Provisional Diagnosis: A Case Study of Samar's Mental Health

This report presents a comprehensive case study focusing on Samar, an Afghan woman living in Australia, to illustrate the application and significance of provisional diagnosis in mental health practice. The report details Samar's socio-demographic background, including her experiences with trauma, displacement, and financial hardship, which contribute to her presenting issues such as sleep deprivation, heart problems, low self-esteem, and depression. It explores the concept of provisional diagnosis, emphasizing its role when complete information is lacking, and highlights the importance of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in guiding mental health practitioners. The analysis includes a discussion of Samar's complex psychological problems, the need for counselling and psychodynamic therapy, and the impact of her past trauma on her current mental state. The report also touches upon the challenges of social discrimination, financial instability, and the importance of addressing these factors in a comprehensive care plan. Overall, the report underscores the significance of a holistic approach to mental health assessment and intervention, particularly in cases involving complex trauma and psychosocial stressors.

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TIMOTHY CHUKWUDI
Contemporary Mental Health Practice

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Introduction
Diagnosis is considered as one of the key factors of health and social care
sector. A health related issue, be it physical or psychological, requires on-time diagnosis
so that it can be identified at an early stage. Effective diagnosis can be able to save
lives of people infected with life-threatening diseases (Resick, 2014). Similarly, in
context of a psychological problem, a timely diagnosis can be helpful in bringing the
affected person back to normal flow of life. Provisional diagnosis is one of the significant
terms used in healthcare sector (Cruwys et al. 2014). A diagnosis is done on the basis
of relevant information regarding the patient. When the available information is
inadequate and the healthcare practitioners are asked to cure the individual, they opt for
provisional diagnosis (Morrison, 2017). Provisional diagnosis refers to a diagnosis
suggested by healthcare practitioners that is not hundred per cent accurate as there is
lack of needful information required to suggest a fulfilling diagnosis. Provisional
diagnosis acts as a temporary solution of the problem unless more information is
gathered regarding the illness or the patient (American Psychiatric Association, 2014).
This essay helps the reader to gain deeper understanding regarding provisional
diagnosis. Based upon a case study, this essay properly illustrates and analyses
different factors involving with provisional diagnosis identified for this particular context
and how to implement it.
Socio-demographic information

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This case study revolves around Samar, an Afghani woman living in Australia.
Samar belongs from Afghanistan but had to leave her motherland at a young age due to
the prevalence of extreme violence leading to conflicts, disappearance and deaths.
Many of her friends and family members disappeared and died during this period. When
Samar left the country her community had been severely affected by drought. After that
her family took shelter in the neighbouring country Pakistan. They lived a miserable life
in the camps which was more like run-down tents and little more than mud huts. Most of
the refugees died of illnesses which were caused due to poor environmental conditions.
Samar was married off at an early age and soon became mother of two sons. After
living in Pakistan for several years, Samar, along with her husband and sons, migrated
to Australia. She is living in Australia for 5 years now. Samar is currently 32 years old
and her sons are aging 13 years and 10 years respectively. Neither Samar nor her
husband has a job and they are finding it hard to make the ends meet.
Samar is concerned about her financial condition and trying for a job in childcare
centre but she is not getting one. She feels that being a refugee she is being
discriminated. Sadness has engulfed her husband who feels like his skills are not being
acknowledged in this country. Although the couple gets unemployment benefits but
household expenses are rising up. One of the most integral expenses is educational
costs. As people are becoming more aware about the utility of education, they are
spending money for the education of their children. Now-a-days, with wide number of
schools and varied courses, education cost has become sky-high (Lumley, Katsikitis&
Statham, 2018). Saving for university costs has become tough for the couple because
of their financial issues. They live in a rented small sized one-room apartment which is

