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Respond to at least two colleagues who identified a different diagnosis or intervention in the following ways: (I thought it was Specific Phobia: With a Natural Environment Specifier
Explain whether you agree with your colleague’s identified diagnosis and recommended treatment and why.
Explain any additional factors that your colleague should take into consideration for treatment planning.
DISCUSSION: DIAGNOSIS of ANXIETY and OBSESSIVE COMPULSIVE and RELATED DISORDERS:
Case Presentation: Nahla is a 29-year-old female who is a Certified Public Accountant and lives with her boyfriend, Dion.She reports the following: ” My job is flexible, and I can work from home often, but lately, my focus has been in other areas, and I justhave trouble getting to work.”
DSM-5 diagnosis for Nahla including ICD-10-CM code, specifiers, severity, and the Z codes:
300.3 (F42.2)Obsessive-Compulsive Disorder (OCD)
300.01 ( F41.0)Panic Disorder
V6120 (Z62.820)Problems Related to Family Upbringing ( Nahla grew up as a military brat in a military environment. She has a close relationship with her father and gets along well with her stepmother.Her father is an Army military Officer.
In the primary diagnosis OCD, Nahla presents with the following symptoms: concerns about germs since adolescence, scrubbing home daily, worries about how others would view the condition of the home, and concern with all areas of her life.Nahla reports scrubbing her home clean is her solution to calm her concerns.In terms of specifiers, many individuals with OCD have dysfunctional beliefs.These beliefs can include an inflated sense of responsibility and the tendency to overestimate threats. Nahla reports common concerns about germs and connects this to learning about sexually transmittable diseases (STIs).In terms of severity, the frequency and severity of obsessions and compulsions vary across individuals with OCD.Nahla’s obsession with cleanliness appears to interfere with her daily schedule, which leads her to clean all day.Differential diagnosis may include Anxiety. Recurrent thoughts, avoidant behaviors, and repetitive requests for reassurance can also occur in anxiety disorders. However, real-live concerns link to generalized Anxiety; andOCD does not involve real-life concerns.
In terms of Panic Disorder, Nahla presents with the following symptoms: intense discomfort feeling dizzy, sweating, trouble breathing, and feels nauseous.In terms of severity, panic attacks vary widely. With Nahla, she reports looking at her home, and this triggers her within minutes.There is no documented evidence of suicide attempts in Nahla’s past.In terms of differential diagnosis, the panic disorder should not be a concern if unexpected panic attacks have not materialized.Although Nahla presents with some anxiety, she has no prior diagnosis of Anxiety.
Evidence-based scale for OCD:In order to validate or confirm Nahla’s diagnosis, an evidence-based assessment scale to consider is Yale-Brown Obsessive Scale ( Y-BOCS).Rapp et al. ( 2016) allude that the Y-BOCS is considered the gold standard assessment tool for OCD symptom severity and possesses good properties.The scale includes54 common obsessions and compulsives behaviors composed in groups representing thematic content and behavioral content ( p. 14).The assessment scale demonstrates good reliability and good to fair validity ( p. 14).
Specific Intervention:For Nahla,an appropriate intervention is Acceptance and Commitment Therapy( ACT) and Exposure Therapy (ERP).According to Fuenmayor et al. ( 2019),Obsessive-Compulsive Disorder refers to repetitive and unwanted thoughts and ritualized behaviors. One of the most common obsessions is the contamination of germs, ranking at 37.8 percent ( p.2).ACT, combined with ERP, may help Nahla because it will change how she engages with thoughts and feelings.In tune with ERP, this is a method of allowing her to experience uncomfortable feelings without acting out the behaviors( Rapp et al., 2019).
Diagnoses eliminated:Based on Nahla’s symptoms, Agoraphobia andGeneralized Anxiety Disorder criteria are not consistent with the client’s symptoms.
Fuenmayor, M. C., Fernandez, J. D., & Roca, H. S. ( 2019). Addicted to compulsions: A complex case study of obsessive and compulsive disorder treated with Acceptance and Commitment Therapy (ACT) and Exposure Therapy (ERP).Drug Dependence and Addiction, 1: 01-07.
Rapp, A. M., Bergman, R. L., Piacentini, J., & McGuire, J. F. ( 2016).Evidenced-BasedAssessment of Obsessive-Compulsive Disorder.Journal of Nervous System Disease, 8: 13-29.DOI: 10.4137/JCNSD.S38359.
Main Question Post
Nahla is a 29-year old hexterosexual, African American female. She resides with her boyfriend; Dion, of four years. Nahla is employed as a Certified Public Account. Her biological mother passed away from cancer when she was 2-years old. Nahla was raised by her military father and step-mother “military fashion” style. She has two step-brothers from the union of her father and step-motehr. Nahla is brought in for services due to presenting with feelings of “life spiraling out of control”.
F42Obsessive-Compulsive and Related Disorders, Obsessive-Compulsive Disorder, with fair insight
Z60.1 Atypical parenting situation
Z61.2 Altered pattern of family relationships in childhood
Z63.3 Absence of family member
Obsessive-Compulsive Disorder, with fair insight
Nahla presents with symptoms and behaviors that are consistent with a DSM-5 diagnosis of Obsessive-Compulsive Disorder, with fair insight(F42). Criterias were met for obsession A 1 and 2. Nahla has recurrent and present thoughts of concerns at intrusive and unwanted times. To reduce concerns Nahla scrubs and cleans her home. Criteria was met for compulsion 1 and 2 as cleaning and scrubbing ther home is a relaxing form of therapy.(Criteria B,C and D) as Nahal is challenged with time management due to meticulous grooming.The need to scrub and clean has interfered with daily living activities.
Other DSM 5 Diagnoses That were Considered
F41.1 Generalized Anxiety Disorder was ruled out due to Nahla not meeting all six symptoms required for some criterias.
F41.0 Anxiety Disorder, Panic Disorder; was ruled out as Nahla did not meet all recommended criteria(criteria D)
Evidence-based assessment scale that would assist in ongoing validation of your diagnosis.
One evidenced-based assessment scale that would assist in ongoing validation of diagnosis is the Yale-Brown Obsessive-Compulsive Scale(Y-BOCS). The Y-BOSCS comprises a symptom checklist and severity scale to rate obsessions and compulsions(Rapp, Bergman, McGuire, 2016 ).. The symptoms checklist includes 54 common obsessions and compulsive behaviors(Rapp, Bergman, McGuire, 2016 ).
Specific intervention and explain why this intervention may be effective in treating the client.
One intervention that may be effective in treating Nahla is behavior therapy. Behavior therapy is a form of therapy utilized to identify and help change potentially self-destructive and unhealthy behaviors(healthline.com).
American Psychiatric Association. (2013). Obsessive-Compulsive and Related Disorder. In Diagnostic and statistical manual of mental disorders(5th ed). Arlington, VA: Author Healthline. BehavioralTherapy. Retrieved October 1, 2020 from https://www.healthline.com/health/behavioral-thera…
Plummer, S-B., Makris, S., & Brocksen, S. M(Eds.). (2014b). Social work case studies: The case of Nahla. Baltimore, MD: Laureate International Universities Publishing. [VitalSource, e-reader).
Rapp, Amy; Bergman, Lindsay; McGuire, Joseph. (July 11, 2016). Evidence-Based Assessment of Obsessive-Compulsive Disorder. Journal of central nervous system disease. Retrieved October 1, 2020 from https://www.researchgate.net/publication/306362565…