Case Study of Emotional Disorders

Emotional Disorders on DSM diagnoses for the Child or Adolescent 

Emotional disorders are patterns of psychological or behavioral symptoms that affect various aspects of a person’s life (Levin, 2006). These disorders generate distress for the individual experiencing these symptoms. Though there are numerous emotional disorders, Nadif exhibits some specific symptoms of two major categories of disorders that we may consider as the Diagnostic and Statistical Manual of Mental Disorders (DSM). These are anxiety disorders and post-traumatic stress disorder (PTSD). 

Anxiety disorders are characterized by persistent and excessive fear, worries and related behavioral disturbances. Nadif comes from war-torn Somalia where they lived in a refugee camp. Nadif used to have an average appetite and slept relatively well. Now, he wakes in the night, often with nightmares in which he becomes lost or separated from his family (Ford, 2009). Nadif’s appetite has also been affected. He often reports stomachaches and lack of appetite. His parents describe him as “nervous” most of the time, particularly when his mother is not home. These symptoms have become so severe such that they have affected his normal life. For instance, Nadif is too afraid to attend school away from his parents. As a result, his mother has chosen to homeschool him until he feels more secure when away from his family. People who suffer from this disorder fear to be away from the attachment figure or the caregiver (Institute of Medicine 2012). In fact, the individual may avoid going away from home such as going to school. Instead, they prefer to stay in close proximity to the attachment figure. 

Nadif may be experiencing PTSD. One common feature of this disorder includes attachment issues (Institute of Medicine 2012). This is quite evident in this case as Nadif seems to feel relatively comfortable out in public, only when his family accompanies him on outings. He is unable to develop normal healthy relationships and attachments with other people who are not part of his family. Other symptoms of PTSD exhibited by Nadif include lack of independence, inability to attend public schools and being too much emotionally attached to his mother (Ford, 2009). His family hopes therapy will help Nadif feel calmer when they are not present so that he can attend school, develop friendships, and become increasingly more independent. 

Evaluating the Two Diagnoses and Considering the Appropriate DSM Diagnosis 

Exposure to traumatic or stressful events causes PTSD and is associated with other disorders such as anxiety disorders (Ford, 2009). The most notable characteristics of this disorder include the inability to experience pleasure, inability to form personal relationships, alienation, anxiety, and depression. Although both anxiety and PTSD disorders affect a person’s behavior, anxiety disorders are different. PTSD is primarily characterized by constant feelings of fear and anxiety. These people constantly worry about future events and they show fear as a reaction to the present situation (Ford, 2009). Such feelings may cause further symptoms like lack of appetite, as is the case of Nadif. Therefore, anxiety disorders differ from PTSD by what results in the symptoms. Moreover, an individual can have more than one anxiety disorder at the same time. 

The most appropriate DSM diagnosis for Nadif is PTSD. Nadif can be diagnosed with PTSD because he once lived in a war zone thus he was directly exposed to traumatic events which involved risk of serious injury and death, both to himself and others. Additionally, Nadif seems to be experiencing intrusions through inability to remember life back at the camp, distressing dreams, and negative alterations in mood, appetite, and cognition. These symptoms have lasted for some time now and hence resulted in clinically significant distress in various domains of Nadif’s life like daily functioning, relationships and schooling (Ford, 2009). If these symptoms persist, Nadif may be diagnosed with attachment disorder in particular. 

Further Description of: 

The Symptoms Required For a Diagnosis of That Disorder 

In most cases, the symptoms required to diagnose PTSD appear after the first month of the traumatic experience. Unlike other emotional disorders, PTSD can be very tough to detect. Though it may look like depression or anxiety, PTSD is different. Some of the most common symptoms for diagnosis include behavior changes, mood swings, and avoidance. 

Behavior Changes 

They can make one’s emotions either more intense or react differently than the person normally does. For instance, if one is used to eating, he/she may lose appetite. Angry and irrational outbursts are common. Most people find it hard to focus. Emotions of being under attack or danger can ruin focus and keep the person from socializing and forming personal relationships (Institute of Medicine 2012). 

