Client’s Information
The client Gina Parks is a young, married, and cisgender Korean American lady. She has two kids with her husband Steve. The client lives with her spouse, her two children, and her parents. The client’s family has recently relocated into the flat of Gina’s parents after a storm rendered their home inhabitable. Gina’s household is presently relocated since their house is undergoing repairs. Gina just left the hospital and got in touch with the emergency services because it was difficult for her to adjust to the changes in her life as a result of a natural catastrophe. Gina mentioned that her coworker and friend Diane provides minimal social support. Because her spouse would worry and her parents would want her to be stronger, Gina said that she does not feel she can ask for support from them. Gina’s reluctance to seek social assistance and her parents’ insistence that she find a solution are consistent with cultural standards. It is considered disgraceful in traditional Asian society to utilize official support systems outside of the home (Cong & Chen, 2022).
Gina acknowledged that she felt powerless and overburdened by the circumstances. Gina reported having arguments with her parents about how to discipline her kids because of her parents’ expectations that she and her husband raise their kids using a traditional Korean approach involving spanking. Gina clarified that while her husband, a westerner who is not familiar with Korean culture, holds the same opinion as her regarding spanking children. Gina said that her parents are unhappy with her marriage to a non-Korean, and that family strife has escalated since the family moved in after the storm.
Client Presentation
Gina is feeling overburdened with household responsibilities and constrained by social norms; therefore, she is meeting with the social work intern Penelope Walsh. Gina, the client, is looking for support in coping with the grief brought on by the disparity between the values she has adopted with her husband, a Westerner, and those of her traditional Korean parents. Given that her family is now staying in her parents’ house on a temporary basis and Gina does not see a way to resolve the differences in culture between her parents, Gina has stated that she felt like giving up. Gina’s capacity to establish her place within the family and the functioning of her family are being impacted by her principal worries about feeling troubled by family conflict and helpless to alter her existing circumstances. Gina, the client, appeared depressed and revealed an increasing reluctance to articulate her worries within the family due to her desire to avoid disputes. Gina also exhibits anxiety and struggles to see the good in her circumstances since she struggles with the choice between upholding her husband’s beliefs and failing her parents.
Client Symptoms
Gina, the client, described and demonstrated a number of symptoms that might contribute to the formation of a diagnostic impression, in the video. Gina’s main symptoms were continuous despondency and a sensation of being confined, both of which are triggered by a disturbance in the family role. The client described an issue within her family that she is facing, which was aggravated by Gina’s difficulty communicating her values to her parents since moving into their house. Gina’s persistent upsetting mood caused her to feel nauseous with a sunken sensation, along with experiencing symptoms like not able to breathe, signs of heart attack, being confined, and undergoing near-panic. The client also expressed her hopelessness, which she attributes to the amount of time her family is anticipated to be apart from their house due to continuing renovations.
The client also reported having a lot on her mind, difficulty sleeping, and being exhausted. Gina expressed concern about several facets of her life, including her kids, another storm, getting stuck beneath a tree, or anything happening to her family. Gina described recalling storm-related incidents that contributed to her feeling confined and powerless to flee. Gina said that it was difficult for her to stay to her schedule because there was more cooking and washing to do. Gina reported feeling defeated and ready to give up.
Gina, the client, mentioned that she needed to keep up her duties at work and failed to disclose any work-related disturbances other than discussing her situation with a coworker. The client appears to have a normal sense of awareness and decision-making. While further inquiries would be required to identify a timeframe, the client’s alteration in circumstances appears to be recent and can be linked to the storm-related change in living arrangements. The clinician would want to know if the symptoms have lasted for more than six months, since this might alter a potential diagnostic impression. Gina’s interaction with her family is impacted by her sentiments of helplessness and confinement, therefore they are clinically relevant.
As a result, the client is suffering a consistent degree of internal distress, resulting in the client’s desire to give up. The video did not indicate any drug or medicine abuse issues. Gina’s risk factors for substance use disorder can be assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) by the clinician. In addition, no other health-related or mental-health condition could be linked to the patient.
Tentative Diagnosis
Preliminary Diagnostic Impression
Obtaining a first diagnostic assessment for Gina based on her presentation was difficult owing because of the similarities in signs for prospective diagnoses and the lack of detail provided about her in the video. For instance, although the diagnostic impression for suspected disorders like PTSD F43.10, Acute Stress Disorder F43.0, mild Major Depressive Disorder F33.0, and Adjustment Disorder F43.23 (with mixed anxiety and depression) are similar, they are differentiated by the start of symptoms, length, severity, and client effect of the symptoms. This significant information was omitted from the video. My clinical perception indicates that the client meets the diagnostic criteria for an Adjustment Disorder F43.23 (with mixed anxiety and depression) as defined in the DSM 5 TR based on the client’s dialogue, presenting symptoms, and the lack of a recognized timeframe (American Psychiatric Association, 2022). Clients with adjustment disorder display behavioral and emotional signs after enduring a stressful incident (Yaseen, 2017).
Gina’s mental symptoms appear to have arisen as a result of the trauma of her house being ruined in a natural catastrophe. The client’s presentation and dialogue indicate that the storm occurred recently, despite the fact that the exact date is unknown. In addition, Gina exhibited or endorsed the symptoms listed: significant sorrow over her circumstances, indicating a wish to give up; severe impairment to functioning in the home; and symptoms presented and compared to disorders defined in the DSM 5 TR. The above outlined symptoms are included in the DSM 5 TR diagnostic criteria for adjustment disorder (American Psychiatric Association, 2022). The Adjustment Disorder New Model 20 questionnaire can assist the clinician with establishing a more conclusive diagnosis of adjustment disorder for Gina.
