worthless and unlovable.

Joan also reports feeling sad and disconnected from her friends and family, as well as lonely, in general. She also notes that she feels like she is never good enough - that she is always letting others down and never does anything correctly. She reports that a couple of times a year over the last 5 years she has had episodes lasting 3-4 weeks where she has stayed in bed crying, sleeping and feeling like she does not matter or that anything matters. She also reports difficulties falling and staying asleep because she can't seem to quiet her thoughts. She reports that during these periods, she has no appetite and misses work often and does not spend time with friends. She describes being fatigued and lacking interest in most activities, including painting, which is one of her passions.

Joan denies current suicidal ideation, but reports that she has attempted suicide three times by overdosing on pills over the last 10 years and the most recent attempt was 3 years ago. She also notes that she has called the suicide crisis line approximately 8 times in the last three weeks because she was feeling really down, lonely and empty inside.

When Joan has enough energy to leave her house, Joan reports that when she is feeling "blue" she often goes on shopping sprees, gambles and binge drinks to "numb" her sadness. She has lost thousands of dollars gambling and finds it very difficult to control her urges to drink alcohol or gamble, especially when she is very upset or feeling down. She states that she drinks alcohol to the point of intoxication at least 3 times per week and has for approximately 9-12 months, but denies any withdrawal symptoms. She notes that drinking helps take her mind off of how sad and empty she feels, but she has noticed that she has had to consume more alcoholic drinks to experience the calming effects. She also reports that there are times that getting intoxicated seems to make her racing thoughts worse, so she will take one or more Xanax when she gets home from a night of partying so she can get some sleep. She reports that this helps her sleep, but often (at least 1 time a week) she is unable to go to work the next day so she can recover.

Step 2: Review the chapter and conduct research on the case.

Step 3: Complete the Posting in which you address the following questions in paragraph format (Your posing should be more than 500 words, and please do not use the Q and A format):

(1) What are the main and most concerning symptoms Joan is experiencing? Why are these symptoms important in the process of diagnosing and treating her symptoms?

(2) Which diagnosis or diagnoses could be consistent with her symptoms, based on the information provided and why? Please cite in-text information from the textbook to support the possible diagnoses you are considering.

Note: At this point you are exploring all the possible diagnoses you are considering. When you answer the next question, you will focus on the diagnosis or diagnoses you think are most consistent with her symptoms.

(3) Which psychological disorder diagnosis or diagnoses (she can be diagnosed with more than one disorder potentially, depending on the disorders) do you think her symptoms are most consistent with of all the possible diagnoses you considered and why? (Please keep in mind that you are hypothesizing diagnoses based on the available information only. You might not be certain. What you are focused on here is providing a through explanation to support your proposed diagnosis (or diagnoses), citing in-text concepts and evidence from the textbook reading,

(6) Which treatment(s) would you recommend and why? Please describe the specific type of biomedical treatment and/or psychotherapy approach (e.g., humanistic, psychodynamic, cognitive, etc.) that you recommend to treat the symptoms of the disorder(s) you named above. Please cite in-text information from the textbook to support the possible treatment recommendations.

(7) What is the expected improvement (prognosis) with treatment and why based on your textbook reading on the efficacy of treatment approaches?

Note: Concepts from chapters 12 and 13 are expected to be discussed and explained (in your own words, not through quotations) and cited throughout your posting in-text.