The Case of CathyCathy is a 32-year-old, divorced, heterosexual African American female. She came to her first initial intake session with complaints of depression with passive suicidal thoughts, anxiousness, and trouble sleeping. She presented as casually groomed, coherent, and goal directed. Cathy’s primary concern was the added stress in helping her mother with her illness.  Cathy reports a history of threatening suicide since she was a teenager. Her family thought she was just trying to get attention. Cathy states that she was  suicidal because she always felt empty, and sometimes she just felt so overwhelmed that she didn’t know how else to cope with these emotions.  She denies any suicide attempts.  The following is a summary of the initial appointment and assessment for Cathy.  Cathy is the oldest of four children (two brothers and one sister), all of whom are married and live in the same community. Cathy believes she is close with all her siblings but sometimes gets so frustrated with them she “can’t stand them”.  Cathy works in a doctor’s office and lives in a one-bedroom apartment where she often “isolates.” She is the primary caretaker of her mother, who was involved in a car accident 20 years ago and was left a quadriplegic. Cathy goes to her home daily to help with her personal hygiene. Cathy has an arrest history and was incarcerated for 3 years for drug-related charges. She was charged with possession and intent to distribute. Cathy stated that at that time she was addicted to heroin and using daily. Cathy reports that she began using marijuana at 14 years old.  As she entered high school she began experimenting with many different kinds of drugs.  Her heroin use began when she was 21 years old.  When she completed her prison sentence, she was paroled and mandated to attend a 1-year outpatient drug treatment program, which she successfully completed. Cathy reported that she returned to using cocaine 2 years ago, stating that it helps her do her fast-paced job better and it keeps her energy up so she can help her mother early in the morning and late at night.  Cathy believes the cocaine use is just an added stress reliever as well as “retail” therapy.  She reports shopping has been a great relief from the time she was working full time.  She said no one in her family or at her job knows that she has been doing drugs. Cathy also takes numerous medications prescribed to her by her primary care doctor, including an antidepressant and pain medication.As we discussed her presenting concerns, multiple issues came up. Cathy shared her feelings about being her mother’s primary caretaker, stating, “I love my mom, but everyone expects me to care for her. It feels so unfair, but it’s because I am not married and don’t have any children, this is when I really hate my siblings.”   Cathy reports never feeling as important as her siblings and believes that is why she is the only one helping her mom now.  She believes they look at her differently since she has a criminal history.  

She said her father does not help with the care of her mother and that all he does is “hang out.” She reported feeling increasingly frustrated with this added responsibility and resentful that her father and siblings have relegated this job to her.  She sometimes resents her mother for her being in this situation.  She was dysphoric as she shared this content and described being “stuck.” She described her father as a “manipulative loser.” She also stated that she recently allowed one of her brother’s friends to move in with her as a favor because he was homeless and had nowhere to go. She said she believed he was a sweet person who just has had a hard time in life, and she wanted to help him. She had been supporting him financially over the last month, and was concerned because it appears that he has not made any effort to get a job. She feared she made a mistake allowing him into her home and has thrown him out several times.  Cathy then felt bad and allowed him back in. Cathy stated that this has been a pattern in her relationships her entire life. When she first meets someone, she idolizes them and believes that they can do nothing wrong, then something always happens and they end up hurting her.     Cathy said that she and this new roommate had sex one time when he first moved in. She said they both got very intoxicated, and she is not sure exactly what happened, but she blacked out and found him in her bed, undressed. She then told him she had herpes, and he responded that it had been a “mistake” and that he did not want to have sex with her again because he was afraid of getting infected. Cathy became angry with him at this. Cathy explained that her promiscuity through her twenties had resulted in this lifelong disease, and she expressed anger and resentment toward some men she had sex with.  She said even though the herpes is controlled with medication, she feels embarrassed and fears she will never have another healthy relationship. She said she feels used, slighted, and humiliated by the man now living in her home. Cathy then shared that when she was 12 years old her father molested her. She stated that she tried to forget what happened to her, but this recent incident with her new roommate brought it up again. Cathy complained of recent nightmares related to the abuse and exaggerated startle reactions to other people’s movements.  Adapted from: Plummer, S.-B., Makris, S., & Brocksen, S. (2013). Social work case studies: Concentration year. Baltimore, MD: Laureate Publishing.

Personality disorders can arise through trauma,  and they often carry added stigma. In this Discussion, you analyze a  case study focused on a personality disorder while also reflecting on  how power, privilege, and stigma affect such diagnoses.

To prepare:  Review “The Case of Cathy” and consider your differential diagnostic  process for her. Be sure to consider any past diagnoses and what  influence they might have on her current diagnosis and needs. Finally,  return to the Week 1 Discussion topic of stigma and reflect on stigma  related to personality disorders.

By Day 4

Post a 300- to 500-word response in which you address the following:

• Provide the full DSM-5 diagnosis. Remember, a full diagnosis should  include the name of the disorder, ICD-10-CM code, specifiers, severity,  and the Z codes (other conditions that may need clinical attention).  Keep in mind a diagnosis covers the most recent 12 months.
• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
• Support your decision by identifying the symptoms which meet specific criteria for each diagnosis.
• Identify any close differentials and why they were eliminated.  Concisely support your decisions with the case materials and readings.
• Explain how diagnosing a client with a personality disorder may affect their treatment.
• Analyze how power and privilege may influence who is labeled with a  personality disorder and which types of personality disorders.
• Identify how trauma affects the case, either precipitating the  diagnosis and/or resulting from related symptoms or treatment of  diagnosis.

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 16, “Diagnosing Personality and Relationship Problems” (pp. 251–270)
 

American Psychiatric Association. (2013m). Personality disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm18
 
Note: You will access this e-book from the Walden Library databases.
 

Cicchetti, D. (2014). Illustrative developmental psychopathology perspectives on precursors and pathways to personality disorder: Commentary on the special issue. Journal of Personality Disorders, 28(1), 172–179. doi:10.1521/pedi.2014.28.1.172
 
Note: You will access this article from the Walden Library databases.
 

Ferguson, A. (2016). Borderline personality disorder and access to services: A crucial social justice issue. Australian Social Work, 69(2), 206–214. doi:10.1080/0312407X.2015.1054296