Assignment on Diagnosis PDF

Running head: DIAGNOSIS ASSIGNMENT TWO
DIAGNOSIS ASSIGNMENT TWO
Name of the Student:
Name of the University:
Author note:

1DIAGNOSIS ASSIGNMENT TWO
Diagnosis Assignment Two
Key Issues
1. Trauma associated feelings of guilt where Peter blames himself extensively for the
accident.
2. Frequent negative recollections and nightmares pertaining to the accident victim
3. Fear associated with the accident leading to illogical driving behaviors.
4. Exhibition of psychosomatic systems as a resultant of guilt such as clenching of hand grip
and sweating at excessive levels.
5. Occupational and martial conflicts with spouse
Rationale for order of prioritization
The feeling of extreme guilt, related to trauma lies at the heart of Peter’s mental illness,
since the emotion has resulted in the manifestation of traumatic thoughts, repentance and
nightmares of the expired accident victim. Further, trauma-related guilt and extreme phobia phas
been associated with exhibition of pathologically harmful behaviors aggravating to obsessive-
compulsive disorder (Hennig-Fast et al., 2015). Peter has been shown to exhibit irrational
behaviors in driving for fear and guilt of the past accident. The feeling has also resulted in
psychosomatic symptoms of sweating and tightening of hands in Peter along with interpersonal
conflict at home and at his workplace.
Important features and Reasons
The important issues here are Peter’s trauma-associated guilt, fear and irrational
behaviors which are resulting in his physiological symptoms, occupational and marital conflicts.

2DIAGNOSIS ASSIGNMENT TWO
Treatment Outcomes
This will include aiding Peter in the self-monitoring and awareness of his feelings of guilt
associated with the accident, to reduce his symptoms by understanding that not every situation
will be under his control. The next outcome would aim at reducing Peter’s illogical behaviors
associated with guilt, such as undertaking new roads while travelling. Lastly, the psychologist
would aid Peter in gaining control of his feelings to prevent their interference in his marital and
work life and the resultant trauma-related conflict.
List of Key Issues of the Client
Peter may present the following list of issues, which may be slightly different than those
written by the psychologist. In accordance to this list, the psychologist will work collaboratively
with Peter for the formulation of his treatment plan:
1. Extreme guilt for causing the accident
2. Occurrences of nightmares of the victim
3. Conflicts with his employer at his workplace
4. Conflict with his wife at home
5. Occurrence of illogical driving behaviors
Additional Information
A biopsychosocial assessment can be performed by the psychologist in order to uncover
additional information about Peter’s biological and social factors which would lead to the
development of a case history which may provide details about the underlying reasons behind his
feelings of guilt (Kent, Rivers & Wrenn, 2015).

3DIAGNOSIS ASSIGNMENT TWO
Diagnostic Impressions
Peter’s recurrent symptoms of guilty, nightmares and fearful flashbacks indicate that he
may be suffering from Post Traumatic Stress Disorder (PTSD). The psychologist can refer to the
fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Mota et al.,
2016):
 Criterion A, Presence of a stressor: The concerned victim experienced exposure to a
stressful event such as a severe injury, possibility of death or sexual violence, either by
being directly exposed, witnessing of the traumatic event, recognizing the presence of a
close one in the situation or exposed indirectly to the details of the stressful experience.
Peter was actively associated with the accident and resultant death of an innocent
individual.
 Criterion B, symptoms of intrusion: The victim relives the trauma through recurrent
nightmares, disturbing recollections and psychosomatic symptoms. Peter continuously
experiences the incident through nightmares leading to sweating and clenching while
driving and associated conflict at work and home.
 Criterion C, trauma-associated avoidance: The patient attempts to avoid re-experiencing
the trauma as evident in Peter adopting new routes while driving.
 Criterion D, negatively altered mood and cognitive functions: Patient finds it difficult to
remember trauma event, possesses negative views concerning oneself and the
surroundings, reduction in interest towards activity performance, loss of positivity,
blaming others and social isolation. Peter shows significant loss in positive attitudes,
constantly blames himself and frequently engages in martial or occupational conflict.