Tentative Rule Out-Diagnostic Criteria
Although Gina appears to exhibit elements related to PTSD F43.10 diagnostic criteria, further details about Gina are needed before an ethical diagnosis can be made. For instance, it is impossible to tell from the information presented if Gina satisfies the criteria for the existence of post-traumatic stress disorder’s diagnostic features listed in section B of the DSM. Moreover, while Gina acknowledged experiencing as if a tree was squeezing her, more clarification will be required to evaluate whether it’s a true recollection of the storm experience, if Gina is having upsetting nightmares, and if she is experiencing dissociative symptoms (American Psychiatric Association, 2022). By conversing with the client and asking about these recollections, it is possible to discern if they are related to the event. In addition, the intern should assess if the client is suffering dissociative experiences or intrusion, as well as avoidance.
The clinician may use the Clinician Administered PTSD Scale for DSM 5 (CAPS-5) to determine whether or not a PTSD diagnostic impression exists. Lastly, as a precaution for the client, the therapist should do a risk assessment using the Columbia-Suicide Severity Rating Scale and create a Stanley Brown Safety Plan to provide the client with crucial contact information and services in the event of an emergency.
Diagnoses Ruled Out
Gina appears to fit the criteria for Acute Stress Disorder F43.0; Exposure to imminent danger of death or serious damage; personally experiencing a storm; witnesses the devastation of her house; exhibiting intrusive sensations; a negative mood; and arousal signs. Furthermore, the client exhibits moderate Major Depressive Disorder F33.0 symptoms, including: depressed mood; decreased interest; sleeplessness; fatigue; and recurring thoughts of death, as described by the DSM-5 TR. Nonetheless, the client’s symptoms should be evaluated further to identify their onset, length, and severity. According to the DSM 5 TR, an adjustment disorder diagnosis seems to be more appropriate when not all criteria are satisfied or when there is uncertainty regarding the when symptoms first appear (American Psychiatric Association, 2022). In lieu of misdiagnosing the individual, diseases are initially ruled out in order to obtain more information from the client concerning symptoms and timeframe. The clinician can use the PHQ-9 questionnaire to test for depression and suicidal ideation and interact directly with Gina in order to reach a clinically sound assessment concerning the shift in a preliminary diagnosis.
Needed Information about the Client
To develop an accurate, ethical, and clinically effective diagnosis, the social worker intern needs more information about the client. Similar symptoms and diagnostic traits were present for each condition for which the client demonstrated preliminary diagnostic criteria. For instance, the diagnostic criteria of adjustment disorder, post-traumatic stress disorder (PTSD), and acute stress disorder are nearly indistinguishable. These disorders may be separated largely by the duration, severity, and frequency of the client’s symptoms (American Psychiatric Association, 2022). Furthermore, to do a biopsychosocial evaluation, the social worker should attempt to collect the client’s medical and prescription history.
Furthermore, because Gina’s environment has changed significantly, affecting her capacity to function, the therapist should undertake additional evaluations pertaining to the client’s living situation (Z59.9 Other Housing Problems). The client Gina described experiencing tremendous anxiety while residing in her parents’ apartment. The anxiety might be caused by a lack of capacity to accommodate four more people. Gina’s failure to utilize available government assistance in the wake of a natural catastrophe may also be a contributing factor in the stress. For example, due to cultural shame, Asian Americans are generally less reluctant to seek formal assistance following a natural catastrophe (Cong & Chen, 2022). The client’s present living situation might be assessed by the clinician to see if it is contributing to her anxiety. Also, the client might benefit from a more thorough evaluation of the severity of the storm encountered by the client (Exposure to Disaster Z65.5). In the video, the client spoke about the storm that damaged her house and the heightened stress reaction she is currently going through.
Understanding the causes that are generating Gina’s stress might assist in identifying potential treatments. The clinician will be capable of creating a solid and ethical diagnostic assessment if he or she has a clearer image of the client’s wants and the necessary details.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Text Revision Dsm-5-tr (5th ed.). Amer Psychiatric Pub Inc.
Cong, Z., & Chen, Z. (2022). How are Asian-Americans different from other races in disaster preparedness in the context of caregiving responsibilities and preparation information access? Natural Hazards, 112(3), 2217–2236. https://doi.org/10.1007/s11069-022-05262-6
Yaseen, Y. A. (2017). Adjustment disorder: Prevalence, sociodemographic risk factors, and its subtypes in outpatient psychiatric clinic. Asian Journal of Psychiatry, 28, 82–85. https://doi.org/10.1016/j.ajp.2017.03.012
Additional resources reference if needed:
Khanijahani, A., & Sualp, K. (2021). Adverse Childhood Experiences, Neighborhood Support, and Internalizing and Externalizing Mental Disorders among 6–17 years old US Children: Evidence from a Population-Based Study. Community Mental Health Journal, 58(1), 166–178. https://doi.org/10.1007/s10597-021-00808-7
Phillips, D. G. (2013). Clinical Social Workers as Diagnosticians: Legal and Ethical Issues. Clinical Social Work Journal, 41(2), 205–211. https://doi.org/10.1007/s10615-013-0444-3
Probst, B. (2012). “Walking the Tightrope:” Clinical Social Workers’ Use of Diagnostic and Environmental Perspectives. Clinical Social Work Journal, 41(2), 184–191. https://doi.org/10.1007/s10615-012-0394-1
van der Burg, D., Crunelle, C. L., Matthys, F., & van den Brink, W. (2019, July). Diagnosis and treatment of patients with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder. Current Opinion in Psychiatry, 32(4), 300–306. https://doi.org/10.1097/yco.0000000000000513