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on a busy street. Samar’s marital life is strained as her husband is at home always and
Samar considers it as ‘unnatural’ for a man. Marriage is about a number of factors that
are being negatively impacted by their difficult way of life. As she has no family left after
the horrendous incidents in Afghanistan followed by tough years in Pakistan, she feels
isolated at times.
She feels disturbed by the negative remarks made by native people towards the
refugees. All these things have made her shy and as a result she is reluctant to meet
new people and form friendship. Samar used to visit a group of Afghani women to make
new friends. But soon after she discovered that talking to them reminds her of her
harrowing memories of her childhood. Nobody wants to recall painful memories of past,
this breaks a person from inside and makes them mentally weak (Schick et al. 2016).
Hence, she stopped visiting the group. Also, she feels guilty about her survival
whenever she thinks about all her friends who died in the refugee camp. As Samar has
no friends, she spends her time by cooking, cleaning the house, taking care of her
children, and watching television in order to improve her English. As a result of reading
English newspapers daily, watching English news and shows related to current affairs,
she can now speak English well. Her Islamic faith has always been made her stronger
to fight tough times. She used praying as a healing process to recover from the loss and
grief. Lately, Samar is not praying much due to her problems.
She has gained a lot of weight and mostly feels teary for past few months. Samar
is afraid to leave the house alone after encountering a ‘heart attack’ on the street due to
backfiring of a car. Therefore, her husband accompanies her wherever she goes. To
Samar her children is the most important part of her life. She wants to keep them away

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from disturbing environment hence she moved to Australia with her family. But Samar is
concerned about her sons as they are not interested in knowing their cultural roots. Both
of them neither fit in Australian culture nor in Afghani culture, therefore, Samar feel they
will be struggling for acceptance in their adolescence. All these things make Samar
stressed and depressed.
Issues
Here, the affected person is Samar. She is experiencing a number of
problems such as sleep deprivation, heart problems, low self-esteem, depression etc.
Sleep deprivation can have a number of reasons working behind it (Salim, 2014). But in
this context, nightmare caused from a trauma is the prime reason behind the
sleeplessness of the patient. Samar has witnessed some unforgettable things which
haunt her in her sleep. She had seen people dying as a result of violence and conflicts
in her home country Afghanistan. Violence leaves a deep impact on the tender brain of
a child, which makes the child psychologically weaker (Slewa-Younan et al. 2017). With
age, the mark left by the negative impact takes form of a scar. A traumatized person is
likely to think about the harrowing experience he or she had gone through in past
(Danieli, Norris & Engdahl, 2017). Samar is experiencing the same issue. Nightmares
are common in this scenario and the patient is likely to suffer from sleeplessness
(Antypa, Vogelzangs, Meesters, Schoevers&Penninx, 2016). Also, among other
reasons behind the sleeplessness of Samar is her tension. She is tensed about a
number of factors such as, their financial condition, academics as well as moral
education of her children, her unemployment, social discrimination, isolation etc.
Education is an integral part of everyone’s life (Sijbrandij et al. 2017). To become

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established and gain respect from society it is mandatory to receive proper education at
every stage of life (Medalia& Bowie, 2016). Both Samar and her husband being
unemployed, their financial condition is not well. They anyhow manage to make the
ends meet. In such a scenario, arranging for university fees of her children would be a
challenge for Samar. She is seeking employment opportunities in childcare centres. But
being a refugee she is not being accepted by the employers. Discrimination is a
worldwide issue and it is common for an outsider to face discrimination in a new country
(Li, Liddell & Nickerson, 2016). Samar is no exception. But the degree of discrimination
is relatively higher towards the Muslims; which is why being an Afghani, Samar is not
being able to get a job opportunity in Australia (Roose, 2016). Moreover, her husband is
also unemployed. All these factors are making a negative impact on their financial
condition. Naturally, Samar is stressed and tensed about the future of her children.
Sleep deprivation is an inevitable outcome of the same. As per the statement of the
patient, the family is currently having zero savings. Therefore, it can be understood that
Samar is going through a hard time which is impacting her psychological wellbeing.All
the tensions and less activity have made Samar gain a lot of weight. Weight gain and
stress are considered as two important factors triggering heart problems (Trick, 2017).
The anxiety within Samar is causing ‘heart attack’ and panic attacks to be precise. Heart
problems require proper treatment but seeing the financial condition of the family it can
be assessed that they are unable to afford any further expense. It is mentioned that
Samar used to live in tough environmental condition in Pakistan, which also caused
death to some of her friends as well. Hence, it is possible that the heart problems are
result of those tough times Samar had survived. Another problem Samar is facing is low

