DSM 5
DSM is the diagnostic and statistical manual that is utilized by the mental health professionals as the diagnostic bible. DSM contains information that pertain information to all disorders of psychiatry. Detailed information and the disorders particular overview are contained in each diagnostic listing.
A bio sycho social assessment is a general approach or model that states the psychological, biological, and social factors that all have a significant role in the way the human functions in terms of illness or diseases. It is of the view that, in order to understand health, a combination of social, psychological and biological factors needs to be utilized as opposed to being purely in biological terms as depicted by the case below.
Mercy is a 32 year old lady with police record of being in possession of narcotics. The time of her presentation is two weeks after the delivery of her son. She presents with loss of interest and a depressed mood with her new born son. The symptoms from her indication are that they began 7 months ago after moving to a new small town from her home in New Orleans. She further indicates that she finds it difficult to cope without her friends around and also she is unable to stay the whole day awake and concentrate with her work as during the night, her son usually wakes up every hour and it is not to her fight with alcoholism since she could drink the same amount and still be active during the day. Even though, with her aunt, they get along well she has been unable to make new friends.
She complains of constantly feeling the guilt of not being able to do much after her husband who really cared for her was shot at and arrested in her presence. On being questioned about suicidal thoughts, she declares that due to the love of her son, she can never think about committing suicide. Since, she was pregnant; she has abstained from the use of tobacco or any illicit drug use but continued taking alcohol. The father of the baby is serving a jail term and Mercy has vowed to keep the baby a decision that is supported by her aunt. After having several welfare visits, both Mercy and her aunt were informed by the welfare officials that the fitness of Mercy to keep the baby will have to be re-evaluated. Previous welfare visits were initiated after a neighbor reported that after knocking on the door for approximately two hours to find out why the baby was crying, he had seen through the window that Mercy was sleeping on the couch while her son cried on the blanket on the floor. As much as she is of the view that she would like to keep her son, she is afraid that on the mental health diagnosis, the social services may not be in her favor.
The problem from the client’s perspective is that she views the mental health diagnosis as a risk. This is because she is of the view that, they might not understand the main reason why she is unable to stay awake during the day is because that her son usually wakes up during the night approximately every hour denying her enough sleep. She instead thinks that, they might mistake it with the abuse of illicit drugs such, tobacco or alcohol. Hence, due to these, deny her the right that she believes her son needs a mother.
The problem from my point of assessment is that the symptoms that are being exhibited by the client could either be caused by her long period and continued reliance on drugs or it could be caused by the trauma that she suffered when she witnessed his beloved one, who really cared for her being shot at and separated from the family she is forced to raise on her own.
Differential diagnostics
A method that is utilized by a clinician in order to determine the causes of a clients symptoms caused by a DSM disorder is referred to as the differential diagnosis. All revelant causes of symptoms are considered by a clinician and then alternative causes are eliminated based on a clinical interview. Hence it involves determining between different disorders that do pose similar symptoms which one is the client suffering from by utilizing systemic contrast and comparison of the clinical findings.
The two plausible diagnosis that might be appropriate include the post trauma stress disorder (PTST) and the substance use and addictive disorders ( DSM-5) Substance use disorder B . There are various arguments that support that Mercy is suffering from substance use and addictive disorder. She fulfills some of the requirements as evidenced by symptoms of disorder B. such as within the past 12 months, she has admitted to have been involved in taking different drugs such as alcohol in larger amounts than she had expected before her boyfriend was imprisoned. Additionally she has been unsuccessful in her attempts to cut down the on the amount of the drugs she has been taking. Also she accepted that due to her being continuously dependant on the drugs, it has led to her being unable to perform at work. The other symptoms that she has exhibited include, the recreational activities she used to be involved in frequently such as swimming on arrival in the new town no longer exist. Also, she admits her body has increased in tolerance. Finally she suffers from withdrawal syndrome whenever she tries to quit the use of drugs.
There exists various arguments that support that she is suffering from the Posttraumatic stress disorder (changes in Criterion A in the in the DSM-5), they include; she was exposed to the threatened death of her husband as he was shot at and arrested to serve a jail sentence. Also she has symptoms such as alienation and detachment as witnessed by her not being able to make new friends in the new town.
The reason why the posttraumatic stress disorder (DSM-5) H fails to be the effective diagnostic is due to various facts such as she explains that suicide is not part of her plans as she understands that her son requires a father. Additionally, her symptoms are linked directly to the effects of a substance that are directly physiological such as use of drugs like, alcohol and not purely due to drug use. The symptom that demerits the substance use and addictive disorders (DSM 5) substance use disorder include she has not exhibited the consumption of the drugs in areas that are physically hazardous to either her own health or to the health of her baby..
The client has the substance use and addictive disorders (DSM-5) and it should be identified which group of severity she does fit in based on 0 or 1 criterion: no diagnosis, 2-3 criteria: mild substance use disorder, 4-5 criteria: moderate substance use disorder 6 or more criteria severe substance use disorder.
Other perspectives
There are various other perspectives that might shed light to the struggles that mercy is undergoing. These include cultural factors, ecological, psychodynamic, trans-diagnostic or temperament processes among the rest. Mercy has reported that her symptoms began a week after moving from Orleans to a new small town and that she finds it difficult to cope without her friends beings around. Hence a probable cause for her symptoms could be due to cultural and or immigration loss. It is evident since the new lifestyle in the small new town might not be similar to the previous lifestyle that she was accustomed to in Orleans as the two different possess a different culture
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