Case 1. Donna Doomas

Case 1. Donna Doomas
Below is the briefly selected information bout the patient which will be used for determining the diagnosis:
 Female, single, 39 years old
 Had problems with marijuana and alcohol since teen years
 Quit senior school and never returned
 Had 2 DUIs
 Had two suicide attempts
 Had several jobs which did not last long
 Experiences communication problems with colleagues
 Experiences mood shifts and quickly gets angry
 Reports feelings of hopelessness
 Gets drunk every weekend and has “one nights stands” with strange men
First of all, it is necessary to list some considerations about the directions for suggesting the correct diagnosis. It is evident that Donna’s problems are closely related to substance abuse – mainly to alcohol, because she regularly gets drunk and does inappropriate things; however, she also uses other substances from time to time. I would prefer to connect the problem with alcohol mostly (and choose appropriate codification), though “mixed substance” might also relate to Donna’s case. Secondly, Donna’s diagnosis might also relate to Axis II because she seems to have such problems since 14-15 years, and it is likely that the disorder has already become part of the personality. Thus, suggestions will be made both from Axis I and Axis II. Thirdly, there is no evidence of Donna’s feelings and moods rather than behavioral explanations – which does not allow to distinguish correctly between Axis II diagnoses; thus, additional information concerning these issues is needed.
One of possible diagnoses is 291.89 Substance induced mood disorder. The reasons for such suggestion are the following: depressed mood and diminished interest to life take place as well as irritability; the symptoms most probably developed due to substance abuse (mostly alcohol), and the symptoms cause great impairment of social activity. I would classify it as the disorder with mixed features – since both irritated mood and depressed mood equally take place (American Psychiatric Association 2000).
Two other possible diagnoses are from Axis II. It is possible to suggest 301.7 Antisocial Personality Disorder due to several reasons: Donna has behavioral and social problems since early age; she often breaks social norms; she is irritable, aggressive and impulsive; she also shows irresponsibility and does not show much remorse concerning her lifestyle; finally, she is more than 18 years (American Psychiatric Association 2000). However, the third diagnosis is most suitable – 301.83 Borderline Personality Disorder. Indeed, Donna has a line of unstable and intense interpersonal relationships; also, it looks like that she has an unstable image of herself, and I suggest that she is worried about feeling abandoned. Also she is impulsive in sex, substance abuse, reckless driving. Finally, this version includes suicidal behaviour and feelings of emptiness as well as frequent displays of anger (American Psychiatric Association 2000). Thus, the most probable diagnosis is 301.83 Borderline Personality Disorder.
Multiaxial diagnoses:case
Axis I.
291.89 Substance induced mood disorder
Axis II.
301.83 Borderline Personality Disorder (or 301.7 Antisocial Personality Disorder)
Axis III.
No general medical conditions were reported.
Axis IV.
It seems that Donna’s parents have overlooked personality disorders since her early age which indicates at least at insufficient attention of parents and maybe at unfavorable environment.
Axis V.
Donna’s condition may be classified as 42 points since she doesn’t have friends, has troubles getting a job and made suicidal attempts.
Case 2. Bob Bonnie
Here are the main facts that will be used to make conclusions about Bob’s diagnosis:
 Male, 29 year old
 Rejects that he has any problems
 Complains that his parents aren’t helping him financially
 Is obsessed with the idea of creating a consulting service
 Recently broke with girlfriend and hurt her by spreading negative rumors
 Did not have friends at school though was good at his studies
 Had no respect for his class- or groupmates
 Is looking down upon the majority of people
Here several considerations are needed. There is no evidence about Bob’s social success or failures, but it is possible to suggest that he has financial problems if he needs his parents to provide financing for him. Also, recent breakdown with girlfriend is an indirect evidence of his problems in personal life. However, it is not know whether Bob experienced problems in different spheres of life for a certain time, and this needs to be cleared out. Let us suggest that since Bob had such attitude and personality traits already at school, he is experiencing the same problems and attitudes for a long time already. If this is not so, than Episodes rather than Disorders should be classified. However, if the suggestion is true, then full-fledged diagnoses can be done. Also, it is not known whether Bob experienced episodes of depression; this question also needs further research.
According to axis I, 301.13 Cyclothymic Disorder can be suggested; indeed, numerous periods with clear hypomanic syndromes such as inflated self-esteem, talkativeness, flight of ideas and increased goal-directed activity can be witnessed; these symptoms do not relate to Schizophrenia, and are not related with any substances (American Psychiatric Association 2000). If there were depressive episodes, than this diagnosis could be true (American Psychiatric Association 2000). Also, Bob’s behaviour can be classified as 296.40 Bipolar I Disorder Most Recent Episode Hypomanic (or even Manic – depending on the length of the period when syndromes took place).
However, everything indicates that Bob’s disorder belongs to Axis II since the symptoms could be noted when he was still at school. Thus, the most suitable diagnosis is 301.81 Narcissistic Personality Disorder. Indeed, Bob has all the signs of this disorder: a great sense of self-importance, believes that he is unique and requires admiration, takes excessive advantage of people (parents, for example), lacks empathy and believes that others are envying him; is arrogant and shows a sense of entitlement (American Psychiatric Association 2000). Finally, Bob is preoccupied of the idea of consulting service and resulting money and power. All the symptoms are present, and thus it is the most appropriate diagnosis.
Multiaxial diagnoses:
Axis I.
301.13 Cyclothymic Disorder or 296.40 Bipolar I Disorder Most Recent Episode Hypomanic
Axis II.
301.81 Narcissistic Personality Disorder
Axis III.
No general medical conditions were reported.
Axis IV.
No special environmental problems were reported.
Axis V.
Bob’s conditions may be estimated as 55 points: he has moderate problems as he has few friends, broke with girlfriend etc., but he does not regard all this as troubles, and there is no evidence of deeper impairment of social functioning.
Source
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Association.