Reason for Referral
Ms. Smith was referred to Dr. Liam for psychological evaluation due to concerns about the risk of self-harm. It was posted from her behavior outside the local apartment building, where she was seen screaming, pacing, and crying. Additionally, her recent separation from her boyfriend, Frank, left her with feelings of abandonment and worthlessness, which quickly changed. Given her negative behavior, unstable relationships, and history of suicidal thoughts, a psychological evaluation was urgently needed to assess her well-being and risk of self-harm (Livesley, 2012).
Resources available for Ms. Smith’s evaluation included information gathered from her interviews conducted on 03/18/19 and 03/25/19 with local police, Fire and Rescue Captain Logan, and Dr. Liam during the psychological evaluation. Smith also provided background information to help understand his current psychological state, including his family history, upbringing, education and work, drug use, legal issues, and observations made during the evaluation. Additional information may include medical records, references from family members or previous doctors, and other psychological tests to evaluate symptoms and specific illnesses and diagnoses.
Background Summary
Ms. Smith’s family and social history were filled with depression and instability. Her parents were drug addicts, and he was abandoned by his mother when he was a child and was left in the care of his father after he was released from prison. Ms. Smith grew up in an environment of drug abuse, neglect, and physical abuse, without the care and support he needed to thrive. His mother’s history of multiple relationships and his father’s emotional turmoil caused him to suffer. Moreover, Ms. Smith’s biracial identity may have influenced his thinking and identity formation, especially given the challenges she faces within her family (Livesley, 2012). Lack of a stable parent and emotional stability during the formative years may have caused problems forming and maintaining relationships later in life.
Ms. Smith’s medical and developmental history is characterized by poor early and inadequate care. Although her mother claimed that she did not use drugs during pregnancy, the lack of prenatal care and stressful environment affected Ms. Smith’s development. Her early years were marked by malnutrition, neglect, and poor family functioning, which could have affected her physical, cognitive, and emotional growth (Beckers & Kindt, 2017). Additionally, lack of parental guidance and support during critical developmental periods might have led to behavior problems and depression later in life.
Ms. Smith’s Educational and professional journey was marked by academic success and unstable employment. Although she encountered problems at home, she showed the ability to learn at an early age at school and was supported by teachers who recognized her abilities (Livesley, 2012). However, various situations hindered her education, such as frequent moving and family instability. Throughout her adult life, Mrs. Smith struggled to establish a stable career, changed jobs frequently, and was interested in pursuing a career as a songwriter in the music industry. Her art, music, and writing talents show that he has a creative talent that can combat depression.
Smith’s behavioral analysis reveals the complexity of her psychological presentation. She exhibits a pattern of mood swings ranging from anxiety to suspicion and exhibits undesirable and negative behaviors such as excessive alcohol consumption and unstable relationships (Livesley, 2012). Her interactions with others are characterized by politeness, rudeness, and outbursts, indicating difficulty controlling her emotions and feelings. Additionally, anxiety about abandonment and worthlessness reflects problems with attachment and self-esteem. In general, Ms. Smith’s behavioral analysis underscores the need for a comprehensive assessment to understand the underlying causes of unstable mood and poor coping mechanisms.
Assessment Data
In addition to a comprehensive diagnostic interview, many assessment tools would be useful to assist Ms. Smith developed an accurate diagnosis and treatment plan. First, applying psychological methods such as the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) will help evaluate the severity of Ms. Smith’s Symptoms of depression and anxiety resulting from Smith’s thoughtful experience, fluctuations, and feelings of worthlessness and fear of abandonment. These measurements will provide more information about the severity of their symptoms, help develop a treatment plan, and monitor progress over time (Livesley, 2012).
Second, based on Ms. Smith’s history of negative behavior and unstable relationships, the Personality Assessment Inventory (PAI) will be used to measure her behavior and identify any personality disorders. These measures will ensure the understanding of Ms. Smith’s attitude, including poor functioning and a tendency toward negative behaviors that can make it difficult for him to solve problems and establish and maintain relationships. Moreover, given Ms. Smith’s childhood trauma and trauma history, the Trauma Symptom Inventory (TSI) can be administered to assess the impact of trauma-related symptoms and their impact on his current psychology of mental functioning (Beckers & Kindt, 2017). These methods will help identify unresolved trauma issues that may be causing his emotional instability, negative behavior, and difficulty controlling emotions.
