-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?
? Create a 5-axis DSM-IV-TR diagnosis for this client, and include the rationale for each of your choices
Axis I 300.7 Hypochondriasis, with poor insight
Axis II V71.09 No diagnosis
Axis III No diagnosis
Axis IV Unemployed
Axis V GAF=65 (current)
* Paraphrased in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR [APA], 2000) criteria for Hypochondriasis are the following symptoms: (a) preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms, (b) the preoccupation persists despite appropriate medical evaluation and reassurance, (c) the belief is not delusional, (d) the preoccupation causes clinically significant distress or impairment in social, occupational, or other areas of functioning, (e) the duration of the disturbance for at least 6 months, and (f) the preoccupation is not accounted for by any other anxiety, or Somatoform Disorder(DSM-IV-TR, 2000, p. 507).
(1) The rationale for the Axis I diagnosis is that Richard's complaints appear to have no physical basis. Based on DSM-IV-TR [APA], 2000) criteria, the essential feature of Hypochondriasis is a preoccupation with fears of having a serious illness. According to DSM-IV-TR guidelines, a specifier is used (with poor insight) if the client does not recognize that his concern about an illness is excessive. (p. 504). These criteria can be related to Richard's case. For instance, even though ...
This solution discusses a DSM-IV-TR diagnosis for a specific case study.