Mood Swings 

PTSD is not like any other disorders that come with flashbacks and nightmares. Sometimes, this illness may appear as mood change unrelated to a traumatic experience. From the negativity, the person may feel numb, hopeless, and bad about him/herself. It is easy to feel suicidal. Moreover, deep feelings of shame and guilt may come. There is no motivation to form relationships, with either family or friends (Levin, 2006). 

Avoidance 

The person does not want to talk about things that are going through his/her mind. He/she pretends to have forgotten everything, which reminds him/her of the bad experience. In addition, this may mean alienating oneself or staying away from the public. This can lead to detachment (Institute of Medicine 2012). 

Possible Causes of the Disorder (Developmental + Multicultural Factor) 

The developmental theory focuses on how traumatic events affect the mind. This theory suggests that the heavy impact of the traumatic event may make the mind unable to process all the emotions and information in a normal way (Levin, 2006). Failure of the mind to process the traumatic event may make someone develop PTSD. Simply put, all traumatic experiences or events can be causes of PTSD. This implies that a sexual abuse, car accident, emotional abuse, bullying, or even robbery incident can trigger the development of PTSD. How one is able to process the emotions or information about a traumatic event determines whether the individual is at risk of developing PTSD. For this reason, some individuals tend to develop PTSD while others do not even if they experienced the same event. This theory further suggests that abnormal hormonal levels can cause PTSD. Abnormal hormonal levels may make a person be more sensitive to PTSD symptoms. In essence, when an individual with abnormal hormonal levels goes through a traumatizing encounter, the person has a higher chance of developing PTSD. 

However, this does not imply that people with abnormal hormone levels will develop the disorder whenever they experience traumatic events. Rather, such people are at a greater risk of developing the disorder. Various studies evidence that people with PTSD continue to generate high levels of flight or fight hormones even in absence of danger. Experts believe that these increased levels of flight or fight hormones cause hyper-arousal and numbed feelings in PTSD people (Safir et al. 2015). 

Multicultural factors play a role in predisposition to PTSD. Many cultures have a strong belief in the role of divine intervention and fate. Such cultural beliefs can make someone accept a traumatic experience (Levin, 2006). In the Western world, some techniques insist on the importance of cathartic verbalization as a trauma resolution strategy. However, this could be contraindicated in cultures, which perceive discussions of traumatic events as improper. For instance, research suggests that Latinos had higher PTSD rates after the Vietnam War, unlike both whites and blacks. Despite the link to other factors like social isolation because of minority status and amount of exposure to combat, the difference has been partly attributed to different rates of symptom reports among Latino sub-groups. Case in point, the Puerto Ricans report more symptoms as a response to PTSD unlike the Mexican Americans (Safir et al. 2015). 

Effective Treatments for the Disorder 

There are various treatments available for PTSD. However, the most effective treatments are medications, psychotherapy, or a combination of the two (Safir et al. 2015). PTSD affects people in different ways and so an intervention that works for one individual may not be effective for another. People with PTSD should seek help from professional mental health providers. Some PTSD patients may require trying different interventions to see what works for them. If a person with PTSD is still experiencing an ongoing trauma, depression, suicidal thoughts, panic disorder and substance abuse, then these problems need to be addressed first. 

Medications 

The most widely prescribed medication for PTSD includes antidepressants. This agent is used to control symptoms of PTSD such as anger, worry, feeling numb and sad. Medications such as antidepressants might be prescribed together with psychotherapy. There are some medications, which are used to counter particular PTSD symptoms. For instance, studies indicate that Prazosin is useful in treating sleep problems especially nightmares commonly reported by PTSD people (Hilt & Nussbaum, 2016). 

Psychotherapy 

The treatment involves about talking with a mental health professional to help treat the disorder delivered to one person or in groups. Psychotherapy normally lasts between 6 to 12 weeks although may take longer for some patients (Safir et al. 2015). Studies reveal that support from friends and family is a crucial element of the recovery process. The models of psychotherapy are diverse and depend on various factors such as one’s job, family, and social problems. The therapist may combine different therapies according to the patient’s needs. The most effective therapies normally emphasize some key elements such as teaching skills to identify things that trigger symptoms, education about the symptoms and skills on how to manage the symptoms. The cognitive behavioral therapy is one of the popular and effective forms of psychotherapy. 

