Tina is a 23-year-old black female. She is currently separated from her husband of five years. She is currently employed by two companies, one at which she works Monday- Thursday mornings, and the other on Wednesday -- Friday evenings, and all day Saturday and Sunday. However, she hasn't shown up for work on a consistent basis for the last four weeks, and not at all in the last two days.
Once an energetic, active, healthy female who loved to exercise at the local gym three days a week, Tina now spends most of her time in her apartment. She hasn't been to the gym in over four weeks, and her body movements that used to be quick and marked are now slow and sluggish. Even though she hasn't changed her eating habits, Tina has been losing weight.
Joe, Tina's husband, left her for another woman approximately four weeks ago. When she found out, Tina immediately locked herself in her room and cried herself to sleep. That night, she slept for about twelve hours straight, but that was the last time she had a long stretch of true sleep. Since then, Tina's sleep habits have been very erratic; sometimes she will sleep for a few hours in the day, some in the evening. She finds herself unable to sleep longer than four hours at a time; as a result, she is constantly fatigued.
When she is awake and able to think clearly, which isn't 100% of the time, Tina is fixated on where she went wrong in her marriage. She feels that if Joe left her for another woman, it must be because she must not be good enough, just like she wasn't good enough for her own father to stay at home when she was seven…he left her and her mother, so she must not have been good enough back then, either.
Tina thought that when she married Joe right out of high school, it would be so wonderful. She had such great plans for the two of them...they would both work their way through college and be successful. But it didn't work out that way, and Tina had to work two jobs just to keep food on the table and the rent paid, because Joe felt it more important to hang out with his friends all day long. If only she had worked harder, or been prettier, or sexier. That must be a lot of it, Tina thinks. She isn't pretty enough, or hard working enough, or good enough, or sexy enough, which is why Joe left her. She was always so tired from working so much, that it was all she could do to crawl in the bed to sleep, much less give Joe the sex he wanted so often.
Tina believes that because of whom she is and what she has done, no one will ever love her and she will never have a relationship again. She keeps saying over and over how worthless she feels, and that her working all the time must have contributed to the downfall of the marriage. The company kept telling her that if she did just a little more, stayed a little longer, worked a little harder, that she would be promoted, which is why she kept pushing herself as she did. Unfortunately, Tina couldn't balance the roles, and lost her husband as a result. She feels like a failure, and that she will always be a failure at life and at love.
Tina thought that she and Joe had many friends, but when Joe left, the friends stopped calling and coming to visit, leaving her alone with her sadness. Shortly after Joe left, she called a few girlfriends, but they eventually tired of her constant complaining and wanting sympathy and stopped answering her calls. As a result, Tina has no one to talk to. It would have been nice to talk to her sister, but her sister committed suicide four years ago after becoming deeply depressed over a broken relationship. Tina has thought about suicide too, but she isn't at the point to do anything about it…yet.
Major Depressive Disorder: Tina Case Study
Major depressive disorder is a difficult disorder to identify, deal with and treat, especially when a single episode of symptoms is the only diagnostic criteria. There is a social tendency to see MDD as a singularly and normal event when its episodic symptoms are associated with real life stressors and therefore something someone will likely work through on their own if they do the right work. This social view of MDD symptoms (especially in singular) episodes often leaves people suffering from MDD with ideation about further inadequacies and social isolation as there is little social support demonstrated by people for the affect of the symptoms of MDD and other depressive disorders, which creates a vacuum for the patient and a challenge for clinicians who seek reasonable and effective treatment intervention (Hybels, Blazer, Steffens & Judith, 2006). Major life stressors can trigger major depressive disorder in a single episode and with appropriate grief work a major depressive disorder can result in resolution or in the diagnostic sense remission. So, finding a balance between action and inaction on the part of the clinician and/or the client is essential as working together to find a resolution for a disorder that can seriously impair an individual's ability to function is crucial to recovery and a return to prior normal and productive living. One of the most essential aspects of major depressive disorder is a lack of ability to feel joy, even when good things happen in one's life. This experience of lack of joy is persistent and devalues one's life, affecting everything about their desires and drives. Tina, in the case study above demonstrates symptomology of a major depressive episode and would likely be helped with diagnosis and intervention. This work will review Tina's case with regard to the diagnostic criteria for Major Depressive Disorder, offer a possible multi-axial diagnosis, discuss theories associated with her possible MDD and finally close with a discussion of possible treatment options for Tina, given her diagnosis and theoretical indices for intervention.
Tina's Possible MDD
The occurrence of MDD is in definite need of review with regard to Tina, her behaviors and feelings indicate a need for appraisal and intervention as the depression she is experiencing is affecting her ability to function both at work and at home and if it continues without treatment may further impair her functioning. Major depressive disorder as described by the multi-axial system includes the presence of a single episode of the mood disorder, Major Depressive Disorder on the Axis I table as the patient has not reported having such an episode prior to this time and the episode is not better explained by any other psychotic disorder nor does she exhibit signs of having mixed episodes including mania. It is also clear that Tina's Major Depressive Disorder episode is linked with the melancholic features as a modifier. The criteria for this modifier, experienced by Tina include loss of pleasure in all or most activities coupled with several of the secondary qualifiers, including distinct quality of depressed mood, as this is a novel reported experience for Tina, early awakening at least two hours before regular time, marked psychomotor retardation (reported sluggishness and inability to move rapidly), significant weight loss, and excessive or inappropriate guilt. The likely diagnosis for Tina would be Major Depressive Disorder Single Episode with Melancholic Features. Axis II does not apply to Tina as she does not report any marked personality disorder. Axis III is also non-applicable as she does not seem to be experiencing any underlying medical or neurological condition that could affect her outward presentation of diagnosis. Axis IV is appropriate to explore as Tina is and has experienced several life changing psychological stressors over her lifetime and is presently experiencing an abandonment. First she still has demonstrative feelings of loss with regard to her father's abandonment of her and her mother when she was a child. Her only sister committed suicide as a result of a depression brought on by a breakup, just a few years prior to Tina's acute period of depressed symptoms and finally she is experiencing the acute feelings of loss and grief associated with a very recent divorce, which is likely at the root of this particular episode of MDD. On an Axis V code Tina would likely code between 41-50 as she is experiencing serious impairment in social and occupational functioning that has gotten worse over the last few weeks, where she was previously able to attend work spottily and now is not attending work at all and she previously was able to reach out to friends and loved ones but is currently nearly completely isolated. (APA, DSM-IV-TR, 2000, pp. 348-350)