You Are the Doctor: Analyzing Psychological Disorders



AP Psychology Unit XI: Abnormal Psychology & Treatment Unit Assignment Corresponding Modules: Modules 65-73

Spring Semester 2015 Topic: Abnormal (7-9%) and Treatment (5-7%)

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YOU ARE THE DOCTOR: ANALYZING PSYCHOLOGICAL DISORDERS

Directions: Read the following case studies, discuss & analyze the symptoms, and diagnose the type of psychological disorder that you believe the patient to have. You should identify the disorder & be able to briefly explain your reasoning for each. It may be helpful to underline relevant symptoms and/or diagnostic criteria. Also, identify the specific type of delusion when delusions are present.

Case Study #1 Diagnosis:

“I'm a doctor you know... I don't have a diploma, but I'm a doctor. I'm glad to be a mental patient, because it taught me how to be humble. I use Cover Girl creamy natural makeup. Oral Roberts has been here to visit me...This place is where Mad Magazine is published. The Nixons make Nixon metal polish. When I was a little girl, I used to sit and tell stories to myself. When I was older, I turned off the sound on the TV set and made up dialogue to go with the shows I watched...I am a week pregnant. I have ...cancer of the nerves. My body is overcrowded with nerves. This is going to win me the Nobel Prize for medicine... there's no such thing as ..., there is only mental telepathy. I once had a friend named Camilla Costello. She was Abbott and Costello's daughter... I'm in the Pentecostal Church, but I'm thinking of changing my religion. When you have Jesus, you don't need a diet. Mick Jagger wants to marry me. I want to get out the revolving door. With Jesus Christ, anything is possible. I used to hit my mother. It was the hyperactivity of all the cookies I ate. I'm the personification of Casper the Friendly Ghost. I used to go outside asking the other kids to be my friend when I was little. California's the most beautiful state in the Union. I've been there once, by television. My name is Jack Warden, and I'm an actress.”

Case Study #2 Diagnosis:

Marilyn is a 33-year-old single woman who works at a local telephone company and lives alone in her apartment. 3 years ago, when driving over a bridge on a very rainy day, she experienced dizziness, pounding heart, trembling and difficulty breathing. She was terrified her symptoms meant she was about to pass out and lose control of her car, and for several moments was convinced she was having a heart attack. She pulled to the side of the road, and after about 30 minutes, her symptoms subsided. Since that time she has experienced 8 similar episodes during which she feared she was about to pass out and lose control of herself. She frequently experiences limited symptom attacks (e.g., feels dizzy and fears she may pass out). As a result of her intense fear of having another episode, she is avoiding the following situations: waiting in line, drinking alcohol, elevators, movie theatres, driving over bridges, driving on the freeway, flying by plane, and heights (e.g., will not go out on her 10th floor balcony). She is often late for work because of taking a route that doesn't require her to take the freeway. She is also finding herself avoiding more and more activities. She frequently feels tearful and on guard. Sometimes she gets very angry at herself as she does not understand why she has become so fearful and avoidant. She is worried that she will end up alone because of her symptoms and their interference in her life. She has also been unable to visit family and friends in Montreal due to fear of having an episode on the plane.

Case Study #3 Diagnosis:

Three men, each of whom claimed to be Jesus Christ, were transferred to the same ward of a hospital in Ypsilanti, Michigan. The following is an excerpt from one of their first encounters.

"Well, I know you psychology, “Clyde said, "and you are a knick-knacker, and your Catholic Church in North Bradley and in your education, and I know all of it-- the whole thing. I know exactly what this fellow does. In my credit like I do from up above, that's the way it works."

"As I was stating before I was interrupted," Leon went on, "It so happens that I was the first human spirit to be created with a glorified body before time existed."

"Ah, well, he is just simply a creature, that's all," Joseph put in. "Man created by me when I created the world--nothing else."

“Did you create Clyde, too?” Doctor Rokeach asked. "Uh-huh. Him and a good many others." At this, Clyde laughed.

Case Study #4 Diagnosis:

Terrance O'Reilly, a single 39-year-old transit authority clerk, was brought to the hospital in May, 1973, by the police after his increasingly hyperactive and bizarre behavior and nonstop talking alarmed his family. He loudly proclaimed that he was not in need of treatment, and threatened legal action against the hospital and police. The family reported that a month prior to admission Mr. O'Reilly took a leave of absence from his civil service job, purchased a large number of cuckoo clocks and then an expensive car which he planned to use as a mobile showroom for his wares, anticipating that he would make a great deal of money. He proceeded to "tear around town" buying and selling the clocks and other merchandise, and when he was not out, he was continuously on the phone making "deals." He rarely slept, and, uncharacteristically, spent every evening in neighborhood bars drinking heavily and according to him, "wheeling and dealing." Two weeks before admission, his mother died suddenly of a heart attack. He cried for two days, but then his mood then began to soar again. At the time of admission, he was $3000 in debt and had driven his family to exhaustion with his excessive activity and over talkativeness. He said, however, that he felt "on top of the world".

