Case of Jacob

A case study on Jacob's differential diagnosis for Post Traumatic Stress Disorder (PTSD) and Obsessive-compulsive Disorder (OCD), considering cognitive, sociodemographic, and cultural indications.

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Case of Jacob
Nicole Hank
California Southern University
PSYCH 8506; Advanced Psychopathology
Dr. Margaret White
May 28, 2022

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Case of Jacob
A differential diagnosis for Jacob will include Post Traumatic Stress Disorder (PTSD)
and Obsessive-compulsive Disorder (OCD). Cognitive, sociodemographic, and cultural
indications will be considered in diagnosis. Research has found that “Blacks had higher lifetime
prevalence of PTSD (8.7%) and Asians (4.0%) considerably lower prevalence than Whites
(7.4%)” (Roberts et al., 2011). Jacob reported witnessing his uncle being murdered as well as
being aclimated to a sociaodemographic area where violence is previlent. His past experiences
and background will be considered in his suspected diagnosis and treatment.
A factor to consider in diagnosis is the cultural and sociodemographic implications that
are imposed on him due to being African American. Neal and Turner (1991) found that blacks
males are exposed to more violent crimes in their neighborhoods and school than are while
males; to which Jacob disclosed growing up in a rough neighborhood where it was not
uncommon to hear gunshots and screaming. Neal and Turner (1991) also reported that African
Americans are more likely to be victims of crime than are white Americans. Homicide ranks as
the leading cause of death among young blacks (Takanishi, 1993), and the homicide rate among
black males has been reported to be seven times that of white males (Bell & Jenkins, 1991).
It is also extremely important to be mindful of Jacob’s past trauma in part of the
differential diagnosis. Research has shown that “approximately two-thirds of youth are exposed
to trauma during childhood, and many develop PTSD as a result. By age 18, roughly 8% of
traumatized youth have met criteria for a diagnosis of PTSD, with numbers rising up to 40% in
cases of sexual abuse and assault. In addition to the psychological suffering imposed, PTSD is
associated with lower academic achievement, and increasing incidence of depression, suicide
attempts, and substance abuse into adulthood” (Herringa, 2017).

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Gender considerations may also be considered as “the average number of traumatic
events reported by exposed men exceeds the corresponding average in women. Men with PTSD
report more impulsivity in response to emotions than women with the disorder” (Pineles, 2017).
Obsessive-Compulsive Disorder
Jacob admits to not being able to leave his house without checking that all the doors are
locked 3 times. Once he feels that the house is safe, he is hypervigilant about walking his
property to make sure that the outside is secure and safe. Further diagnostic clarification is
needed as this may be a reflection of past trauma.
Provisional Diagnosis for Jacob
Posttraumatic Stress Disorder 309.81 (F43.10) (APA, 2013).
Diagnostic Criteria
A. Exposure to actual death through direct experience, witnessing the event as it occurred to
another individual, learning that the traumatic event occurred to a family member and
experiencing repeated exposure to aversive traumatic events.
B. Recurrent distressing dreams (nightmares). Dissociative reactions (flashbacks).
C. Avoidance of external reminders (people, places, situations).
D. Negative alterations; inability to remember important aspects of the traumatic event.
E. Marked alterations in arousal and reactivity. Sleep disturbance. Irritable behavior. (“odd
behaviors”).
F. Duration of disturbance is more than 1 month.
G. Disturbance causes distress or impairment in social, occupational, or other important
areas of functioning.

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H. Disturbance is not attributable to the physiological effects of a substance or another
medical condition.
Treatment
Cultural considerations
Since Jacob is of African American descent, it is important to include cultural
considerations in his treatment plan. “Given the aforementioned cultural and ecological
considerations, African Americans’ reliance on individuals within their natural support systems
can probably better mitigate feelings of guilt, defeat, humiliation, and powerlessness than the use
of mental health services. Many African Americans view therapy as being for “crazy people.”
Some assume that clinicians will operate in the same way as do professionals in other agencies
(e.g., welfare system, schools), who have been intrusive in telling families what they can or
cannot do and own (e.g., telephone or television). African Americans may also fear
misdiagnosis, the prescribing of medication for behavioral and population control, and
governmental abuse” (Hines, 2005). Therefore it is important that the therapist “be sensitive to
the diversity within African American culture. Key to effective engagement, assessment, and
intervention with African Americans is to convey genuine respect, to move beyond
generalizations, to communicate interest in learning about clients’ specific realities, and to help
them reclaim and retain a sense of hope while moving toward the changes that will enhance their
well-being” (Hines, 2005).
Legal and ethical issues
Safety assessments and suicide risk assessments will be utilized in onset of treatment due
to an increased risk of suicide. “PTSD is associated with significant morbidity and mortality and
increased the risk for suicidal ideation, attempts, and completed suicides in war veterans”

