Introduction and Background
A psychological disorder is defined in abnormal psychology as an "ongoing dysfunctional pattern of thought, emotion, and behavior that causes significant distress, and that is considered deviant in that person's culture or society" (Butcher, Mineka, & Hooley, 2007). Abnormal behaviors are, therefore, perceived as behaviors that are not in line with culturally or socially constructed normality. In a case presented for the current project, Danny who is a 22-year-old college student presents with some behaviors that are considered abnormal. For example, Danny's mother says that at one point during his adolescent years, he attempted to commit suicide after he found out that his girlfriend was cheating on him. Danny also has this obsession with fast cars and feels he should be owning one. At one point, he took another student's car without permission for what he later said was a test drive. The parents also say that Danny hardly gets enough sleep and could be spending between 2-3 hours a night sleeping and the rest playing video games. Now, Danny has been brought for counseling but seems to say he has no problem or depression as people, including the college administration, believes. Asked whether he gets depressed, he answers that he sometimes does but that that should be normal because he believes everyone does have a few weeks or months of depression at some point. The problem is now to verify whether or not Danny's behaviors are abnormal and if they are, then what psychological disorder could be responsible for the abnormal behaviors.
Need for More Information
The information provided by Danny and his parents as well as the college are substantial, but not sufficient enough to enable a diagnosis to be completed on Danny. It is clear that the behaviors by Danny are abnormal in the sense that they are not considered culturally or socially acceptable and that they reflect behaviors of a person who is either depressed or somewhat driven by an obsession or compulsion. For example, at one point Danny had attempted to end his life and that makes suicidal ideation one of the symptoms of his psychological disorder. Also, Danny does not have enough sleep many nights, which makes insomnia another probable symptom of Danny's problem. Furthermore, Danny has shown obsession with fast cars to the extent that the obsession led him compulsively to drive another student's car without prior permission from the student.
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Suicidal ideation and insomnia would lead to the conclusion that Danny has a Major depressive disorder (MDD) (Alderman et al., 2015). On the other hand, the obsession and compulsion would lead to the conclusion that the patient is suffering from Obsessive Compulsive Disorder (OCD) (Moran, 2013; Van Ameringen, Patterson, & Simpson, 2014). In short, additionally, information is required for a differential diagnosis. For example, there is need to distinguish whether the obsession and compulsion are associated with another psychological disorder other than OCD, in which case DSM-5 would recommend that OCD diagnosis is excluded (Stewart, n.d). Also, there is a hint about the feeling of worthlessness and that could also help to strengthen the position that Danny is suffering from MDD, but still there is need to verify whether there are ruminations that are restricted to the feeling of worthlessness to reach that conclusion.
Ideally, further questions that help to verify the cause of the obsession with fast cars and compulsions to drive or own fast cars and to play video games. If the compulsion to play video games is verified to be out of an effort to repress the feeling of distress about not owning a fast car or being worthless, then it might be possible that Danny has OCD. If the feeling of worthlessness leads to ruminations restricted to them, then Danny might be having MDD (Alderman et al., 2015). Also, such as questions about his appetite for food and whether he often feels fatigue could help to reinforce differential diagnosis for MDD.
The Dilemma
What makes it difficult to diagnose Danny with either OCD or MDD distinctively, even though he clearly shows psychological disorder related to the two, is that it is possible to verify that he has repetitive behaviors for driving fast cars or that his repetitive behavior for playing video games could be out of compulsion or the need to repress distress resulting from obsession for fast cars. Also, one cannot independently verify with the information provided that Danny had had suicidal ideation at any other point other than when he found his girlfriend cheating on him. However, DSM-5 adds in the diagnosis of OCD a specifier indicating whether an individual who has the psychological disorder has it "with good or fair insight", " with poor insight", or "with absent insight/delusional beliefs" with adds another layer of confusion here (American Psychological Association, 2013). It is clear that Danny has a good or fair insight about depression and this is realized when he is asked whether he often feels depressed and answers that he does, but also observes that people do have months or weeks when they feel depressed and that that should be normal. If the latter information is to be relied on with regard to doing a differential diagnosis, then the conclusion would be that Danny has OCD. Such a conclusion would be immature so long as the obsession and compulsions have not been verified to be tied to some other psychological disorders other than OCD.
References
Alderman, B., Olson, R., Bates, M., Selby, E., Buckman, J., & Brush, C. et al. (2015). Rumination in major depressive disorder is associated with impaired neural activation during conflict monitoring. Frontiers In Human Neuroscience, 9 . doi: 10.3389/fnhum.2015.00269
American Psychological Association. (2013). Diagnostic statistical manual of mental disorders. 5th ed. Washington, DC: APA.
Butcher, J., Mineka, S., & Hooley, J. (2007). Abnormal psychology and modern life. 13th ed. Boston, MA: Allyn & Bacon.
Moran, M. (2013). DSM-5Updates Depressive, Anxiety, and OCD Criteria. Psychiatric News, 48(4), 22-43. doi: 10.1176/appi.pn.2013.2b39
Van Ameringen, M., Patterson, B., & Simpson, W. (2014). DSM-5 OBSESSIVE-COMPULSIVE AND RELATED DISORDERS: CLINICAL IMPLICATIONS OF NEW CRITERIA. Depression and Anxiety, 31(6), 487-493. doi: 10.1002/da.22259
Stewart, S. E. Obsessive-Compulsive Disorder. Springer.com. Retrieved 16 May 2018, from https://www.springer.com/cda/content/document/cda_downloaddocument/9781934115503-c1.pdf?SGWID=0-0-45-1551279-p173765228
