Psychopathology of mental health patients

Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.

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 her 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.

Describe the presenting problems.
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
Discuss which cluster the primary diagnosis belongs to.

Full Answer Section

     
  • Past risky sexual behavior: Vee reports a history of engaging in unprotected sex with multiple partners.
Primary and Differential Diagnosis (DSM-5 and ICD-10 codes) Primary Diagnosis:
  • Borderline Personality Disorder (BPD): Vee's symptoms strongly align with the criteria for BPD in the DSM-5 (301.83) and ICD-10 (F60.3). These include:
    • Fear of abandonment and unstable relationships
    • Impulsive behavior in multiple areas
    • Identity instability
    • Non-suicidal self-injury
    • Suicidal ideation or threats
    • Emotional dysregulation with intense and fluctuating moods
Differential Diagnoses:
  • Major Depressive Disorder (MDD): While Vee experiences low mood, her self-harm and relationship issues suggest BPD is more likely.
    • DSM-5 (311): Consider if depressive symptoms are prominent and not better explained by BPD.
    • ICD-10 (F32): Similar considerations as DSM-5.
  • Post-Traumatic Stress Disorder (PTSD): Vee's past risky sexual behavior might be linked to trauma. However, the lack of reported trauma symptoms suggests BPD is a better fit.
    • DSM-5 (309.81): Evaluate for trauma history and characteristic PTSD symptoms.
    • ICD-10 (F43.1): Similar considerations as DSM-5.
Cluster of Primary Diagnosis (BPD) Borderline Personality Disorder falls under Cluster B: Personality Disorders in both the DSM-5 and ICD-10. This cluster includes disorders characterized by dramatic, erratic, and emotional behavior patterns.  

Sample Answer

   

Vee presents with several concerning symptoms that require a comprehensive mental health evaluation. Here's a breakdown of her presenting problems:

  • Self-harm: Vee has a history of non-suicidal self-injury (NSSI) through cutting and reports chronic suicidal ideation.
  • Emotional dysregulation: She experiences episodes of "zoning out" and has difficulty managing stress.
  • Identity instability: Vee struggles with a consistent sense of self, changing interests and behaviors based on her social circle.
  • Relationship instability: She exhibits an unhealthy pattern of idealization and devaluation towards her partner, with impulsive behaviors and emotional