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DSM-IV-TR Diagnoses

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Case:
Sam R. is a 16-year-old African American high school student. He has recently moved to a new town with his parents and younger sister due to his father's promotion and job transfer. Sam's old high school included a mix of students from many racial, ethnic, and economic backgrounds. At his new school, there are few African American students and Sam feels like an outsider.

Sam has always been a quiet and serious person. Although he usually has one or two close friends, he feels awkward trying to start conversations with others and has never mixed easily in large groups. A good deal of activity at this new school takes place around sports and student government: two areas Sam has little interest in.

Sam also feels unprepared for the level of work that is expected of him at this school, particularly the emphasis placed on presenting oral reports and participating in debates in front of the class. He becomes embarrassed and tongue-tied when he has to speak in front of others. Sam often "gets sick" on the day of an oral report so he can stay home from school, and he is worried this will impact his grades.

- What are the possible diagnoses based on Sam's presenting issues. What would list on Axis I?

- How Sam meets all of the specific DSM-IV-TR diagnostic criteria for the Axis I disorder? If he does not meet all of the criteria, what other information would you need?

- How is the impact of the larger social system (school and community) important to consider when assessing and diagnosing Sam? For example, how might the new school's ideas about 'achievement' or the ways in which teachers/counselors define 'healthy peer relationships'? influence their evaluations of Sam?

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Solution Preview

Axis I Anxiety Disorder

(1) What are the possible diagnoses based on Sam's presenting issues. What would list on Axis I?

Initially, I thought a possible diagnosis for Sam could be Adjustment Disorder because he appeared to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR [APA], 2000. However, upon further considerations, his emotional problems do not appear to be clinically significant, one of the conditions under Criterion B (1) is that "There is a marked distress in excess of what should occur in response to the stressor". Then I considered Specific Phobia because he has a fear of speaking in public. However, Sam's fears extend to more than just speaking in public (a specific phobia). For instance, he is embarrassed in conversation with others, and doesn't mix well with others. Given these other conditions, based on DSM guidelines, Sam's fears are more generalized, and more likely he should be diagnosed with Social Phobia.

(2) How Sam meets all of the specific DSM-IV-TR diagnostic criteria for the ...

Solution Summary

This solution examines discusses the Axis I diagnosis for a specific case study in 531 words with two APA-format references.

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Diagnosing Clients With Psychological and Physical Symptoms

-Create a 5-axis DSM-IV-TR diagnosis for this client, and include the rationale for each of your choices. If you need more information to be sure of a diagnostic choice, list the additional questions you would ask.
-Describe some of the treatment goals you would have in working with this client.
-Describe what might be some personal reactions that others might have when working with a client who presents with a combination of physical and psychological symptoms. (example of some assumptions and beliefs about the relationship between the information we code on Axis I and Axis III of the DSM-IV-TR.)

The case of Richard:

Richard is a 47-year-old man who has been referred for counseling by his physician, Dr. Abrams. Dr. Abrams has been seeing Richard frequently over many years for a variety of physical complaints including joint pain, weakness in his fingers, dizziness, constipation, and headaches. Although Richard does have a medical diagnosis of ulcers and has been diagnosed with anemia in the past, Dr. Abrams has found no evidence of any illness or condition that would account for these symptoms over the years. Richard does not drink or use substances, and he is not currently taking any medications.

Richard also worries that he has a disease like AIDS or hepatitis, and every time he feels sick he believes it is a sign of a more serious illness. Dr. Abrams has repeatedly reassured him that he does not have these diseases, but Richard does not believe him and demands more tests be performed.

Richard is extremely distressed, has alienated most of his friends, and has lost three jobs in the past several years because of absences due to illness or medical appointments. Currently, Richard lives in the basement apartment of his parentsâ?? house, and has not been able to find steady work. He spends most of his days on the Internet researching medical conditions or in chat rooms with others who have similar problems. He often feels anxious.

In the first counseling session, Richard describes his history of physical symptoms in great detail, presents files of medical procedures and tests, and starts to cry, saying he is probably going to die of a â??horrible disease.â? He resists any deeper exploration of his emotions or thoughts, saying, â??This is not all in my head!â?

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