• Explain whether you agree with your colleague’s identified diagnosis and recommended treatment and why.
• Explain any additional factors that your colleague should take into consideration for treatment planning.

Colleague 1: Tiffany 

Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention).  Keep in mind a diagnosis covers the most recent 12 months.

Obsessive-Compulsive Disorder F42.2 with absent insight/delusional beliefs, Trichotillomania F63.3, Upbringing away from parents Z62.29

Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

I choose OCD because I feel as though Aretha meets the diagnostic criteria. Obsessional symptoms or compulsive acts or both must be present on most days.

In her case she has “recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress” (DSM, 2013). For Aretha she has had an unrealistic fear of germs since she learned about them as an adolescent.

Next she displays compulsions which are defined by “repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly” (DSM, 2013). Aretha feels the need to compulsively clean on a daily basis. She has health issues which makes it harder for her as well. This is very time consuming, however she does not see it as an issue due to her not working.

In addition to OCD I believe Trichotillomania F63.3 would also fit.  This is because the pulling out of her hair is not a vanity related combined with her attempts to stop the behavior, and social impairment.

In addition to this she has feelings of abandonment that are attributed to her parents dying when she was younger. This symptom was triggered by her sister getting involved in a romantic relationship. I would defiantly say that she “attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action” (DMS, 2013). This is where the hair pulling comes into play. She uses the hair pulling as a form of treatment for when she gets worked up. The hair pulling did not start until she moved out on her own.

I also chose Upbringing away from parents because there seems to be some unresolved issues surrounding how she grew up and the type of support and love she felt.

Discuss other disorders you considered for this diagnosis and eliminated (the differential diagnoses).

Making this diagnosis was challenging for me. At first I thought the diagnosis was what I settled on (OCD, and Trichotillomania). Then the more I read I thought that it was just OCD with her thoughts and the hair pulling. Then I realized to diagnose OCD for the hair pulling she would have to pull her hair for an hour a day. Which I don’t believe she does. So after I read that I went back to my original diagnosis. The only other diagnosis I thought about was Body dysmorphic disorder. However I quickly realized that this had nothing to do with vanity do I eliminated this diagnosis.

Describe an evidence-based assessment scale that would assist in ongoing validation of your diagnosis.

One of the commonly used scales for OCD would be the Yale-Brown Obsessive-Compulsive Scale. This assessment is a series of ten questions which the client answers about their compulsion, thoughts, distress etc. This is followed by a symptoms check list that the therapist will go over with the client. You are given a score to determine where you fall.  

Recommend a specific intervention and explain why this intervention may be effective in treating the client.

The intervention that I found was called Exposure Response Prevention Therapy (ERP therapy). “This therapy involves the person with OCD facing his or her fears and then refraining from ritualizing. This can be extremely anxiety provoking initially, but eventually the anxiety starts to wane, and can sometimes even disappear” (ERP Therapy, 2015). I thought this was good because typically talking about the fears and continuing to go over it adds anxiety to the person. This is because OCD is not a rational. With the help of the right therapist this treatment can help reduce the compulsions of OCD.

References

Clinical Definition (DSM-5) of Obsessive Compulsive Disorder (OCD). (2018). Beyond OCD. https://beyondocd.org/information-for-individuals/...

ERP Therapy – A Good Choice for Treating Obsessive Compulsive Disorder (OCD) - Obsessive Compulsive Disorder (OCD) & Anxiety Disorder Attacks, Symptoms & Treatment. (2015). Mentalhelp.net; https://www.mentalhelp.net/blogs/erp-therapy-a-goo...

Colleague 2: Vanessa 

• Provide the full DSM-5 diagnosis for the client.

It is my belief that Ms. Aretha has Obsessive Compulsive Disorder, or OCD 300.0 (F42). The specifiers include fair insight which includes compulsively cleaning her home on a daily basis. Z codes for Ms. Aretha include F43.22 with anxiety, F60.0 Avoidant personality disorder, and possibly F43.20 Adjustment disorder, unspecified.

• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

Ms. Aretha presents as having Obsessive-compulsive disorder due to the fact that she has the following symptoms:

Recurrent and persistent thoughts, and urges to clean her home daily.

She attempts to ignore or suppress her thoughts by showing signs of anxiety and pulling out her hair

She repetitively cleans her home and pulls out her hair. These acts take longer than one hour per day and she plans her day around cleaning.

• Discuss other disorders you considered for this diagnosis and eliminated (the differential diagnoses).

Other diagnosis considered and eliminated where

1. Generalized Anxiety Disorder
2. Trichotillomania
3. Unspecified Obsessive-compulsive and related disorder

Generalized anxiety disorder was ruled out due to the client pulling out her hair. There were also no reports of her trembling, twitching, feeling shaky, or having muscle aches or soreness. She did not have a majority of the criteria. Though she did have anxiety, sleep disturbance, and has a hard time controlling her anxiety. Trichotillomania could very well be an appropriate diagnosis, however it seems that there is more to it than that. Unspecified obsessive-compulsive disorder is mentioned due to the vast amount of symptoms. It assures that the right diagnosis is harder to find than one would expect.

• Describe an evidence-based assessment scale that would assist in ongoing validation of your diagnosis.

The first step in identifying and treating OCD is through a thorough evidence-based assessment (Rapp, et al., 2016). The Y-BOCS (Goodman, 2018), would be beneficial in this case as an assessment scale that would assist in validation of the diagnosis. The reasoning is that it is simple, yet to the point and can provide the needed information to further the confirmation of the diagnosis. 10 questions are asked and then the score is tallied at the end to determine if there is indeed a diagnosis needed. This same assessment can be utilized to later determine the success in treatment or if there is something that needs to be changed.

• Recommend a specific intervention and explain why this intervention may be effective in treating the client.

When an obsession occurs, it almost always corresponds with a massive increase in anxiety and distress (Lack, 2012). The recommended intervention for Ms. Aretha would be medication management. The right medication could allow her to gain a better control on her anxiety. Medication alongside 1:1 therapy would be most beneficial.

Amy M. Rapp, R. Lindsay Bergman, John Piacentini, & Joseph F. McGuire. (2016). Evidence-Based Assessment of Obsessive–Compulsive Disorder. Journal of Central Nervous System Disease, 2016(8), 13–29.

Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., Charney, D. S., Berman, N. C., Shaw, A. M., & Wilhelm, S. (2018). Yale-Brown Obsessive Compulsive Scale. Cognitive Therapy and Research, 42, 674–685.

Lack, C. W. (2012). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World Journal of Psychiatry, 2(6), 86–90. https://doi-org.ezp.waldenulibrary.org/10.5498/wjp...