Finally, supporting information from family members, previous doctors, and medical records will support the evaluation process by providing additional context and history about Ms. Smith’s psychological functioning, medical history, and social support (Livesley, 2012). A comprehensive assessment using clinical interviews, standardized tests, and evidence will provide a better understanding of the issues addressed by Ms. Smith and help develop a treatment plan tailored to his unique needs.
Tentative Diagnosis
According to the information provided in the study, when choosing a diagnosis using DSM-5, Ms. Smith’s initial diagnosis could be Borderline Personality Disorder (BPD), with additional considerations of depression and probability of alcohol use disorder. The DSM-5 code for Borderline Personality Disorder is 301.83 (F60.3) (New et al. of Opportunity, 2023).
Borderline Personality Disorder is marked by a pattern of instability in interpersonal relationships, self-image, and emotions and pronounced impulsivity. Ms. Smith demonstrates various BPD signs. For example, she has had unstable relationships in the past, which can be seen in the impulsive way she jumps into a relationship with Frank, whom she describes as her “destiny,” after just six dates. After enthusiastically pursuing a relationship, he soon feels unworthy and despairful when Frank breaks up with her, which is thought to mirror his unstable self-image (Beckers & Kindt, 2017). Additionally, Ms. Smith’s pattern of impulsive and self-destructive behavior, like consuming unprotected sex with multiple partners before meeting Frank and overindulging in liquid, meets the requirements of BPD. Her immediate mood swings, ranging from extreme agitation to apathy, indicate an emotional dysfunction as well as another well-known symptom of BPD.
Ms. Smith will probably be diagnosed with comorbid depression, seeing that she has reported symptoms like pervasive sadness, worthlessness, and suicidal ideation. Her fluctuating states, between extreme restlessness and indifference, could be a sign of depression. Moreover, her history of impulsive actions and unstable relationships can intensify her depression, making it difficult for her to keep consistent moods.
Treatment Recommendations
Given that Ms. Smith’s presentation is quite complicated and her symptoms are very severe, ethical treatment would be to refer her to a psychiatrist for formal psychiatric assessment and treatment. Psychiatrists are medical doctors who specialize in the diagnosis, treatment, and prevention of mental illnesses, including personality disorders such as Borderline Personality Disorder (Beckers & Kindt, 2017). The psychiatrist would be ready to conduct a thorough examination, which will include the issues of pharmacological interventions for managing Ms. Smith’s symptoms, specifically if there is a comorbid depression or other psychiatric disorders. Furthermore, a psychiatrist may work with other mental health professionals to develop a comprehensive treatment plan designed specifically for Ms. Smith, involving individual therapy, group therapy, and medication management.
Evidence-Based Treatment Recommendations
One evidence-based treatment recommendation for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT) (Livesley, 2012). DBT is a structured, skills-based therapy that was developed especially for patients with BPD. It works as well in reducing suicidal behaviors, increasing mood control, and improving interpersonal skills. DBT is a theory that combines the strength of cognitive-behavioral therapy (CBT) and mindfulness strategies to teach people skills necessary for dealing with powerful emotions and impulsive behaviors. DBT commonly includes individual therapy, skills training groups, phone coaching, and therapist consultation meetings. Given the reports of Ms. Smith’s inability to regulate emotions, impulsivity, and unstable relationships, DBT would be a suitable and evidence-based approach that could be used to help her cope with her symptoms and improve her overall functioning.
