RUNNING HEAD: 9-1 FINAL PROJECT ONE SUBMISSION Lillie Limbrick Southern New Hampshire University COU 650 Diag: Emotional and Mental Disorders Dr. Ferreira 9/25/2021 1 FINAL PROJECT ONE SUBMISSION: DIAGNOSING 2 Biopsychosocial Summary A. Problem The 42-year-old multi-racial (Filipino/Black) woman is a client who identifies as cis-female. The client needs counselling because she reports not “feeling like herself”, a claim backed by her wife wo reports that she observes the client staring into space and is often incapable of making her snap out of her trance. The client claims that while some days she manages to get out of bed, on other days she feels like someone else is “out to get her”. This issue has been going on several occasions or periods since the client and her wife met: 22 years. Even though they do not associate the occasional stupor with any real-life issues or challenges, they claim that they lost their dog eight months ago. This loss can be associated with the recent surge in the frequency, severity, and duration of the occurrences, hence their decision to seek help from an expert. B. Symptoms i. Behavioral Symptoms ✓ Lack of motivation to start and complete daily tasks, especially at work ✓ Procrastinating and getting off work early or calling off work, adversely affecting her career ✓ High degree of alcohol codependence since she was 14 years old ii. Cognitive Symptoms ✓ Inability to focus and concentrate on tasks, causing her to stare off into space ✓ Poor judgement emanating from the belief that others are “out to get her” and take her job away iii. Emotional Symptoms ✓ Sever social anxiety and depression ✓ Paranoia that people talk about her behind her back and want her out of her job FINAL PROJECT ONE SUBMISSION: DIAGNOSING 3 ✓ Suicidal thoughts iv. Physiological Symptoms ✓ Dermatological symptoms such as allergies emanating from her anxiety ✓ Muscular tension at work that makes her incapable of performing her duties and puts her in a stupor state C. Harmful Behavior i. Aggression Client is hardly aggressive. However, she reports having been subjected to emotional and physical abuse as a child. She reports being bullied in school and being mentally and emotionally abused by her high school boyfriend. Her father, mother, and siblings also emotionally abused her, with her alcoholic father subjecting them to torture by yelling every night at her mother and waking everyone up. ii. Harm to others The client does not pose any potential threat to harm others. However, she seems to be taking her partner down with her due to her anxiety and depression; the same person she considers to be her strength and support. iii. Harm to themselves The client reports wishing to be dead and having suicidal thoughts, indicating that she is a danger to herself and has self-destructive tendencies that may lead her down a path of hurting herself with the intention of killing herself. Her self-destructive tendencies at work denoted by frequently calling off work and leaving early may also hurt her professional career. D. Family History FINAL PROJECT ONE SUBMISSION: DIAGNOSING 4 The client reports a history of mental illness that condemned her brother, mother, and sister into struggles with anxiety and depression. Her early life experiences with physical and emotional abuse in the hands of her parents, siblings, and high school boyfriend may affect her in the form of causing her PTSD. Specifically, the toxic romantic relationship she had with her high school boyfriend may affect the health of her current relationship due to fear of history repeating itself. Having been hospitalized for mental health or psychiatric reasons before, the client’s early life relationships with her family (who were suffering from anxiety and depression too) may already be affecting her current life and the life of her wife. E. Evidence-Based Research The client’s family’s history of mental illness could be the reason why she is also struggling with mental health issues like depression and anxiety. Several psychiatric disorders related to mental illness have been proven to run in family, hence their potential for having genetic roots or influences (Levinson, 2013). Due to the client’s genetic makeup, her vulnerability to major depression and anxiety symptoms increased. Recent studies on mental health issues have revealed that there may exist shared genetic risk factors for depression and anxiety disorders (McGrath et al., 2014). The client’s struggles with depression and anxiety could, therefore, be because of genetic factors that run in her family. Moreover, the tendency to develop allergies is often hereditary, meaning that they are passed down from parents to offspring through genes. Her allergies to dust, nuts, animals, pollen, and dairy could, therefore, be genetically inherited from her parents. Another biological factor