Bipolar Disorder Case Study Diagnosis and Recommendation

Part I: Reason for Referral

1. What was the reason for the referral?

The rationale for the referral is related to the behavior of Ms. Smith and he once boyfriend Frank. She seems to be exposing her erratic and often volatile behavior to others. This erratic behavior has a history of being self-destructive to both Ms. Smith and the individuals she is often involved in relationships with. Ms. Smith also appears to be exhibiting poor judgement as it relates to her behavior towards others. She appears to have very low self-confidence as indicated by her aggressive sexual behavior towards others, her ability to shift her emotions to anger quickly, and her ability to harm others or herself. This my particularly stem from her childhood which relative normal standards was very tough. As a result, she may have experienced very traumatic events that ultimately impacted her ability to diagnose situations correctly while having proper emotional intelligence.

2. What sources of data do you have and need?

As far as data source currently available, we have the childhood history of Ms. Smith. We have a clear understanding of her background and her upbringing. We can draw some connotation between her upbring as a child and her desire for love and relationships now. As a child Ms. Smith longed for a loving relationship which was ultimately denied to her over 18 years. She now desires this love and affection from Frank. After he denied her, she lashed out, not only at him but in response to many years of emotional abuse. We also have the data from her altercation with Frank and how she perceived their relationship. We have data related to the education, occupation, and socio-economic status of Ms. Smith. Finally, we also we have data related to many of the symptoms she feels immediate before and after committing self-harm. These symptoms which oscillate between joy and sadness, show some signs of bipolar disorder. We, need more information related to recent events in Ms. Smiths life and her emotional stability. We need more information on the frequency of the self-harm and if she has sought treatment.

Part II: Background Summary

1. Family/Social, (supports) Include ethnic/racial/cultural

As noted in Part 1, Ms. Smith has a heavily troubled social and family background. First her parents both suffered from drug addictions which heavily influenced Ms. Smith. Her mother, Ms Taylor, who is former heroin addict did not want to Ms. Smith mother. As a result, she gave her to her dad, who also was a heroin addict. This created a tumultuous and unstable environment in which Ms. Smith had to grow up in. For one, her dad was unpredictable in both his mood swing and his ability to take care of the family. He was lower on the socio-economic status rung and therefore could not provide many of the basis necessities many young girls would like. For example, growing up Ms. Smith only had one pair of shoes, one pair of jeans and four shirts. As a student she was heavily picked on and emotional abused by other students (Berger, 1995).

This constant cycle of abuse took its tool on Ms. Smith. For one she had to live within an unstable family knowing that her mother did not want her. Then once she is able to leave that environment she must endure abuse from other students for 5 days a week. This manifested itself in her behavior towards Frank. Here, she simply wants to feel appreciated and given the affection that she was denied for so long as a child. Her stop mother was not any help in this regard as she too ignored Ms. Smith. Even when Ms. Smith brough home straight A’s neither her father or her step mother supported her hard work. This all culminated into severe depression and alcohol abuse as means of coping. She also began to develop severe negative emotions towards others as she was often shunned and ostracized by the very individuals she needed to welcome her. The combination of unstable family, bad school relationships, and confusions related to her place in the world ultimately created many of the anger management issues she is facing today. Exacerbating the issue is drug and alcohol abuse.

2. Medical/ developmental

Ms. Smith has work with many therapists to combat these issues, but very few can understand the circumstances she is going through. This is understandable as many individuals do not have a background dealing with two heroin addicts and an unrelenting childhood full of emotional abuse.

3. Educational/occupational (hobbies)

Ms. Smith is currently employed as a waitress. She performed well in middle and high school, but did not attend or graduate college. While in high school however, Ms. Smith took many advances classes demonstrating her capacity and willingness to learn. She is also very adept at the arts, with a particular focus on writing. She also enjoys music and aspires to be a song writer within the music industry.

4. Behavioral observations

From a behavioral perspective, Ms. Smith exhibits behaviors once would expect with a childhood of emotional abuse. She is often very erratic when it comes to her behaviors as she can be cogent one period and angry the next. She also has a habit of self-harm which is a side effect from her anger towards other as a child. Many, including her parents and peers would ridicule her and cause her emotion pain. This occurred year after year from her early years until her high school graduation. This behavior is also exacerbated by her drug and alcohol abuse which only heightens her anger (Wheatley, 2012).

Part III: Assessment Data

1. In addition to a good diagnostic interview, what assessment tools would you recommend using to aid in giving an accurate diagnosis and developing a treatment plan?

The first tool I would use would be related to mood disorders. Here, I would leverage the Mood Disorder Questionnaire and the Bipolar Spectrum Diagnostic Scale. I would use these two assessment tools first as Ms. Smith looks to have symptoms of bipolar disorder or borderline personality disorder. The basis for this assumption comes from the erratic oscillation of behavior Ms. Smith is exhibiting. She has been known to harm herself in one instance but and then fall in love with another person the next. She often jumps from mania which is characterized by feeling of euphoria and bliss to bouts of extreme depression leading to self-harm. These are symptoms of bipolar disorder which can be properly ascertained using the assessments above. Likewise, Ms. Smith my also have a form of personality disorder. This is attributable to her harsh upbring and the need to be welcomed and accepted by others. She may develop a personality designed specifically for Frank which she believes is ideal for their relationship. She even goes so far to say that they are soul mates and meant for one another. However, Frank does not feel this way which indicates a disconnect between what Ms. Smith is feeling and what is actually occurring in the relationship (Waltz, 2000).

In addition, I would also use the Addiction Severity Index and the Drug Abuse Screening Test. Ms. Smith due in part to her upbringing has shown signs of addiction related to drugs and alcohol. Even more alarming is that both of her parents where heroin addicts. Although the case states that her mother didn’t do heroin while she was pregnant, there is also a strong possibility that she is lying in order to be perceived in a more favorable light by society. Due to the high degree of usage within her family, there is a strong correlation to her potential drug abuse as well. Likewise, her use of alcohol during her teenage years as a coping mechanism also appears to crystalize adverse behavior. Both of these instances can cause further damage to Ms. Smith both physically and psychologically. In order to properly ascertain her condition, both of these assessments will be vital.

Finally, I would use the Columbia Suicide Severity Rating Scale to determine Ms. Smiths propensity to commit suicide. Here again, Ms. Smith has a track record of self-harm, intensified by her use of drugs and alcohol. Although not yet apparent, it would be prudent to text for suicidal tendencies to ensure she protects herself and those around her.

Part IV: Tentative Diagnosis

1. Select a diagnosis using the DSM-5 - DSM codes (add resources) http://ezproxy.umgc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1610168&site=eds-live&scope=site&ebv=EK&ppid=Page-__-1 Defend which diagnosis/diagnoses are possible using specific examples from the case.

Based on the evidence presented above I would select the Bipolar II Disorder “With seasonal Pattern” specifier. Here this diagnosis only applies to a pattern of major depressive or euphoric episodes. This pattern centers around all mood episodes including, manic, hypomanic, and depressive. As noted in the above sections, Ms. Smith exhibits very dynamic behaviors that change frequently and without warning. Major episodes such as a break up with Frank or a therapist observation can trigger her. For example, during one observation, when challenged Ms. Smith would become angry and then immediately apologies the next. She also seemed to shift moods depending on the topic of the observation. She also has a tendency to harm herself, especially when drugs and alcohol are involved (Mondimore, 1999).