Vignette Analysis: Differential and Provisional Diagnosis and Theoretical Models

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Jane’s Case Analysis
Differential Diagnosis
Based on the vignette, there are several potential diagnoses to consider. Jane’s history of mood swings, self-destructive behaviors, and suicidal ideation suggests the possibility of a mood disorder, such as bipolar disorder or major depressive disorder, specifically, major depressive disorder, recurrent, severe, with psychotic features (American Psychiatric Association & American Psychiatric Association, 2013). Her history of self-harm also suggests borderline personality disorder as a possible diagnosis. Additionally, her struggles with anorexia and bulimia indicate the possibility of an eating disorder, specifically anorexia nervosa or bulimia nervosa. Her erratic behavior, agitation, and apparent delusions suggest the case of a psychotic disorder, such as schizophrenia or schizoaffective disorder. It is important to note that comorbidity among these disorders is common, and Jane may be experiencing more than one disorder simultaneously. Additional information about Jane’s symptoms, medical history, and family history may be necessary to confirm the diagnosis. Furthermore, it would be essential to explore Jane’s trauma history and the impact of sexual abuse on her mental health.
Provisional Diagnosis
Based on the information in the vignette, one possible provisional diagnosis for Jane is Major Depressive Disorder, Recurrent, Severe, with Psychotic Features (American Psychiatric Association & American Psychiatric Association, 2013). Here is a walk-through of the DSM-5 diagnostic criteria for this disorder, matched with relevant vignette content:
* The individual has experienced at least two major depressive episodes.
Jane has a history of self-abuse and suicidal ideation, mood swings, angry outbursts, and erratic, impulsive, and self-destructive behavior throughout her life.
* The individual’s current episode is characterized by either a depressed mood or loss of interest or pleasure in nearly all activities and four (or more) additional symptoms of depression.
Jane has been struggling with anorexia and bulimia since age 12, has lost significant weight, is not sleeping, and has been “talking crazy.” Her parents often find her up all night having conversations with herself that make no sense. These symptoms suggest a loss of interest or pleasure in activities, disturbed sleep, and psychotic symptoms.
* The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Jane has alienated most of her friends and has been struggling with anorexia and bulimia for years, despite treatment. Her symptoms are causing significant distress to both her and her parents.
* The episode is not attributable to a substance’s physiological effects or another medical condition.
There is no mention in the vignette of Jane using drugs or having a medical condition that could account for her symptoms.
* Another mental disorder does not better explain the episode.
While limited information is provided about other possible mental disorders, the psychotic symptoms, for instance, t...