Other evidence-based treatment recommendations for BPD are Mentalization-Based Treatment (MBT). MBT is a psychodynamic therapy intended to enhance individuals’ capacity to interpret their own and other people’s mental states, which is mostly deficient in BPD. MBT emphasizes strengthening people’s abilities for mentalization, or the skill to contemplate and grasp one’s and others’ thoughts, emotions, and intentions, thus promoting more resilient interpersonal relationships and emotional regulation. Mostly, MBT includes individual and group therapy sessions and discussions with therapists who focus on examining interpersonal interactions and promoting mentalization abilities. As a consequence of Ms. Smith’s previous history of traumatic events, problems in forming and maintaining relationships, as well as emotional control, MBT may be a suitable evidence-based treatment that can alleviate her symptoms and relational problems.
Considerations
Developmental Considerations
The developmental processes are influential for the presentations and the course of Borderline Personality Disorder. Ms. Smith’s early years, full of neglect, abandonment, and abuse, could explain the origin of her personality disorder. Studies suggest that growing up with adverse childhood experiences, for instance, parental drug abuse, neglect, or physical abuse, has been shown to increase the likelihood of individuals suffering from BPD as they grow older (Livesley, 2012). Ms. Smith’s history of inconsistent attachments, maladaptive coping mechanisms, and emotion regulation difficulties are in line with BPD developmental theories, which highlight the role of early relational experience on personality development. Hence, the treatments that target Ms. Smith’s BPD symptoms should include her developmental history and the relational processes that might have caused her current psychological problems.
Sociocultural Considerations
The social and cultural factors also contribute greatly to how Ms.Smith experiences borderline personality disorder and her access to needed treatment (Beckers & Kindt, 2017). Due to being biracial, Ms. Smith might encounter special hurdles in identity shaping, cultural norms, and social support networks. Studies show that marginalized racial and ethnic individuals may have reduced access to mental health services and might face cultural obstacles to getting help. Hence, Ms. Smith’s culture and past experiences of systemic oppression should be considered when designing treatment programs and interventions.
Ethical Considerations
The ethical issues in the diagnosis and treatment of Ms. Smith’s Borderline Personality Disorder include seeking informed consent, protecting patient privacy, and promoting autonomy and beneficence. Due to the high risk of suicidal or self-harming behaviors in Ms. Smith, the first step for mental healthcare providers is to prioritize safety and risk management while at the same time respecting the patient’s right to autonomy and self-determination (Livesley, 2012). Also, the treatment providers should observe ethical guidelines like competence, professional boundaries, and cultural competence while working with people suffering from BPD. This implies regular supervision, consultation, and further education in order to guarantee the provision of care that is both effective and ethical.
Conclusion
Ms. Smith’s case study illustrates a challenging clinical picture that is associated with symptoms of borderline personality disorder (BPD). These include the instability of interpersonal relationships, emotional dysregulation, impulsiveness, and a history of trauma. Among many other contributing factors like early exposure to discard and childhood neglect, and issues of race and socio-culturally, Ms. Smith’s life situation has been shaped. Ethical issues around diagnosis and treatment planning should be considered, such as obtaining informed consent, respecting confidentiality, and embracing cultural competence. A prescription for evidence-based treatment modalities like Dialectical Behavior Therapy (DBT) and Mentalization-Based Treatment (MBT) could provide effective solutions for Ms. Smith’s symptoms and enhance overall functioning. Therefore, a multidisciplinary approach comprising psychiatrists, psychologists, and other mental health professionals is a need of the hour, and this is the only way to ensure that Ms. Smith will receive well-rounded, holistic care.
References
Beckers, T., & Kindt, M. (2017). Memory reconsolidation interference as an emerging treatment for emotional disorders: Strengths, limitations, challenges, and opportunities. Annual Review of Clinical Psychology, 13(1), 99–121. https://doi.org/10.1146/annurev-clinpsy-032816-045209
Livesley, W. J. (2012). Integrated Treatment: A Conceptual Framework for an Evidence-Based Approach to the Treatment of Personality Disorder. Journal of Personality Disorders, 26(1), 17–42. https://doi.org/10.1521/pedi.2012.26.1.17
New York State of Opportunity. (2023). Valid DSM-5 accepted in 2023 PCS application. https://omh.ny.gov/omhweb/pcs/submissions/valid_dsm5_sorted_by_label.pdf
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