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self-esteem. As she is unable to support her family by finding a suitable job, she feels
that she is not capable of supporting the dreams of her children. She is feeling
worthless and as a result she has become unmindful to her household chores. Lack of
energy generating from sleeplessness is reducing her willpower and physical strength.
Hope keeps everyone going and people hope through prayers. But Samar is praying
less lately. This indicates that she is very much depressed and disappointed with her
current condition.
Provisional diagnosis
The situation through which Samar is going through is indeed a complex one.
Psychological problems are always more tricky than physical issues (Hindman & Beck,
2015). Here, the patient is suffering from not one but multiple problems. Such complex
problems need more information which is not provided in this case. Therefore,
provisional diagnosis would be of much help for the individual to overcome the issues
she is facing. Trauma is considered as the key driver of her problems. The mental
health practitioners follow Diagnostic and Statistical Manual of Mental Disorders (DSM)
while suggesting diagnosis to the patients (Brink, 2014). The DSM V is the latest and
most updated version of the same. As the patient here is dealing with multiple problems
being caused by stress and depression, proper methods should be followed to help the
patient regain overall wellness. Mind is the most important part of human body as its
influences a person to act accordingly (Leichsenring et al. 2015). To attain overall
wellbeing it is essential to ensure the wellbeing of the mind. In Samar’s case, she has
gone through a bitter experience during her early years. She had seen deaths of her
family and friends which had made negative impact on her brain. Samar went through

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mental trauma as a result she cannot sleep at night. The horrendous incident of past
haunts her terribly. She has no friend, therefore, she is unable to share what is going
inside her and feel lighter. As a result, the stress has turned into a burden for Samar
who is seeking medical help to lead a normal life.
Bad times are inevitable part of life, but for Samar, most part of her life is all
about loss and grief. She desperately needs someone to share her thoughts and fears.
Counselling is one of the most effective ways to deal with depression or grief ( Baer,
2015). Samar should consult with her a psychologist and take up counselling to ease
her burden. Counselling can be time consuming, but it is proven as one of the most
effective methods (Leibovich &Zilcha-Mano, 2017). The psychologist can adopt
psychodynamic therapy in this case. From the case study, it seems like the root of all
the problems of Samar’s life is the trauma of her past life. Although she is 32, but she is
yet to overcome her fear and grief which was resulted from that trauma. The memory of
the violence she witnessed in Afghanistan is still fresh in her mind. The wound she got
is not healed yet. Psychodynamic therapy is all about helping the patient to recover by
healing the past wounds and help the patient to successfully move forward in life
(Driessen et al. 2014). The therapy aims to make patients understand how their past
wound is connected with their present situation so that the patient can have proper idea
of that individual’s condition (Holmes, Iyadurai, Jacob & Hales, 2015).
Formulation matrix for Samar
Precipitating
factors
Predisposing
factors
Perpetuating
factors
Protective
factors

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(immediate factors
that have caused
the presenting
issue/s)
(factors in the
person’s history
that makes them
more susceptible
to the presenting
issue/s)
(factors that
are causing
the person’s
presenting
issue/s to
continue or
worsen)
(factors that
provide
resilience and
strength and
help to mitigate
the presenting
issue/s)
Biological
factors
 Trauma
 Weight gain
 Trauma
from past
experienc
es
 Isolation
 Weight
gain
 Lack of
concen
tration
 Lack of
energy
 Lack of
privacy
 Fear of
sicknes
s
 Physical
strength
 Active life
Psycholog
ical
factors
 Bereaveme
nt occurring
from deaths
and
disappearan
ce of her
family and
friends
 Stress
 Excessive
tension
 Depression
 Loss/ grief
 Sense of
failure
 Tension
 Anxiety
about
future
 Lack of
confide
nce
 De-
motivati
on
 Trust
issues
 Insight
 Adherenc
e to self
 Confidenc
e for
overcomi
ng the
barriers
 Belief in
Almighty
 Motivation
to make
the
situation
better
Social
factors
 Social
discriminatio
 Joblessne
ss
 Straine
d
 Knowledg
e gain

