Case Study: Vee

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Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
Scenario: Vee is a 26-year-old African-American woman who presents with a history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.”
When she is stressed, Vee says that she often “zones out,” even in the middle of conversations or while at work. She states, “I don’t know who Vee really is,” and describes a longstanding pattern of changing her hobbies, style of clothing, and sometimes even her job based on who is in her social group. At times, she thinks that her partner is “the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at the thought of him leaving her. Vee reports that, before she began dating her current partner, she sometimes engaged in sexual activity with multiple people per week, often with partners whom she did not know.
Questions: Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
1. Describe the presenting problems.
2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
3. Discuss which cluster the primary diagnosis belongs to.
4. Formulate and prioritize a treatment plan.

Sample Solution

Analysis of Vee’s Case

Presenting Problems:

Vee presents with several concerning symptoms that require a comprehensive evaluation:

  • Non-suicidal self-injury (NSSI): A history of cutting her arms and legs since her teenage years.
  • Suicidal ideation: Chronic thoughts of suicide as a way to cope with stress.
  • Two suicide attempts: Overdosing on medications as a teenager and six months ago.
  • Dissociation: Frequent episodes of “zoning out” during conversations or work.
  • Identity Issues: Difficulty defining her core identity and changing interests/behavior based on social groups.
  • Emotionally Unstable Relationships: Idealization followed by devaluation of her partner, with impulsive behaviors and subsequent regret.
  • History of Risky Sexual Behavior: Engaging in casual sex with multiple partners previously.

Differential Diagnosis:

Based on the DSM-5 and ICD-10 codes, Vee might have one or more of the following diagnoses:

  • Primary Diagnosis (Most Likely):
    • Borderline Personality Disorder (BPD): DSM-5: 301.83 (ICD-10: F60.31) characterized by unstable moods, relationships, self-image, and impulsivity. Vee exhibits several core symptoms of BPD, including self-injury, suicidal ideation, unstable relationships, identity issues, and impulsive behaviors.
  • Differential Diagnoses (To Be Ruled Out):
    • Major Depressive Disorder (MDD): DSM-5: 311.0 (ICD-10: F32) While Vee experiences depression related to suicidal thoughts, the presence of impulsivity, unstable relationships, and identity issues points more towards BPD.
    • Post-Traumatic Stress Disorder (PTSD): DSM-5: 309.81 (ICD-10: F43.1) A history of trauma could explain some symptoms, but Vee’s presentation lacks the specific criteria for PTSD.
    • Substance Abuse Disorder: DSM-5: (various codes) (ICD-10: F1x.xx) Substance abuse could be a factor, and should be investigated, but not prominent in the current presentation.

Cluster of Primary Diagnosis:

The primary diagnosis of Borderline Personality Disorder (BPD) falls under Cluster B: Personality Disorders in the DSM-5. Cluster B disorders are characterized by dramatic, erratic, or emotional behavior patterns.

Treatment Plan:

  1. Priority: Safety and Crisis Management:
  • Assess immediate risk of suicide and self-harm.
  • Develop a safety plan with Vee, including emergency contact information and coping strategies for suicidal ideation and self-injury urges.
  1. Individual Therapy:
  • Dialectical Behavior Therapy (DBT) is the gold standard treatment for BPD. DBT focuses on emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
  • Explore the root causes of Vee’s difficulties and develop healthy coping mechanisms.
  • Address identity issues and promote self-awareness.
  1. Medication Management (Consider in consultation with a psychiatrist):
  • Medications might be used to manage co-occurring conditions like depression or anxiety, but they are not a primary treatment for BPD.
  1. Support Groups:
  • Connecting with others who understand BPD can be helpful for Vee.
  1. Healthy Relationship Skills Training:
  • Develop healthy communication and conflict resolution skills to improve Vee’s relationships.

Evidence-Based Research:

Numerous studies support the effectiveness of DBT for BPD. A 2019 meta-analysis by Stoffers et al. found strong evidence for DBT’s effectiveness in reducing suicidal behavior, self-injury, and improving overall functioning in individuals with BPD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504201/]

Please Note: This analysis is for educational purposes only and does not constitute a formal diagnosis or treatment plan. A comprehensive psychiatric evaluation is necessary for accurate diagnosis and treatment recommendations.

 

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