raised in the case is the client’s excessive menstrual cycles, which forced her to have a hysterectomy at the age of 38 years. These excessive cycles can be associated with hormone imbalances. Hormone imbalances have been proven to result in stress, FINAL PROJECT ONE SUBMISSION: DIAGNOSING 5 and vice versa (Cisse et al., 2019). Therefore, the client’s struggles with depression and anxiety may have resulted to her hormonal dysregulation, leading to worse experiences with excessive menstrual cycles that in turn result in more emotional instability in the form of depression and anxiety, hence creating an unwanted cycle or loop of hormonal imbalance and depression/anxiety symptoms throughout her adult life (Cisse et al., 2019). F. Cultural Characteristics i. Age: 42 years old ii. Disability: N/A iii. Religion: Identifies as Roman Catholic but has not practices Catholicism in ten years iv. Social class: Based on her life activities and employment status at a school district, she is middle class v. Sexual orientation: Lesbian, married to her lesbian wife vi. Indigenous background: Client is multi-racial (Filipino/Black), hence identifies with the indigenous Filipino from the country of Philippines. vii. National origin: Since her ancestors supposedly came from the Philippines, the client’s national origin is the Philippines, but can also identify with the United States where she currently lives and was supposedly born. viii. Gender identity: Cis-gender female, denoting that her personal identity and gender corresponds with her birth sex, hence identifying as a woman with masculine tendencies. G. Cultural Identity Overall, the client culturally identifies as a middle-class cis-gender female who is married to her lesbian wife of 22 years without any children. She has a master’s degree as a Licensed Professional Counselor (LPN), with a job at an American school district as an LPC. She FINAL PROJECT ONE SUBMISSION: DIAGNOSING 6 identifies as Roman Catholic despite not being too religious herself and is a law-abiding citizen with no criminal priors. She is a good partner and daughter who values family and identifies as a bi-racial US citizen who embraces both the Filipino and Black cultures as a part of who she is. Diagnosis Justification Initial DSM Diagnosis Amelia Yee-Jones, a 42-year-old multi-racial (Filipino/Black) woman, was initially diagnosed with Generalized Anxiety Disorder (GAD). This is a mental health condition characterized by excessive worrying about different things. Patients are extremely concerned and worried about impending disasters in their work, family, health, and finances, among other issues. People diagnosed with GAD often find it challenging to gain control over their worries, hence plunging into a pit of restlessness, constant worries, and lapse in concentration (Hobbs et al., 2014). The criteria that must be met when diagnosing GAD include the presence of excessive worry and anxiety about different things occurring regularly for at least six months, and the worries must be very challenging to control since it shifts from one area of focus to the next. Third, the anxiety must be accompanied by at least three of the following: Excessive fatigue, restlessness and edginess, reduced concentration that leads the mind to draw blanks, muscle soreness, irritability, and difficulty in sleeping (Andrews et al., 2016). The main client behaviors used to meet the diagnostic criteria include her lapse in concentration that causes her to stare into space and makes it difficult for her spouse to snap her out of it, her exhaustion that forces her to sleep a lot and refrain from getting out of bed, and her restlessness at work due to the excessive worries that everyone at work is out to get her or push FINAL PROJECT ONE SUBMISSION: DIAGNOSING 7 her out of her position. All these behaviors align with the symptoms of GAD, hence the diagnosis. Cultural Limitations About the Diagnosis Culture influences the way people feel about their symptoms and describe them. It determines whether a client chooses to focus more on her emotional symptoms, physical symptoms, or any other type of symptoms, or all these categories. One of the major limitations is cultural stigma around mental health diagnoses, which entails specific cultures considering mental health challenges a weakness and making it harder for the client to talk about it (Kimmel et al., 2015). Amelia’s closing statement that she hates to ask for help may be tied to such stigma. Another limitation can be the lack of resources. Finding treatment options and resources that take a client’s specific cultural beliefs into account can be challenging (Kimmel et al., 2015). However, based on Amelia’s family support and help from her spouse, she has the community support to ensure that she receives the mental health help she needs. Moreover, her history of