Question Description

chose two questions and answer it:

For everyone: do you think it is possible that the list of disorders recognized by western society is all inclusive? Based on what evidence? As was the case with homosexuality in the past, is it possible today that the DSM-5 contains disorders that are not "real" disorders? Is it possible that "real" disorders are missing from the DSM-5?

What are the potential cultural implications of having an imperfect diagnostic system?
When is having a reasonably good classification system "good enough" and when is it detrimental?

Why is there no "Independent Personality Disorder" in the DSM-5? Would Independent Personality Disorder be a culture-bound syndrome if it were included in a psychiatric diagnostic manual used in another country? Consider a culture which highly values interdependence more than independence in interpersonal relationships.

Dependent Personality Disorder
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1 Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

2 Needs others to assume responsibility for most major areas of his or her life.

3 Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)

4 Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

5 Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

6 Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

7 Urgently seeks another relationship as a source of care and support when a close relationship ends.

8 Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Dr. Harper

Reference
American Psychiatric Association. (2013). The diagnostic and statistical manual
of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Publishing.

briefly answer the questions: Would it be appropriate to treat this client or not? If so, what would be the purpose/goal of treatment? What would be the DSM-5 diagnosis? What biases are you aware of within yourself that influence how you view these cases?

1) Ariella and her husband are originally from Israel. Her husband was found to be having an affair. Ariella has asked for a divorce. In her culture, women are not allowed to ask for a divorce, only men can ask for a divorce. All of Ariella's family members and in-laws believe Ariella has a mental illness because she continues to ask for a divorce and will not be intimate with her husband since learning of the affair. Jewish divorce lies within the discretion of the husband alone and the rabbi said he will not interfere with that discretion. The family does not typically go beyond the rabbi for situations like this; however, one of the cousins, Calev, studied psychology and has convinced Ariella's husband that a "good, Jewish psychiatrist" may be able to make Ariella understand why she is wrong to ask for a divorce and give her some medicine to calm her down.

2) Madea (70+-year-old, African American female from rural South Carolina) recently lost her husband of 54 years. Her adult children have observed Madea talking to her deceased husband and she tells them what he said about them. She claims to have seen him and that he came back to let her know that he was okay. Madea's oldest daughter believes their mom is hallucinating and "must be schizophrenic." Madea is showing no other signs of psychological distress--she, of course, becomes saddened at times and misses her husband; however, she is carrying out her daily responsibilities and self-care effectively. Except for when she gave birth to her children and to take her children to the doctor for shots, check-ups and when the youngest boy broke his arm, Madea does not use conventional physicians much for herself. She typically uses root medicines.

3) Miguel (2nd generation Mexican American, born in South Texas) comes to your clinic after taking an abnormal psychology class. He is convinced he has an anxiety disorder. When he explained what he was experiencing to his grandmother, she told him he just had "nervios" and should go to the curandera for help. When you ask him about symptoms, he tells you that he worries a lot. He also wants to know what he should tell his grandmother about going to the curandera.

same of an answer:


Hello Class,
For Ariella, I would not suggest giving her medication to settle her down, even considering her culture. Without knowing more about her behaviors, and whether she has engaged in other risky behaviors other than asking for a divorce and withholding sex, as women in her culture are not allowed to do so-- I feel it is hard to give her an accurate DSM-5 diagnosis. Since this is the case, I would apply V71.09 for "no diagnosis given," as you mentioned in response to Shannon (APA, 2014). However, I would recommend counseling therapy for both Ariella and her husband, at her husband's discretion. My personal bias in this case is based on my disgust with the sacrilege of marriage, regardless of culture.
For Madea, I feel it may be appropriate to offer counseling to help her in her time of grief. Many people who lose their loved ones will often dream about them, or claim to have seen visions of the deceased, as Madea explained; but since her hallucinations do not interfere with her abilities to carry out day-to-day life, I would not give her a diagnosis of schizophrenia, and would instead diagnose her with "persistent complex bereavement disorder" (APA, 2013). For treatment I would offer counseling with the goal of helping her overcome her bereavement and safely move through the stages of grief. If her symptoms continue to persist or worsen after thorough counseling, then I would consider an underlying major depressive state or PTSD as possible alternate diagnoses that may overlap with persistent complex bereavement disorder (APA, 2013). Regarding myself, I cannot identify any potential for serious bias in this case, however I would be concerned about her avoidance of physical exams and the usage of root medicines.
For Miguel, I would likely diagnose him with "generalized anxiety disorder" given his symptoms of constant worry and his grandmother's belief that he just has nervios (APA, 2013). It may be appropriate to offer to prescribe Miguel with an anti-anxiety medication after some baseline evaluations, but given his culture I would not discourage him from seeing the curandera (a healer traditionalized by some Spanish/Latin cultures), and would encourage him to talk to his grandmother about what his new options are. In any case, the purpose of treatment would be maintenance for his anxiety disorder. Also, I cannot think of any bias I may have regarding this case at this time.

References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. Retrieved from https://scholar.google.com/scholar?hl=en&as_sdt=0%... (Links to an external site.)