Controversies Related to the Treatment of PTSD 

Controversies continue to emerge related to the integrity, representation, and transparency of the DSM criteria. The biggest controversy regards the diagnosis of PTSD. Recently, critics have attacked the secrecy of the DSM and the presence of the pharmaceutical industry influence on the DSM process. Some arguments postulate that PTSD is underdiagnosed and undertreated among veterans (Levin, 2006). A good example is the Vietnamese veterans who continue to suffer from PTSD as reported by a recent research by Hilt and Nussbaum (2016) published in JAMA Psychiatry. This study reports that PTSD incidence among current military personnel has doubled between 2005 and 2010. This has led to an overburdened veteran’s affairs health system. In response, the Court of Appeal ordered that the Veterans’ Affair overhaul its mental health services because inadequate and delayed services were being given to returning veterans with PTSD. 

Another controversy relates to the prevalence of PTSD among civilians. According to the National Sexual Violence Resource Center, the majority of sexual assault survivors cannot meet the PTSD diagnostic criteria (Levin, 2006). The increasing incidence of traumatic events among both adults and children has prompted medics to recommend the use of trauma-informed care consisting of supportive, collaborative, and skill-based treatments, which address the pervasive effects of trauma. In addition, emerging studies underscore the need to refine the current conceptualization of PTSD by acknowledging the critical role that shame plays in the dynamics (Hilt & Nussbaum, 2016). For long, anxiety about external dangers has been perceived as the major emotion of PTSD. However, the perceived internal risk of exposing personal shame normally predominates for most victims, particularly those who have been through interpersonal violence. 

Contrary to the issue of underdiagnosis of PTSD, most experts who intervene after a crisis offer public education, which normalizes reactions to disasters (Levin, 2006). Here, the controversy is that widening the PTSD diagnostic criteria might generate the unintended effect of pathologizing natural human reactions to greatly disturbing incidents. Another related issue is that practitioners and researchers are advocating for an increased awareness of the phenomenon of post-traumatic growth. This suggests that most trauma victims eventually attain greater degrees of personal well-being, wisdom, and maturity. In the current environment, PTSD remains a diagnosis marred with numerous controversies. 

Ethical Issues on the Use of Psychiatric Medications to Treat Emotional Disorders in Children and Adolescents 

Today, psychiatric medications are among the most widely prescribed agents in PTSD. In fact, the wide application of these medications has greatly improved the lives of millions of children and adolescents suffering from emotional disorders. Sadly, greater dependence on psychiatric medications in children has elicited societal and ethical concerns. Research indicates that children who use drugs such as antidepressants may have a higher risk of suicidal behavior unlike those who receive placebo (Levin, 2006). In addition, agents like atypical antipsychotics are linked to some potentially serious negative metabolic impacts such as diabetes and hyperglycemia. In addition, there are other concerns regarding over-prescription or otherwise the widespread application of psychotropics. This ethical issue is further fueled by the fact that nonpsychiatric providers are apparently the source of psychotropic prescriptions countrywide (Safir et al. 2015). 

Ethical healthcare is founded on the principle of informed consent. It is promoted by the therapeutic relationship and is all about providing information to the client and allowing the client to make informed decisions. The information sharing aspect of the informed consent principle emphasizes the relevance of communicating appropriate, balanced, and accurate information about the benefits and risks of treatment alternatives. However, it is sometimes difficult to determine how much information to discuss with the patient (Levin, 2006). Moreover, it may be even harder to know exactly what a reasonable human being would need to know in order to make an informed decision. 

References  

Ford, J. D. (2009).  Posttraumatic stress disorder: Scientific and professional dimensions . Amsterdam: Elsevier/Academic Press. 

Hilt, R. J., & Nussbaum, A. M. (2016).  DSM-5 pocket guide for the child and adolescent mental health . American Psychiatric Pub 

Institute of Medicine (U.S.). (2012).  Treatment for posttraumatic stress disorder in military and veteran populations: an Initial assessment . Washington, D.C: National Academies Press. 

Levin, A. (January 01, 2006). VA to keep using DSM to diagnose PTSD in Vets.  Psychiatric News, 41,  14, 1. 

Safir, M., Wallach, H. S., & Rizzo, A. (2015).  Future directions in post-traumatic stress disorder: prevention, diagnosis, and treatment . Springer US