Problem
Case Study: Josefina
Josefina is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Josefina has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. She is a second generation Puerto-Rican and has experienced quite a bit of pressure to be successful. Her immediate and extended family see her as an example to all of her relatives and she is often reminded that her choices will be closely watched by others in the family and community. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past.
For the past few weeks Josefina has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping.
At home, Josefina's husband has noticed changes as well. She's shown little interest in sex and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He's overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what's bothering her, she pushes him away with an abrupt "everything's fine".
Josefina's best friend has suggested she see the counselor at the med school. She refused, fearful that other students might find out. However, she did agree to meet briefly with a student who is in their residency for psychiatry - just a casual meeting...to talk things over. During the meeting Josefina was very nervous and distracted; constantly looking around to see if others would see her talking to this student. During the conversation, she admitted that although she hasn't ever considered suicide, Josefina has found herself increasingly dissatisfied with her life. She's feeling unsure about her career choice, but knows that she is a model for her family and refuses to even contemplate switching careers. She's been having frequent thoughts of wishing she was dead. She doesn't feel she can talk with her husband about it because she, "asks so much of him to tolerate already with her hours at school; and he is just really not the emotional type...it wouldn't go well". She gets frustrated with herself because she feels like she has every reason to be happy, yet can't seem to shake the sense of doom and gloom that has been clouding each day as of late.
A. What DSM -5 Diagnosis did you derive from Josefina's case presentation?
B. What behavioral markers did you identify to lead you to this conclusion?
C. What other information appeared relevant to your diagnostic assessment?
D. Assume that you are a clinician seeing Josefina; what would be your next steps in working with her?
E. What other important information would have helped you make a more accurate diagnosis?
Important information from the Professor in answering the questions and case study
Using the attached, DSM 5 Nonaxial diagnosis guide, complete a DSM 5 diagnosis for this case study.
You should first briefly list any additional information that would assist you in your decision-making process for diagnosis. This is a brief case vignette and not unlike your initial interactions with real clients/consumers, you will not have all of the information from those beginning meetings that you would like to have.
Following your non axial diagnosis, complete and submit a one-page paper discussing the vocational impact of the diagnosis and a brief description of how you would approach working with this client to address the vocational impact.
The DSM 5Nonaxial guide is attached, also the case study is attached along with 2 options for potential diagnostic categories from the DSM 5. The case vignette should best fit one of the 2 diagnostic categories provided. If you have access to the DSM 5 text, please do feel free to use it instead to refer to the diagnostic categories included. Please recall that you should work independently on this case and this submission should be in APA format with a title page, appropriate margins, spacing and headings, citations and a reference list if applicable.
1. Generalized Anxiety Disorder Diagnostic Criteria (docx)Download Generalized Anxiety Disorder Diagnostic Criteria (docx)
2. Major Depressive Disorder Diagnostic Criteria (docx)Download Major Depressive Disorder Diagnostic Criteria (docx)
3. Case Study 1 - Josefina (docx)Download Case Study 1 - Josefina (docx)
4. DSM-5 Nonaxial System (pdf)Download DSM-5 Nonaxial System (pdf)