Problem:
Learning Objectives
1. Apply diagnostic criteria to a complex, multi disorder presentation.
2. Practice differential diagnosis and clinical reasoning.
3. Integrate cultural, developmental, and ethical considerations into case formulation.
4. Generate evidence based treatment priorities for co occurring conditions. Need Assignment Help?
Case Vignette:
Arman K. is a 26 year old graduate student in architecture who presents to the university counseling center complaining that "my body and brain are out of sync." For the past two years Arman has experienced chronic mood fluctuations: some weeks they feel unusually energetic, sleeping 4-5 hours, sketching late into the night, talking rapidly about multiple design ideas, followed by days of feeling "foggy," pessimistic, and lacking motivation. None of these episodes lasts more than five days, and Arman has never missed classes entirely, but the swings have become distressing.
Over the last four months, Arman has also had four sudden episodes of intense fear while riding the subway, described as a "wave of doom" with pounding heart, trembling, and fear of losing control. The first attack occurred "out of the blue." Since then Arman avoids crowded trains and carries a phone loaded with a meditation app "just in case." They worry daily about another attack.
Arman eats a very limited range of foods, mostly soft noodles, bananas, and protein shakes, because of an intense fear of choking that began after witnessing a roommate gag on chicken three years ago. Their BMI is 19.8, and recent labs show mild iron deficiency anemia. Arman denies body image concerns but admits the diet is "embarrassing" and avoids social meals.
To keep up with studio deadlines, Arman secretly buys extended release amphetamine (Adderall 30 mg) from a classmate, taking it most weekdays. On weekends without it they crash, sleeping 12 hours and feeling "wired and empty." They tried to quit during winter break but experienced headaches, irritability, and could not focus, so they resumed use.
Friends describe Arman as "brilliant but rigid." They insist on minor design details being "exactly right," rewrite group emails repeatedly, and become frustrated if teammates deviate from instructions. Arman keeps every draft drawing "for reference" and spends hours color coding class notes. These habits strain group projects and intimate relationships.
Family history is notable for a mother with panic attacks and an uncle treated for bipolar II disorder. No history of psychosis, self harm, or suicidal behavior is reported, but Arman admits to fleeting thoughts of "disappearing" during low energy weeks. They identify as non binary (they/them), grew up in a bicultural Iranian American household, and pay for school through scholarships and a part time campus job.
Assignment Questions (Answer all)
Write in complete sentences. Approx. words total.
1. Primary Task - Diagnostic Identification
a. List up to five diagnoses that best explain Arman's presentation.
b. For each diagnosis, cite specific vignette evidence that meets the core criteria.
2. Differential Reasoning
For each diagnosis you selected, name one differential diagnosis you considered and explain exactly why it was ruled out in this case.
3. Comorbidity Interaction Analysis
Discuss two ways Arman's co occurring conditions might maintain or exacerbate one another (e.g., functional links, self medication, behavioral cycles).
4. Treatment Prioritization
Rank the identified disorders from most to least urgent for treatment. Defend your ranking using clinical risk, functional impairment, and prognosis.
5. Evidence Based Intervention Planning
Choose two of Arman's diagnoses and outline one empirically supported treatment approach for each (brief description only, citing at least one research source or practice guideline).