Depersonalization/ Derealization Disorder. Case Study Mrs. Spinner (Essay Sample)
Instructions: In each case read the case carefully and note the patient's symptoms, their signs (observable behavior) and their history. Then align each symptom, behavior, etc. with the actual criteria in the DSM. Make sure you indicate in your write-up how each piece of information in the case is an example of the criteria in the DSM so that you can justify your diagnosis. The next section will require you to offer "rule out" diagnoses. These are possible diagnoses that "could" be true, but after careful analysis do not meet ALL OF THE CRITERIA necessary to make that diagnosis. A medical example: a patient complains of a severe headache, stiff neck and a high temperature. You may suspect meningitis....that would be a "rule out" that requires further investigation. Clearly, it is a possible diagnosis, but when a spinal tap is done, it is negative, and meningitis is "ruled out." It was the flu! When you give me two rule outs for the case make sure each one is plausible. For instance, if your final diagnosis turns out to be schizophrenia, a rule out of a phobia for elevators is not even close to the symptoms of schizophrenia and would never be a possibility. You must describe why each of your rule outs DO NOT describe the patient by noting the DSM criteria that are not met. As you read about disorders you will see that there are clusters of somewhat similar disorders that can be differentiated from one another. Finally, you will be asked to discuss treatment options for your diagnoses and the prognosis for the patient, that is what is the likely outcome and possibility for improvement or deterioration. Remember, all reports must be at least 1 full page, single spaced 12-point font.
Make sure you read the case study info below very carefully. Most critical is that you line up each symptom, complaint, sign, and history with the exact criteria in the DSM 5 that will justify your diagnosis. Do not generalize, but do a criteria by criteria justification. For instance, Mr. Q complains of feelings of tiredness and not getting pleasure out of his usual hobbies (Dx criteria that aligns are" fatigue and anhedonia" to help justify a dx of Major Depression). You are also required to rule out diagnoses that "could "be possible but not all necessary criteria. are met. List all criteria that are Not met. Notice that many diagnoses in a chapter are somewhat similar but have significant differences. This exercise is called "differential Diagnosis" for that reason.
Assignment 12: Depersonalization/ Derealization Disorder
Case Study of Mrs. Spinner
Mrs. Spinner is a 46-year-old woman who was referred by her husband who described “attacks” of dizziness that his wife experienced that left her incapacitated. She described being overcome with dizziness and nausea 4-5 times a week, when the room would begin to “shimmer” and she had the feeling that she was “ floating” and could not maintain her balance. The attacks almost always occurred at about 4PM, after which she had to lie down until 7 or 8PM. After feeling better she would spend the rest of the night watching TV, would fall asleep on the couch and go to the bedroom at around 3AM.
The patient was evaluated medically and all tests were negative. She was in fine physical condition. When asked about her marriage she stated that her husband was abusive verbally and demanding of her and her children. She admitted that she dreaded his arrival home from work each day. When she was unable to make dinner, her husband and children would have to go out to eat. He came home, watched TV and had no conversation with his wife.
What is her diagnosis?
What are the symptoms that helped you make this diagnosis? What diagnostic criteria do they relate to?
What are two other possible diagnoses and why did you not choose them?
How would Mrs. Spinner respond to psychotherapy designed to address her “emotional” problems?
What therapeutic approach would you consider and why?
What is her prognosis?
Depersonalization/derealization disorder is a type of dissociative disorder which refers to mental health conditions that cause feelings of psychological, emotional and physical separation from the perception of reality. The disorder causes a persistent and pervasive sense of disconnection from oneself and the world (Lynn et al., 2014). Depersonalization refers to the feelings of separation of an individual’s mind and body from activities and sensations while derealization refers to an individual’s sense of disconnection from other people, natural, social and natural environment. People suffering from the disorder experience a distorted inner reality and the surrounding environment seem something distant and alien; it even affects their thoughts and memories. If not treated after the onset of symptoms depersonalization/derealization disorder can severely disable the daily functioning of an individual. Effective and comprehensive treatment can enable individuals to deal with the condition and resume a normal life by gaining back control and learning how to manage their symptoms.
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