Adjustment Disorder with Mixed Anxiety and Depressed Mood

Cognitive Behavior Therapy
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Summary of the client’s issues and diagnosis based on the DSM-V
In this roleplay, the client presented concerns about boundaries in her relationships, specifically with her partner. She reported feeling insecure and unappreciated, expressing that she often feels she is giving more to the relationship than she is receiving in return. The client expressed a desire to work on establishing boundaries to protect herself from being hurt or taken advantage of. The client shared that she often feels invalidated by her partner and friends, who minimize her feelings and tell her to be patient. This experience of invalidation has been a long-standing one for the client, who reported that her family did not respect her boundaries or validate her feelings as a child. The client described her relationship's pain, frustration, and loneliness, citing stonewalling, dismissal, and defensiveness from her partner. She reported feeling unimportant and worthless due to her partner's behavior.
Based on the DSM-V, from the client's descriptions of feeling "nervous," "sad," and "frustrated" during the session, she may be suffering from adjustment disorder (AD) with Mixed Anxiety and Depressed Mood (MADM code: F43. 23) (American Psychiatric Association, 2013). The client expressed feelings of being taken for granted, unappreciated, and disregarded in her relationships, which may contribute to anxiety and depression. Furthermore, the client's descriptions of her partner's behavior - including stonewalling, dismissing her feelings, and not reciprocating her care - could contribute to her experiencing anxiety around the relationship, as well as feelings of worthlessness or emptiness that may be associated with depression. The client's mention of a difficult childhood in which her feelings were often invalidated may also suggest a longstanding pattern of experiences that could contribute to both anxiety and depression. While the client has not been formally diagnosed with adjustment disorder (AD) with Mixed Anxiety and Depressed Mood, the session transcript suggests several indicators could warrant further exploration of this possibility.
The client expresses concerns about feeling invalidated and disregarded in relationships with her partner and her friends. She also references childhood experiences in which her family did not respect her boundaries or validate her feelings. These experiences raise the possibility that the client may have post-traumatic stress disorder (PTSD- Code: F43. 10). People with PTSD often experience anxiety, avoidance, and emotional numbing in response to traumatic events. They may also share hypervigilance, intrusive thoughts, and nightmares (Substance Abuse and Mental Health Services Administration, 2014). The client's experiences of feeling shut out and unheard in her relationships could be related to PTSD symptoms such as avoidance and emotional numbing. Additionally, her descriptions of feeling like she is constantly pouring into others without reciprocation could suggest hypervigilance, as she may be anxiously trying to maintain relationships to feel safe. While the client does not explicitly mention experi...