4DIAGNOSIS ASSIGNMENT TWO
 Criterion E, arousal and reactivity associated alterations: Suspected victim shows harmful
behavior which is aggressive and irritable, along with displaying shortcomings in sleep
and concentration. Peter’s sleep and lifestyle is constantly affected with nightmares along
with displaying of conflicting behavior at home and at work.
 Criterion F, symptom duration of more than a month. Peters symptoms have lasted for
almost 3 months now.
 Criterion G: significance at functional levels: Victims symptoms affects his work or
home associated behaviors. Peter’s conflicts at home and at work have increased since
the traumatic event.
 Criterion H, Peter’s symptoms are occurring irrespective of any drugs, diseases or
medicines.
Additional Co-Occurring Disorders
Additional disorders which may be occurring in Peter is Obsessive Compulsive Disorder
(OCD) as evident in his engagement towards conducting irrational behaviors such as driving
unnecessarily around blocks and alleys. OCD is characterized by conducting inappropriate,
repetitive behaviors which lead to considerable stress. Anxiety disorders such as PTSD and OCD
have also been found to coexist in the same patient due to their traumatic or stressful nature.
Hence, Peter’s psychologist may conduct an additional DSM-5 diagnosis specific to OCD, for
appropriate diagnosis (Morina et al., 2016).
Rationale behind Diagnosis
The DSM-5 manual for diagnosis, formulated by the American Psychiatric Association is
the rationale behind the diagnosis due to its credibility since 1952.

5DIAGNOSIS ASSIGNMENT TWO
Recommendations for Treatment
The psychologist can conduct one or more of the following treatments for Peter’s
condition of PTSD:
 Cognitive Processing Therapy (CPT) which allow Peter to openly express and modify his
traumatic thoughts pertaining to the occurrence of the accident (Resick et al., 2015).
 Prolonged Exposure Treatment (PE) will help Peter to directly and gradually confront his
memories, emotions and driving situations related to the accident, which he has avoided
(Helpman et al., 2016).
 Alternatively, the psychologist can conduct a treatment of Eye Movement Desensitization
and Reprocessing which will help him/her and Peter to understand and process the
trauma based on eye movements and response to sounds (Acarturk et al., 2016).
 Teaching Peter relaxation strategies like massages or supervised breathing for reducing
distress, known as Stress Inoculation Training (Hourani et al., 2016).
 The psychologist can also attempt Cognitive Behavior Therapy for Peter, which will aim
to reduce his stressful thoughts, identify the causes of his stressful feelings and aim to
modify them as a response to stimuli related to the memories of the accident (Shou et al.,
2017).
 Considering the effect of Peter’s trauma on his family, family centered care and family
therapy can be used by the psychologist to involve his wife in treatment-associated
decision-making and also educate her on the complexities of Peter’s condition (Carr,
2014).

6DIAGNOSIS ASSIGNMENT TWO
References
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(2016). The efficacy of eye movement desensitization and reprocessing for post-
traumatic stress disorder and depression among Syrian refugees: Results of a randomized
controlled trial. Psychological medicine, 46(12), 2583-2593.
Carr, A. (2014). The evidence base for couple therapy, family therapy and systemic interventions
for adult‐focused problems. Journal of Family Therapy, 36(2), 158-194.
Helpman, L., Marin, M. F., Papini, S., Zhu, X., Sullivan, G. M., Schneier, F., ... & Lindquist, M.
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Hennig-Fast, K., Michl, P., Müller, J., Niedermeier, N., Coates, U., Müller, N., ... & Meindl, T.
(2015). Obsessive-compulsive disorder–A question of conscience? An fMRI study of
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biopsychosocial model of self-regulation, executive functions, and personal growth

7DIAGNOSIS ASSIGNMENT TWO
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