Case Study #5 Diagnosis:

Ilene, age 77, is taken to the community mental health center by her daughter, Amy. Amy explains to the psychiatric nurse practitioner that Ilene came to live with her and her family three years ago, after Ilene’s husband, Ray, died. Ray and Ilene had been married for more than 50 years. They had two children, Amy and a son, Charles, who lives 500 miles away. Ilene and Ray had lived in a small town all their married life. Amy and her family live in the suburbs of a large city. Amy explained that because Ilene had no relatives in the small town, they felt it would be better if she came to live with Amy and her family (a husband and two teenagers).

Amy explains that for the past 10 months, Ilene has become increasingly withdrawn and isolates herself in her room. She eats very little and has lost about 25 pounds in the past 7 months. She has trouble sleeping, and Amy reports hearing Ilene up walking around at night. Amy became concerned when she overheard Ilene talking on the phone to a friend back in her hometown. She heard Ilene say, "I don’t have a lot left to live for."

In the intake interview, Ilene speaks only when spoken to, keeps her head downcast, and twists a handkerchief in her hands. When asked to explain the statement that was overheard by Amy, Ilene starts to cry and states, "I miss my friends and my church. My husband is buried back in that town. I don’t know anyone here. Amy and her husband both work and the kids are in school and busy with their friends. I feel so alone. I miss my husband. I really don’t think I have a lot left to live for. I just want to die!"

Case Study #6 Diagnosis:

Janet, age 29 and the mother of a 6-year-old girl and an 8-year-old boy, has come to the community mental health center alone. She tells the psychiatric nurse practitioner that she is here because her husband said he would leave her if she didn’t get some help. She describes her problem as, "My nerves are shot." When asked to explain, she states that she likes everything to be "in order." She says she cleans her house "from top to bottom" every day. Then when her husband and children come home, she "has to go along behind them and clean as they mess up!" She explains that she can’t leave the house without checking and rechecking locks on all doors and windows, and checking and rechecking all electrical outlets and appliances. Sometimes, this routine takes most of an hour before she feels satisfied and ready to leave the house. She said she had to get started getting ready to come to the clinic this morning about 3 hours before she left. "We seldom go out anymore, because my husband says it’s just not worth the effort. I’m driving everyone crazy, and I don’t know how to stop. I can’t stop!"

Case Study #7 Diagnosis:

Martha, age 35, is a client on the psychiatric unit. She was admitted through the emergency department where her husband had taken her when she complained of severe pain in her abdomen. In the intake interview, the psychiatric nurse obtains the following history:

Martha was sexually abused by her stepfather when she was a child. This occurred over a period of 5 years, until she was able to report it to her mother, who filed charges against the stepfather. He was arrested and sent to prison. Since that time, when Martha was 10 years old, she has suffered from numerous physical complaints. She missed a great deal of school as a child and teenager because of illness. Martha’s menstrual cycles were frequently accompanied by nausea and cramping that often sent her to bed.

Martha married Phillip when she was 21 years old. They have one child, Henry, who is 12 years old. Martha had a difficult pregnancy and stated, "I would never go through that again!" Martha had a hysterectomy when she was 27 years old. Martha has seen many doctors over the years for her numerous physical complaints. She has complained of headaches, abdominal pain, respiratory difficulties, chest pains, back pain (with numbness down the back of her legs), and pain with intercourse. Her husband tells the nurse that they have not had sexual relations for more than 2 years. Martha also complains of frequent bouts of nausea and diarrhea. The current pain in her abdomen began 2 days ago.

The physician has performed a complete physical examination with chemistry profile, EKG, x-ray studies of the chest and abdomen, and urine studies. He finds no organic pathology. Martha says to the nurse, "I can’t imagine what I’m doing here! I have pain in my stomach! I’m not crazy!"

Case Study #8 Diagnosis:

Frank Welsh, a 32-year-old electrician, came to the clinic complaining of difficulties in his social life. Frank did his job competently. He seldom missed work and was never late. His co-workers found him somewhat quiet at times, but they noted nothing unusual about his behavior. The problem that brought him to the clinic was the threatened breakup of his current romance. Since his divorce 5 years earlier, Frank had dated 5 successive women. On each occasion, he had been more interested in the relationship than the women had been, and each of the previous four relationships had ended in a serious heartbreak for him. When the most recent woman in his life began suggesting that they both date other people, Frank sought professional counseling.

