Even when Jordan was a tiny infant, it seemed that there was something very different about her. She was an intense baby; she seemed to always be easily upset, she didn’t adjust very easily to new circumstances, and she was hard to comfort. Her parents assumed that all babies are different, and that this was just a phase. In fact, they knew of plenty of other parents with kids who had started off like this, but that had ended up being easy-going adults. Additionally, Jordan’s father had ADHD growing up, and knew that his mother had told him he had occasionally been difficult as well.

However, as Jordan grew, she didn’t seem to “just grow out of it.” She continued to be easily upset and difficult to comfort, and she had very severe separation anxiety. If her mother left the room, Jordan would scream until she returned. Still, her parents were not too concerned.
Separation anxiety is pretty typical for kids to go through. And Jordan had so many sweet qualities; at times she could be the most loving child. They often had really wonderful times together.

When Jordan hit her early teens things started to change. There were fewer and fewer good times. Jordan became increasingly sullen and angry. She started acting out more and more — yelling at her parents and teachers and engaging in impulsive behaviors, like running away from home. She at times would have a close friend or two at school, but some conflict seemed to always arise and that friendship would end. Jordan talked about how alone and bored she felt, how no one understood her. Again, this seemed like it might just be typical adolescent behavior, so while her parents were starting to get concerned, they weren’t yet ready to seek help.

By the time Jordan turned 17, things were starting to get really out of control. Jordan’s experienced serious emotional instability, her mood changes were totally unpredictable, and could turn on a dime. She was having fights with her parents almost daily, and they would usually involve her yelling and throwing things. At times, she seemed terrified to be without her mother, at other times she would leave the house in a fit of intense rage and not return for a few days.

One day, Jordan’s mom noticed scars on Jordan’s arms. When her mother first confronted Jordan about them, Jordan told her the cat had scratched her. But when pressed she admitted that she was self-harming because she felt so lonely and bored and this was the only thing that made her feel better. This was the last straw; her parents decided it was time to find help.

Jordan’s parents were able to find a psychiatrist in their area. The psychiatrist spent time talking to Jordan, and asking Jordan and her parents about her symptoms. Based on this brief assessment, the psychiatrist prescribed Lithium for her.

The new medication seemed to help, and Jordan and her parents were hopeful that things were getting better. In attempt to better understand her disorder, Jordan’s parents tried to read more about bipolar disorder and how to help their daughter recover. The things they read, however, didn’t quite fit with their daughter’s symptoms. For example, Jordan’s moods seemed to change
multiple times a day — this seemed different than the infrequent but intense mood changes typical of bipolar disorder.

At 23, now takes a combination of medication, Effexor and Ritalin, and has participated in 1 year of dialectical behaviour therapy, which have reduced her symptoms considerably. She no longer self-harms, and she is working part-time and has a few close friends. Jordan still has times when she feels overwhelmed, and has difficulties with anger and in relationships, but she is working on learning coping skills to manage these symptoms.

Her plan is to maintain her medications, engage in follow-up “booster” sessions of therapy as needed, and save money to go to college. She is hopeful she will be able to get into a stable romantic relationship at some point, as she would like a family of her own at some point.

Questions

1. List the symptoms you feel Jordan displays. Which disorder category, and which specific disorder within that category would you say match the symptoms Jordan displays. Explain.
2. Does this case appear to fit with the concept of Impairment? Personal Distress? Psychological Dysfunction? Atypical Response? Explain.
3. Explain the psychotherapy treatment that was used with Jordan? What theoretical orientation does this treatment fall under? What is this treatment called? Was it effective? Explain.
4. Complete the biopsychosocial chart on the next page based on the information provided from the case.