### Case Study Analysis: Vee
#### 1. Presenting Problems
Vee, a 26-year-old African-American woman, presents with several psychological and behavioral issues. She has a history of non-suicidal self-injury, specifically cutting her arms and legs, which began in her teenage years. Vee has made two suicide attempts by overdosing on prescribed medications, one during her teenage years and another six months ago, and she experiences chronic suicidal ideation. She describes “zoning out” during conversations and at work, which indicates episodes of dissociation. Vee expresses uncertainty about her identity, frequently altering her hobbies, clothing style, and even her job based on her social group’s influence. Her relationship with her partner is tumultuous; she alternates between idealizing him and expressing intense anger towards him, often resulting in impulsive behavior and subsequent regret. Additionally, before her current relationship, Vee engaged in frequent and often unprotected sexual activity with multiple partners whom she did not know well.
#### 2. Primary and Differential Diagnosis
**Primary Diagnosis: Borderline Personality Disorder (BPD)**
– **DSM-5 Code:** 301.83
– **ICD-10 Code:** F60.3
BPD is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity beginning by early adulthood. Vee exhibits classic symptoms of BPD, including her self-injurious behavior, chronic suicidal ideation, identity disturbance, dissociative symptoms, and unstable relationships marked by alternating extremes of idealization and devaluation.
**Differential Diagnoses:**
1. **Major Depressive Disorder (MDD)**
– **DSM-5 Code:** 296.32
– **ICD-10 Code:** F33.1
– Vee’s chronic suicidal ideation and history of suicide attempts suggest MDD, but her mood instability and impulsive behaviors are more consistent with BPD.
2. **Bipolar II Disorder**
– **DSM-5 Code:** 296.89
– **ICD-10 Code:** F31.81
– Bipolar II Disorder includes episodes of hypomania and major depression. Vee’s mood swings and impulsive behaviors could indicate bipolarity, but the lack of distinct hypomanic episodes leans towards BPD.
3. **Post-Traumatic Stress Disorder (PTSD)**
– **DSM-5 Code:** 309.81
– **ICD-10 Code:** F43.10
– Dissociation and self-injurious behavior can occur in PTSD, but Vee’s pervasive instability in relationships and self-image align more with BPD.
#### 3. Cluster of Primary Diagnosis
BPD belongs to **Cluster B** of personality disorders, which are characterized by dramatic, emotional, or erratic behavior. This cluster also includes Antisocial, Histrionic, and Narcissistic Personality Disorders. Individuals with Cluster B disorders often struggle with impulse control and emotional regulation.
#### 4. Treatment Plan
**Short-term Goals:**
1. **Safety and Crisis Management:** Develop a safety plan to address Vee’s suicidal ideation and self-injurious behavior. This may involve creating a list of emergency contacts, identifying triggers, and establishing coping strategies.
2. **Medication Management:** Evaluate the need for psychotropic medications to stabilize mood and manage symptoms. Selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers may be beneficial.
**Long-term Goals:**
1. **Dialectical Behavior Therapy (DBT):** DBT is an evidence-based therapy specifically designed for BPD. It focuses on building skills in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. DBT has been shown to reduce self-harm, suicidal behavior, and improve overall functioning.
2. **Cognitive Behavioral Therapy (CBT):** CBT can help Vee address and reframe maladaptive thought patterns, reducing impulsivity and improving emotional regulation.
3. **Interpersonal Therapy (IPT):** IPT can assist Vee in understanding and improving her relationships, addressing patterns of idealization and devaluation.
4. **Psychoeducation:** Educate Vee about BPD and its symptoms, emphasizing the importance of treatment adherence and developing healthy coping mechanisms.
**Supportive Measures:**
1. **Family Therapy:** Involving Vee’s family or partner in therapy can help them understand her condition and support her treatment.
2. **Support Groups:** Encourage participation in support groups for individuals with BPD to reduce feelings of isolation and gain peer support.
#### References
– American Psychiatric Association. (2013). *Diagnostic and Statistical Manual of Mental Disorders (5th ed.)*.
– Goodman, M., & Carpenter, D. (2016). *Dialectical Behavior Therapy for BPD*. Psychiatric Times.
– Kearns, M., & Cramer, R. J. (2015). *PTSD and Borderline Personality Disorder: Differential Diagnosis*. Journal of Traumatic Stress.
– Linehan, M. M. (2018). *DBT Skills Training Manual*. The Guilford Press.
– National Institute of Mental Health. (2020). *Borderline Personality Disorder*. Retrieved from [NIMH](https://www.nimh.nih.gov/health/topics/borderline-personality-disorder)
By addressing Vee’s complex presentation through a structured and evidence-based treatment plan, the aim is to stabilize her symptoms, enhance her emotional regulation, and improve her overall quality of life.
Case Study: Vee
| Purpose: | Analyze and apply critical thinking skills in the psychopathology of mental health patients
and provide treatment and health promotion while applying evidence-based research. |
| Scenario: | Vee is a 26-year-old African-American woman who presents with a history of non-suicidal self-injury,
specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.” When she is stressed, Vee says that she often “zones out,” even in the middle of conversations or while at work. She states, “I don’t know who Vee really is,” and describes a longstanding pattern of changing he r hobbies, style of clothing, and sometimes even her job based on who is in her social group. At times, she thinks that her partner is “the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at the thought of him leaving her. Vee reports that , before she began dating her current partner, she sometimes engaged in sexual activity with multiple people per week, often with partners whom she did not know. |
| Questions: | 1. Describe the presenting problems.
2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes. 3. Discuss which cluster the primary diagnosis belongs to. 4. Formulate and prioritize a treatment plan. |
Submission Instructions:
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 4 academic sources.
· Wednesday July 17, at 11:59pm
·
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