visiting therapists as a child and a young woman makes it clear that she had the necessary resources and professionals to help her with her anxiety and depression throughout her earlier life. Developmental Patterns Amelia was born when her mother was 20 years old. Despite being born early, her development was no different from the normal development of kids her age. She said her first word at 18 months and could speak in full sentences at two and a half years. Her motor, physical, and cognitive skills and functioning developed normally throughout her childhood. However, her mental health as she grew older would be faced by significant challenges. FINAL PROJECT ONE SUBMISSION: DIAGNOSING 8 Having been involved in a car accident at the age of three that hindered normal walking for about a year and a half, Amelia’s father dies when she was 12 years old from a fatal fall off a building. Even though her family members have stayed close to her all her life, even supporting her when she came out as gay in college, Amelia maintains that her early life was laden with bullying and physical and emotional abuse from her high school boyfriend. She admits having been in counselling before in her life, seeing therapists and psychiatrists that helped her as she struggles with the death of her father and the abuse and bullying, she faced during the earlier years of her life. She was also in counselling when she came out as a lesbian in her early twenties to deal with the anxiety and depression. Observable Behaviors Amelia’s irritability is one of the behaviors that can be observed by other people, as evidenced by her tendency to be toxic in her relationship to push her wife away since she feared that she would leave her eventually. Also, her impaired concentration can be exhibited through her constant staring off into space, as well as her tendency to miss work or leave early due to anxious thoughts. Another observable client behavior is a high degree of alcohol dependence, which resulted from his anxiety and depression that has persisted into his adulthood and current life. Ruling Out Other Diagnoses Despite the client’s tendency to lose concentration and stare into space, dissociative disorders can be ruled out as appropriate diagnoses because her symptoms do not necessarily fulfill the DSM criteria for dissociative disorders. She only seems detached from people at work, but her family and spouse are still close to her through the milestones she has been forced to overcome in her life. Moreover, she does not suffer from any form of depersonalization or loss of FINAL PROJECT ONE SUBMISSION: DIAGNOSING 9 memory, hence ruling out the chances of dissociative disorders being a part of her mental health diagnosis (Kimmel et al., 2015). Secondly, despite Amelia’s feelings that people at work are out to get her and throw her out of her position in the workplace, she does not seem to exhibit the necessary symptoms for a severe social anxiety diagnosis. She does not suffer from any form of social phobias that most people diagnosed with severe social anxiety have. She does not have a definitive fear of being watched or judged by others (Kimmel et al., 2015). However, her claim that she is not feeling like herself has generated feelings that have affected her work and other daily activities that were previously a part of her routine. FINAL PROJECT ONE SUBMISSION: DIAGNOSING 10 References Cisse, Y., Borniger, J. C., & Nelson, R. J. (2019). Hormones, circadian rhythms, and mental health. The Oxford Handbook of Evolutionary Psychology and Behavioral Endocrinology, 365-379. https://doi.org/10.1093/oxfordhb/9780190649739.013.20 Levinson, D. F. (2013). Genetics of depression. Neurobiology of Mental Illness, 396410. https://doi.org/10.1093/med/9780199934959.003.0030 McGrath, J. J., Wray, N. R., Pedersen, C. B., Mortensen, P. B., Greve, A. N., & Petersen, L. (2014). The association between family history of mental disorders and general cognitive ability. Translational Psychiatry, 4(7), e412e412. https://doi.org/10.1038/tp.2014.60 Andrews, G., Mahoney, A. E., Hobbs, M. J., & Genderson, M. (2016). DSM-5 generalized anxiety disorder: The product of an imperfect science. Treatment of generalized anxiety disorder, 1-18. https://doi.org/10.1093/med:psych/9780198758846.003.0001 Hobbs, M. J., Anderson, T. M., Slade, T., & Andrews, G. (2014). Structure of the DSM-5 generalized anxiety disorder criteria among a large community sample of worriers. Journal of Affective Disorders, 157, 1824. https://doi.org/10.1016/j.jad.2013.12.041 Kimmel, R. J., Roy-Byrne, P. P., & Cowley, D. S. (2015). Pharmacological treatments for panic disorder, generalized anxiety disorder, specific phobia, and social anxiety disorder. Oxford Clinical Psychology. https://doi.org/10.1093/med:psych/9780199342211.003.0015 
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