Discussion:
DSM-IV-TR Diagnoses
Case:
Sam R. is a 16-year-old African American high school student. He has recently moved to a new town with his parents and younger sister due to his father's promotion and job transfer. Sam's old high school included a mix of students from many racial, ethnic, and economic backgrounds. At his new school, there are few African American students and Sam feels like an outsider.
Sam has always been a quiet and serious person. Although he usually has one or two close friends, he feels awkward trying to start conversations with others and has never mixed easily in large groups. A good deal of activity at this new school takes place around sports and student government: two areas Sam has little interest in.
Sam also feels unprepared for the level of work that is expected of him at this school, particularly the emphasis placed on presenting oral reports and participating in debates in front of the class. He becomes embarrassed and tongue-tied when he has to speak in front of others. Sam often "gets sick" on the day of an oral report so he can stay home from school, and he is worried this will impact his grades.
Questions:
1. What are the possible diagnoses based on Sam's presenting issues. What would list on Axis I?
2. How Sam meets all of the specific DSM-IV-TR diagnostic criteria for the Axis I disorder? If he does not meet all of the criteria, what other information would you need?
3. How is the impact of the larger social system (school and community) important to consider when assessing and diagnosing Sam? For example, how might the new school's ideas about 'achievement' or the ways in which teachers/counselors define 'healthy peer relationships'? influence their evaluations of Sam?