At first the therapist noted little out of the ordinary. Soon, however, it became apparent that Frank had a much more serious problem than his shaky romance. The therapist's suspicions were first aroused when he offered Frank a cup of coffee from the clinic "coffee station." Frank used a number of delaying tactics to avoid drinking his coffee until he had seen another person pour a cup of coffee from the same pot and take a drink of it. He was also wary of the one-way mirror in the counseling room, and he absolutely refused to allow the therapist to tape-record their sessions. Finally, after several sessions, Frank told the therapist about the people who regularly followed him to the clinic. Ultimately it came out that Frank was convinced that he was being pursued by a group of people bent on killing him. Through an elaborate system of safeguards, he had been able to thwart them so far, but much of his private life was devoted to these efforts at self-protection. Recently he had begun planning strategies of reprisal.

Case Study #9 Diagnosis:

The patient was 19-years-old, and the account was provided by his father. When George wakes in the morning... he feels that his hands are contaminated and so he cannot touch his clothing. He won't wash in the bathroom because he feels that the carpet is contaminated and he won't go downstairs until he is dressed. Consequently, I have to dress him, having first cleaned his shoes and got out a clean shirt, underclothes, socks and trousers. He holds his hands above his head while I pull on his underpants and trousers and we both make sure, by proceeding very cautiously, that he doesn't contaminate the outside of his clothing. Any error or mishap and he will have to have clean clothes because he must avoid at all costs passing on the contamination to others. George then goes downstairs, washes his hands in the kitchen and thereafter spends about 20 minutes in the toilet... I have to stand in the doorway and supervise him; my main function is to give reassurance that he has not done anything silly to contaminate his clothing... Incidentally, I have to put newspapers down on the floor of the toilet and change them daily to make sure that his trousers never come into contact with any contaminating substances. If he only wants to urinate, then ...I simply have to check his trousers and boots for splashes, sometimes getting down on my hands and knees with a (flashlight)...Recently he has been checking that there are no public hairs on the floor and he asks me to get down on hands and knees to check the floor meticulously....When he washes his hands...he meticulously scrubs each finger and methodically works his way up as far as his elbow... At this stage I usually have to supervise him so that when he is finished he is absolutely certain that the job has been done perfectly without missing a square inch of contamination.

Note: This was only the morning routine. The rest of the day followed a similar course.

Case Study #10 Diagnosis:

Hilda is 32-years-old and has a rather unusual problem. She is terrified of snow. She can't go outside in the snow. She can't even look at pictures of snow and panics even to hear about it on the weather report. This problem severely restricts her day to day behavior. At age 11, she was playing at a ski lodge and was buried briefly by a small avalanche of snow. She had no recollection of this experience until it was recovered in therapy.

Case Study #11 Diagnosis:

On admission to a psychiatric hospital, a 42-year-old, married male was bent forward at the waist (at a 45-degree angle); unable to straighten his body or move his legs. For 15 years, he had complained of lower back pain. Despite two orthopedic surgeries, his complaints continued. Every four to six weeks, he had 10- to 14-day episodes of being totally unable to walk. The patient had been hospitalized many times and treated with heat and muscle relaxants. He had been retired for five years and had taken on household duties while his wife went to work to support the family. Orthopedic and neurological evaluations revealed no abnormalities. Behavioral assessment, however, indicated that the patient received considerable reinforcement for his physical complaints, such as being served breakfast in bed and not having to do household chores. Moreover, a number of stressors in his life coincided with periods of being unable to walk. These included problems with his children and difficulty adjusting to the role reversal with his wife.

Case Study #12 Diagnosis:

Alice was a chubby toddler. Her mother, who had been a model before her marriage, enrolled Alice in dancing school when she was 3 years old. Alice was a fast learner and became very good at all kinds of dancing. In grade school, she became particularly interested in ballet. Although she gained weight easily, she learned to eat the appropriate foods to stay healthy and maintain an appropriate weight. Dancing became her obsession, and she practiced long hours every day. In high school, she won dance competitions all over the United States. As a junior in high school, she began to prepare for a competition that would award a scholarship to a prestigious dance academy in Paris, France. At this time, Alice had achieved her adult height of 5’6" and weighed 105 pounds. During one of her rehearsals with her private dance instructor, she was having particular difficulty with one movement. The instructor responded, "Well, it wouldn’t hurt if you took off a few pounds!" Alice panicked. She began to perceive herself as fat. She came to believe that because of her weight, she would not stand a chance at the scholarship. She knew how important it was to her mother and father that she win this competition. Her mother was relentless in her pressure for Alice to excel. She even hired a private tutor for Alice, so that Alice could complete her education without having to follow the structured classroom hours and would have more flexibility in her time for dance practice.

Alice began to diet. She ate very little, and when she did eat, she often induced vomiting by gagging herself with her fingers so that she would not retain the calories. She exercised relentlessly and pushed herself, although she felt weak much of the time. She increased her hours of dance practice and felt proud when her dance instructor noticed that she had lost weight. The winter before her graduation, she collapsed at the local gym. The manager called 911. Alice was taken to the emergency department, and her parents were contacted by the supervisor. Alice was admitted to the psychiatric unit. She weighed 87 pounds on admission.