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(Pompili et al., 2013). “Among PTSD-diagnosed participants, bivariate relations between
suicidality and scores indexing the severity of distinct clusters of PTSD and MDD symptoms
were all of modest to moderate strength, with shared variance ranging from 5% - 14%” (Guerra
et al., 2011). Due to the increased risk of sucide after trauma and increased risk on veterans of
war, he should be referred to a psychiatrist for a full evaluation.
Cognitive-Behavioral Model
Cognitive-Behavioral therapy (CBT) has been known to be highly successful in helping
with treatment of PTSD. Research has shown that “Trauma-Focused Cognitive Behavioral
Therapy (TF-CBT) is widely evidenced as an effective treatment choice for PTSD in recognition
of the developing evidence based practice with a trauma-focus treatment method” (Simon et al.,
2019).
CBT treatment plans can be tailored to the individual. In Jacob’s case, CBT can be
utilized in relationship with his military service. “Treatment involved three sessions of training in
imagery and relaxation, followed by imaginal desensitization based on a hierarchy of the 10 most
stressful scenes. There were 48 sessions of 30 minutes each. Desensitization led to greater
reduction in muscle tension and PTSD symptoms” (Simon et al., 2019). By decreasing Jacob’s
continued heightened awareness, his therapeutic relationship might become enhanced. This
would allow both him and his therapist to build a therapeutic relationship and explore thoughts
and feelings.
Due to his explanation of not being able to leave his house without performing rituals
around his property, Jacob’s obsessive-compulsive desires will also be explored in treatment.
Support groups have been shown to aid in self-efficacy and recovery for both PTSD and OCD.

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References
Bell, C.C., & Jenkins, E.J. (1991). Traumatic stress and children. Journal of Health Care for the
Poor and Underserved, 2, 175-185.
Guerra, V. S., Research, M. A. M. I., & Calhoun, P. S. (2011). Examining the relation between
posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample.
Journal of anxiety disorders, 25(1), 12-18.
Herringa, R. J. (2017). Trauma, PTSD, and the developing brain. Current psychiatry reports,
19(10), 1-9.
Hines, P. M., & Boyd-Franklin, N. (2005). African American families. Ethnicity and family
therapy, 3, 87-100.
Neal, A., & Turner, S. (1991). Anxiety disorders research with African Americans: Current
status. Psychological Bulletin, 109, 400-410.
Pineles, S. L., Hall, K. A. A., & Rasmusson, A. M. (2017). Gender and PTSD: different
pathways to a similar phenotype. Current opinion in psychology, 14, 44-48.
Pompili, M., Sher, L., Serafini, G., Forte, A., Innamorati, M., Dominici, G., ... & Girardi, P.
(2013). Posttraumatic stress disorder and suicide risk among veterans: a literature review.
The Journal of nervous and mental disease, 201(9), 802-812.

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Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic
differences in exposure to traumatic events, development of post-traumatic stress
disorder, and treatment-seeking for post-traumatic stress disorder in the United States.
Psychological medicine, 41(1), 71–83.
Simon, N., McGillivray, L., Roberts, N. P., Barawi, K., Lewis, C. E., & Bisson, J. I. (2019).
Acceptability of internet-based cognitive behavioral therapy (i-CBT) for post-traumatic
stress disorder (PTSD): a systematic review. European Journal of Psychotraumatology,
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Takanishi, R. (1993). The opportunities of adolescence--Research, interventions, and policy.
American Psychologist, 48, 85-87.