-What are Annie's Axis I and Axis II diagnoses? (linking the clientâ??s symptoms to specific DSM-IV-TR criteria).
-How might age, gender, ethnicity, and relationship dynamics contribute to the symptoms and issues this client is presenting?
-What factors would you need to consider when developing a treatment plan for this client?
-How would an Axis II diagnosis impact the client-counselor relationship, goals of therapy, and interventions you might choose?
Case of Annie:
Annie is a 47-year-old Chinese-American woman who has come to therapy because of difficulties she is having with her husband. Since her last child left home for college, Annie has felt increasingly lonely and has been asking her husband to spend more and more time with her. His response has been to become angry and critical, saying her expectations are unreasonable and that she needs to find other ways to fill up her time.
For over two years, Annie has felt sad most of the day. She has low energy, poor concentration, and often feels a sense of hopelessness. Annie is in good health and does not use alcohol or drugs. She has not felt this â??lowâ? before in her life.
Annie does admit that she has always felt a lack of confidence in herself, even as a child, and has relied on friends and family to provide guidance and direction. She remembers a reluctance, dating back to elementary school. to disagree or express a different opinion for fear of losing friends. She has looked to her son and husband to make all of the important decisions in the family, and has counted on her two daughters for continual reassurance.
Annie hates to be by herself and cannot imagine being able to face life on her own. She is terrified that her husband may leave her and has been clinging more to her friends, calling them frequently and asking them for advice. Lately her friends have been less available for her however, and suggested that she should really be talking to a therapist about these things. This has made Annie feel even more frightened and unhappy.
Personality Disorder Diagnosis
(1) What are Annie's Axis I and Axis II diagnoses? (Linking the client's symptoms to specific DSM-IV-TR criteria).
Based on the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV-TR) criteria, Annie has a "pervasive and excessive need to be taken care of which leads to submissive and clinging behavior, fear of separation. The condition may begin by early adulthood and present in a variety of context, and with five of the following symptoms:
1. Has difficulty making every day decisions without advice
2. Needs others to assume responsibility
3. Has difficulty initiating projects; lack self-confidence
4. Needs nurturance and support from others
5. Feels uncomfortable or helpless when alone; exhibit exaggerated fears of being able to care for self
6. Urgently seeks others as a source of care and support when one relationship end
7. Unrealistically preoccupied with fears of taking care of self (DSM-IV-TR, 725).
Given that Annie wants her husband to spend more time with her. In addition, she looks to her husband to make decisions for her, and thus meets criterion 1.She relies on friends and family to provide guidance and direction for her (Criterion 2). She lacks self-confidence (Criterion 3); She has fear of losing ...
This solution describes treatment for a specific based on an Axis II diagnoses for Personality Disorder.