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n
 Unemploym
ent
 Economic
al
condition
relation
ship
with
spouse
 Financi
al
proble
ms
 Shynes
s
 Acquiring
skills
 Overcomi
ng
shyness
 Becoming
outgoing
Both in physical and psychological problem, it is essential to receive medical
intervention in order to eliminate the problems the patient is going through or to reduce
it to a greater extent (Medalia, Herlands, Saperstein &Revheim, 2017). Here, Samar is
leading a troubled life which is caused by a number of factors. From poor financial
condition to isolation to lack of confidence to crumbled relationships, all these are major
factors which made Samar mentally disturbed in such an extent that she is suffering
from sleeplessness, has developed heart problem, feeling low and de-motivated most of
the time. However, it is evident that the major reason behind the existence of all the
troubles of Samar’s life is the painful memories of her home country. The violence and
conflicts of Afghanistan had left a deep impact on the mind of Samar. That is why even
after all these years she still has nightmares regarding the same.
The Afghanistan women’s group had also made her recall all those harrowing
times from past. Samar feels like an outsider in Australia and feels unwelcomed due to
religion and racial differences. All these are effects of the trauma she received as a
child. Psychodynamic therapy will be the best suited psychological intervention for
healing the wound which Samar received as a child in Afghanistan (Li, Liddell &

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Nickerson, 2016). The available data regarding Samar indicates that she needs to
recover from her traumatic past firstly in order to attain overall mental wellness. This
would make her more confident to achieve her goals and lead a happy life.
Person Centred Care Plan for Samar
Goal/s:
 To move forward in life by forgetting bitter incidents of past
 To gain more knowledge and employment skills
 To get proper sleep
 To overcome her anxiety
 To feel confident
Strengths to draw upon:
1. Willpower
2. Willingness to learn
3. Helpfulness
4. Faith
5. Morale
Barriers which interfere:
1. Fearfulness
2. Anxiety
3. Shyness
4. De-motivation
5. Physical unfitness
Short term objectives:
 Not to react upon remembering past memories
 Boosting self-esteem and increase confidence level
 Increasing knowledge level and acquiring more skills to get a suitable
job
 Making new friends
 Self-motivation for overcoming the problems
 Offering prayers more
Interventions and action steps:
1) The background of the individual is to be analysed by a health consultant
2) The family members are to be interviewed by the health consultant to gain
more information about the individual’s behaviour
3) The consultant will follow psychodynamic therapy (provisional) to know
about the past incidents
4) Counselling sessions are to be fixed
5) Monitoring of post counselling progress is a must
6) Recreational activities are to be arranged for the individual along with other
people experiencing anxiety related issues

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7) More information is gathered regarding patient to decide a final diagnosis.
A medical issue with provisional diagnosis is clearly not equipped with enough
data. The data can be the history of the patient or the current condition of the patient or
anything similar. Such cases can have different medical interventions from different
people depending on the thinking level of the person. Two other persons were
contacted to discuss about the case of Samar so that there is more flow of ideas.
Person A (medical student) and person B (psychology student) were asked about best-
suited provisional diagnosis for Samar. Person A was adamant that Samar is going
through Posttraumatic Stress Disorder, whereas, person B suggested that Samar needs
family therapy as her problem is impacting her family as well. Person A feels that
posttraumatic stress disorder has made Samar mentally weak; hence, she is
experiencing sleeplessness and anxiety problems. Again, person B thinks that Samar’s
problem is much related with her family; therefore, it is important to include family
members in the treatment process. Among both the suggestions, the idea given by
person A seems more convenient as it deals with stress generating from a horrendous
past event. As Samar’s mental disorder is related to the past events of her life, this
method can be followed in order to make her condition better. The family therapy is
partially correct but it would not be able to attain overall wellness for Samar. Hence, the
situation must be analysed in order to gain desired outcome. Also, A being a medical
student would be able to analyse the overall situation whereas B would be able to study
the psychology and work closely to improve the mental health of Samar.