Lucy Johnson, a 15-year Caucasian 10th-grade academician, has recorded absenteeism in school. Besides, she has started declining in academic performance and also displaying withdrawal behavior. Her case has caught the attention of diagnosis. The DSM diagnosis incorporating Z codes concerning this case is considered. The DSM diagnosis, including the Z codes for this particular case, will require five-step. First, as a psychologist, I will rule out the Malingering together with Simulated Disorder. Second, I will rule out the etiology of the substance incorporating drugs of abuse. Third, I will differentiate the disorders from adjustment emanating from the residual unspecified or specified disorders. Lastly, I will create a boundary without any mental disorder.
The National Association of Social Workers (NASW) requires all its members to perform their work under certain standards. The most applicable standards in this scenario are ethics and values, self-awareness, self-determination, cultural awareness, showing respect to the worth and dignity of the client, social justice, and social diversity. The proper application of these standards will enhance the process of decision making when ruling out each diagnosis. In the first step of the process – ruling out malingering as well as a factitious disorder – the element of good faith will be necessary. As a psychologist, I will require Lucy to be honest with the report of symptoms; otherwise, I will not be able to come up with an accurate diagnosis. Diagnosis thus depends solely on the accuracy of the report of symptoms.
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The second step is ruling out the substance etiology. Before I make a decision, I will have to consider whether the symptoms are influenced by substance abuse. When substance abuse is realized, then the etiological connection between substance and the mental symptoms should be taken into consideration. The third step will be choosing a particular primary disorder. At this point, I will pinpoint the particular primary disorder. Most of the diagnostic consortia in DSM are aligned along with the common presenting symptoms. In the fourth step, I will differentiate the adjustment disorders from unspecified categories. If Lucy presents subthreshold symptoms which are still very severe to induce clinically significant distress, I will consider applying adjustment disorder against other specified or unspecified disorder. When the symptoms are a maladaptive reaction to a psychosocial stressor, then I will apply the adjustment disorder. Finally, I will create a boundary with no mental disorder. As a specialist, I will assess whether the symptoms of Lucy induce clinically significant distress in learning, social, or in other vital areas of functioning.
The malingering disorder varies from factious disorder depending on the motivation. Malingering is determined by achievement of vivid recognizable goals like avoiding responsibilities while factious disorder happens when there is no obvious external award. There must be no handling Lucy like a hostile witness before a judge. The suspicion of the disorders must only be raised in particular settings and situations. In the second step, I both interviewed Lucy and promised to talk to her mother to address the issues. In the third step, I carefully chose the primary disorders. Besides, I considered a differential diagnosis that assisted me in ensuring that the other probable candidates clarifying the behavior of Lucy have been reflected and ruled out. In the fourth step, I used the unspecified to opt for withholding an indication of the reason. In the fifth step, Lucy came to my office when she reported to school after visiting her home. This case indicates that when she came for my help, it is an indication of being clinically significant. Lucy is an outgoing person who likes doing things outdoors and often fairly happy. However, she has been stigmatized of late by various circumstances occurring in her life including the behavior of Joe. Also, the tendency of her mother’s boyfriends has degraded her normally good self-esteem.
References
Raffo, C. D., Hasin, D. S., Appelbaum, P., & Wall, M. M. (2019). A data-driven method for identifying shorter symptom criteria sets: the case for DSM-5 alcohol use disorder. Psychological medicine , 49 (6), 931-939.
Stevens, J., Steinley, D., Boness, C. L., Trull, T. J., & Sher, K. J. (2018). Combinatorial optimization of classification decisions: An application to refine psychiatric diagnoses.