Case Study #13 Diagnosis:

A man, aged 32, was admitted to a psychiatric hospital. Two months before commitment the patient began to talk about how he had failed, had “spoiled” his whole life, that it was now “too late.” He spoke of hearing someone say, “You must submit.” One night his wife was awakened by his talking. He told her of having several visions but refused to describe them. He stated that someone was after him and trying to blame him for the death of a certain man. He had been poisoned, he said. In the admission office of the hospital he showed many mannerisms, lay down on the floor, pulled at his foot, made undirected violent striking movements, again struck attendants, grimaced, assumed rigid postures, refused to speak, and appeared to be having auditory hallucinations. He was at once placed in a continuous bath where, when seen later in the day, he was found to be in a stuporous state. His face was without expression, he was mute and rigid, and paid no attention to those around him or to their questions. His eyes were closed and the lids could be separated only with effort by a doctor. There was no response to pinpricks or other painful stimuli. For five days he remained mute, negativistic, and inaccessible, at times staring vacantly into space, at times with his eyes closed.

Case Study #14 Diagnosis:

The patient was hospitalized at the age of 18. During the preceding year there had been a gradual disintegration of personality, evidenced by inappropriate laughing and giggling, bizarre conversation, and failure in school. The patient’s illness began soon after her father departed from home. As described by the patient’s mother, “She started to worry about a year ago. My husband left and she began to think about him all the time. She used to talk funny – funny things all the time. She used to hear an airplane and stand on the kitchen table looking at the ceiling. She would look out of the kitchen window at children who were playing at school about a mile away and ask if the other children could see her. She would stay away from school and wouldn’t help with the housework but stood outside staring at nothing. She would say, “I don’t know whether I’m a boy or a girl. Do you think I’ll ever get married and have a baby?” And she would say, “You are staying young and I am growing old.”

Case Study #15 Diagnosis:

During an interview, the 50-year-old female patient expressed beliefs covering almost the entire range of delusions. She felt that her niece was in on a plot with other relatives to take away the property she owned in 106 countries, which she was planning to use, after training religious missionaries, to establish missions to convert heathens. In spite of the fact that her husband was alive and visited her weekly, she maintained that her husband was dead and that he had been killed by the FBI. The FBI had 6 agents assigned to her alone and had killed her husband. She had learned of their spying and talking about her from the television where they were portraying her life in several of the continuing series programs. She had learned other things about the plot from the voices that came between the television programs and the commercials. She was convinced that the hospital attendants were in on the conspiracy and that poison was being placed in her food. She was also concerned about the electrical waves that were “messing up” her mind.

Case Study #16 Diagnosis:

This case deals with a woman of 75 who believed that her son–in-law planned to assault and kill her. Her reaction to this idea was expressed in many letters sent to friends and relatives, mailed surreptitiously, and causing the daughter and son-in-law much embarrassment. Aside from this idea, the woman behaved normally and at no time did she show any tendencies to violence. When interviewed in her son-in-law’s home she was somewhat suspicious at first, conversed logically about impersonal matters, showed no defects in memory or orientation. As she became friendly with the examiner, she began to verbalize her delusion, explaining that she based her idea on the fact that articles in her room were sometimes disarranged, that the son-in-law walked past her door unnecessarily or looked at her in a strange manner. The patient was “clear,” aside from the one delusion, and her ideas were consistently organized and acted on. Insight was lacking only in the one area of functioning, as she kept busy with gardening.

Case Study #17 Diagnosis:

Mrs. M. was first admitted to a state hospital at the age of 38, although since childhood she had been characterized by swings of mood, some of which had been so extreme that they had been psychotic in degree. At one point she became depressed and asked to return to the hospital where she had been a patient. She then became overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for reestablishing different forms of lucrative business. She purchased many clothes, brought furniture, pawned her rings, and wrote checks without funds. For a period thereafter she was mildly depressed. In a little less than a year Mrs. M. again became overactive, played her radio until late in the night, smoked excessively, took out insurance on a car she had not yet bought. Contrary to her usual habits, she swore frequently and loudly, created a disturbance in a club to which she did not belong, and instituted divorce proceedings. On the day prior to her second admission to the hospital she purchased 57 hats.

Case Study #18 Diagnosis:

Lila, an 18-year-old high school senior, is known among her classmates as the resident “drama queen.” While she is a successful student, Lila appears to be overly dependent on romantic relationships and has a reputation for promiscuity, as evidenced by her rather scandalous clothing choices. Last week, Lila’s boyfriend broke up with her in between classes and she had a complete meltdown at her locker which including throwing herself on the floor and uncontrollable sobbing.

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