References

Comer, R.J. (2005). Fundamentals of Abnormal Psychology. New York: Worth

Publishers.

Ozer, E.J., & Weiss, D.S. (2004). Who Develops Posttraumatic Stress Disorder? Current

Directions in Psychological Science, 13(4), 169-172.

After addressing his post-traumatic stress disorder, I would focus my efforts towards the deeper-rooted aspects of Sal’s mental state. Antidepressant medication may be continued to lift Sal’s depression, and cognitive therapy would be implemented to allow Sal more accurate estimations of the rewards and consequences of his actions. The somatization disorder may be more difficult to eliminate (as it tends to last for many years), but I believe effective psychotherapy would ultimately help his condition. Because Sal has a number of disorders, it is very important to keep monitor Sal’s progress and setbacks and to not to rush the course of treatment. I believe that with a solid understanding of Sal, his abnormal behaviors, and his treatment options, I can lead Sal to a favorable prognosis.

Treatment. My immediate concern for Sal would be to first quiet his post-traumatic stress disorder. I would refer Sal to a psychiatrist so that he may receive antianxiety drugs or antidepressants as needed. In conjunction with medication, I would help Sal overcome the trauma of the shooting with a behavioral exposure techniques such as flooding. The psychiatrist and I would work closely together to monitor Sal and adjust our treatments so that he may obtain maximum mental stability.

Etiology. There are many possible psychological theories that can explain Sal’s symptoms. For example, a psychodynamic argument may be that his general mental abnormalities stem from the death of his mother. A behaviorist may believe that a learned reward system explains why Sal is so withdrawn or why he has mysterious, unexplained pains. Cognitively, Sal may not be an accurate judge of reality and how his actions negatively affect himself or others. I believe one of the biggest explanations can be found in the family systems theory, which states that the structure and workings of the family unit influence some members of that family to behave abnormally (Comer 2005). The arrival of a stepmother may have caused some disruption in normal family life, and the ways in which both she and Sal’s father respond (or do not respond) to Sal can perpetuate his abnormalities, even into young adulthood.

Cultural Context. A number of social factors may be affecting my client. Sociocultural stressors (provided by inherent economic disadvantages, race discriminations, and the amount of crime and violence in his neighborhood) may leave Sal predisposed to develop certain mental abnormalities, such as generalized anxiety or depression. The degree to which Sal’s family copes with and supports his symptoms may also continue to affect his mental health. Labels given to those who stray from norms often perpetuate abnormal behavior (Comer 2005), and, in this respect, I would like to further investigate if Sal has had to endure direct application of such labels from his family. Also, Ozer and Weiss (2004) reported that those with great social support are less likely than those without social support to develop post-traumatic stress order after a traumatic event. Perhaps Sal’s social support system has not adequately helped him in a time of need.

Assessment. To confirm or reject other diagnoses as well as create a tailored progression of treatment for Sal, I need to learn more about him and his behaviors. As I briefly mentioned earlier, Sal may be struggling with generalized anxiety. Sal’s stepmother noted that “Sal has always been the worrier of the family. He freaks out about little things.” If I was to probe Sal about what his stepmother has told me and determine that his symptoms are in fact abnormal, I may be able to confirm or disprove generalized anxiety disorder. I would also like to speak more with members of Sal’s family to learn about their perceptions of Sal’s behavior and their general family dynamics; this information may help pinpoint some origins of Sal’s troubles. I believe the use of some clinical tests may also be helpful. A personality inventory (such as the MMPI) would be implemented to determine if Sal’s thoughts and behaviors are indeed deviant according to the test’s ten major scales. I may also implement the Beck Depression Inventory, but I would have to be wary of the timing of my administration; thoughts and emotions resulting from the post-traumatic stress disorder may unduly affect Sal’s responses.

In addition to these diagnoses, I have a pondered a number of differentials that do not apply because Sal does not quite fit the criteria or because I have not yet gathered enough information. These differentials include generalized anxiety disorder (due to Sal supposedly being the “worrier” of the family) or another somatoform disorder such as conversion disorder. I hope to acquire more knowledge about Sal that will lead to a certain disconfirmation of these disorders.

As for Sal’s most recent struggles, I am rather confident in diagnosing Sal with acute stress disorder that has progressed into post-traumatic stress disorder. His current PTSD symptoms are in response to a traumatic event, have lasted longer than one month, and have caused difficulty sleeping with recurrent, distressing dreams. The trauma has also caused Sal to repeatedly mumble phrases that display his fright. Sal’s significant weight loss, though not a criteria for acute or post-traumatic stress disorder, may be the result of a decrease in appetite brought on by the traumatic event. Also, because the shooting occurred in a convenience store, Sal may simply be avoiding food to discourage reliving aspects of the event. This avoidance may be severe enough to cause weight loss.

Diagnosis. Sal meets the criteria for multiple Axis I diagnoses. One of the first disorders presenting in Sal is unipolar depression. Symptoms of his depression have been present since the age of 10 and include increasingly reclusive behaviors. He has also been amotivated in several aspects of normal life, including finding appropriate housing, holding a job, and maintaining his physical appearance. In addition to depression, Sal also seems to meet the criteria for a diagnosis of somatization disorder, a somatoform disorder that results in physical complaints with psychosocial causes (Comer 2005). I will need to gather further information about the nature of Sal’s “medical conditions” to make a concrete diagnosis, but because Sal is young, has struggled with these particular ailments for seven years, and has never been offered a physiological cause for his symptoms, I am led to believe that he has somatization disorder.

: A Case Report

Presenting Problems. Sal, a 19-year-old African American male, was referred to my care after witnessing a traumatic event and subsequently failing to cope with the events surrounding his trauma. During the course of his visits, however, I learned of an entire history of mental health symptoms that have or had troubled my client, including anxiety, social withdrawal, physiological pains without a biological basis, repetitive muttering to self, recurring nightmares, and hopelessness. These symptoms are considered abnormal in my client according to their deviance from norms, the distress they cause him, and the amount that they interfere with my client’s daily functioning (Comer 2005). After having reviewed Sal’s history, I have established a comprehensive diagnosis and treatment plan.