CASE STUDY - ALLISON

This paper was co-written with Chihiro Yamabe and Ryan Rathgeber, Feb 13, 2008 for my UFV 241 Psychology (Psychological Disorders) course, taught by Professor Ron Laye.

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Section I - Diagnosis

General description of the client

Allyson is a 43 year old female who has been married to her husband, Roy, for 12 years and have a 10 year old daughter, Rose, between them. Allyson claims that she has been feeling depressed and is seeking a treatment due to a fear that she would lose everything.

Problems and the context in which they occur

Allyson claims that she has been experiencing feeling of depression. She claims she is always sad, tired, and angry and feels hopeless. For her, everything seems gray. She reports that she lost interest in activities which she was interested in before, and upset about the fact that she lost interest in raising Rose. According to Allyson, she first started feeling depressed after she gave birth to Rose. Allyson claims that her doctor did not diagnose her as experiencing postpartum depression. About 3 weeks later, her mood up lifted again but her symptoms worsened past year or so. In addition, she claims she experiences abnormal sleep pattern which causes her to over sleep about 12 hours and 14 hours. She alluded that the onset of the condition was about 7 month ago and which is considered to be concurrent with depression.

Source of referral, and a brief overview of personal, family and occupational context

It seems Allyson self referred herself to a treatment since she reports none of the doctors she saw diagnosed her as having depression. Allyson grew up in the family who experienced holocaust and according to her, her mother also experienced depression. She reports that she has experienced feeling depressed as early as she was 13. However, according to Allyson, her family does not admit weakness and does not believe in therapy, she did not get proper treatment which may have worsened her symptoms. Allyson was not a good student at high school and college. She did not go through any significant traumatizing events such as loss of close people, abuse, bullying and so on. Allison worked for a telecommunications company for eight years before her marriage to Roy and their moving to New York. She now works as a consultant while raising Rose. She is financially very stable due to her husband who is a medical doctor and herself working as a consultant.

Diagnosis

Axis I

296.32 Major Depressive Disorder, Recurrent, Mild without Psychotic Features; 307.44 Hypersomunia Related to Major Depressive Disorder

Axis II

No Diagnosis

Axis III

Complication of Pregnancy; Childbirth

Axis IV

Threat of Job loss; Parenting Skills

Axis V

GAF = 70

DSM-IV TR states that to be diagnosed as having Major Depressive Disorder, individual needs to experiences 2 or more Major Depressive Episodes of the symptoms on the list. Of those, followings are what are reported by Allyson.

1. She claims that she experience depressing mood most of the day.

2. Her interest in all or almost all activities diminished. They include interest in sex, their daughter and activities which she was interested in before onset of the disease.

3. She experience decrease in appetite which results in significant weight loss which she claims to be something positive since she perceives herself as over weight.

4. She experience hypersomunia which result her to sleep 12 to 14 hours a day on weekends.

5. In addition, she experience excessive fatigue or energy loss. These fatigue because her not being able to concentrate on the job and commuting to the job is now a big trouble for her.

6. Because of her malfunctioning and loss of interest, she blames herself and fears that she will lose everything. This results in suicidal thoughts in her.

From her report, though she has been depressed, she has never been prescribed with medication. In addition, she has never been on any drug or severe substance use. Thus, it seems depression is not caused by medications. In addition, she did not report any Manic Episode, a Mixed Episode or a Hypomanic Episode. For Axis II, it seems there is no Personality Disorders which fits her perfectly. She does not seem to have a tendency to excessively avoid nor depend on others. Moreover, since she reported she worked for the same company for 8 years, and she is now working as a consultant, her personality is seems stable, nowhere near antisocial (Nevid, Greene, Johnson & Taylor, 2005).

However, it is also worth to note that this diagnosis is made based on report from Allyson only, thus there is more room to consider for possible personality disorder if more information is made available.

Differential Diagnosis

Instead of diagnosing her as experiencing Major Depressive Disorder, 300.4 Dysthymic Disorder could have been applied. However, Ally claimed her mood worsened past year or so, thus there is a possibility that within two years, she lived without symptoms more than 2 months at a time. Thus, Major Depressive Disorder is selected over Dysthymic Disorder.

Section II - Etiology

Allison appears to be suffering from depression. Her lack of energy, libido, and interest in anything in her life is indicative of this. Now we shall attempt to perceive what the underlying causes, or the etiology, of her depressive symptoms are.

The Canadian edition of the textbook Essentials of Abnormal Psychology in a Changing World (Nevid, J., Greene, B., Johnson, P., Taylor, S., 2005) provides some theories that have been proposed by psychodynamic theorists.

According to Freudian psychodynamics, depression is derived from a loss in one’s life. For example, if a woman’s husband divorces him, Freud would suggest that the wife would first feel angry at the husband. She would then “introject, or bring inward, a mental representation of the [husband]” in order to preserve some psychological connection to him. Therefore, she turns the anger and rage meant for her husband on herself and this leads to depression. Later psychodynamic theorists propose the self-focusing model.

This model suggests that when one loses someone or something dear to them, depression prone individuals may spend all of their attention and thought on themselves and how they may restore the lost connection to the lost person or object.

None of these explanations would suit Allison’s case. She has not lost anything; in fact she has a very regular life. She has a husband, a child, and a job. Therefore, we must consider other psychoanalytical approaches. One more recent psychoanalytical explanation of depression suggests that individuals who utilize immature versions of unconscious defense mechanisms are more prone to depression (Kwon, P., Lemon, K., 2000).

Allison shows signs of maladaptive defense mechanisms as a child. She explains that at the age of thirteen she gained weight and was teased. She explained that to cope with it, she withdrew from her peers. This suggests that she was attempting to repress these hurtful thoughts from her consciousness. The manner in which she represses is not typically suitable or healthy behavior, which suggests that she has developed an immature defense mechanism. She also practiced regression, or the defense mechanism which explains when an individual returns to an earlier developmental stage in life.

Because of the verbal attacks from her peers at school, she remained in bed some days, where she relied on her mother for her care. It is said that defense mechanisms mature with age; therefore she may have slowed the development of her psychic defenses near this age. She says how at this time she stays in bed for many hours of her weekends, which could be explained as a return of her regressive behavior. This suggests that she still has underdeveloped defense mechanisms, which could account for some of her depressive symptoms.

Drinking and drug use has been said to increase the chance of having a mental disorder, but this would not apply in this case. Allison is clean; she does not do drugs and only drinks a little bit occasionally, so her depression could not be derived from substance abuse.

But in the case of Allison, it seems that most of her symptoms could be attributed to biological factors. She explained how her mother suffered from depression as she was growing up. Her mother’s symptoms, such as oversleeping and lack of energy, are very similar to the ones Allison is experiencing. As stated in the textbook, genetics play a fair role in contributing to depressive symptoms. Several studies, such as twin studies, have provided evidence for this notion. Twins who grow up in different environments are shown to more likely be similar in mood.

If one is depressed, it is likely that the other will also be depressed. Therefore, there is a good chance that Allison has acquired some of her depressive symptoms from her mother genetically. There is also some possibility of her learning these symptoms through observation. Allison gave details on how her mother would often be found in bed for long hours.

Her mother displayed her lack of attention and focus as well; for example, while preparing a meal, she would often stop cooking for no apparent reason. This is indicative of her mental health, which leads us to believe that Allison may have inherited as well as learned these traits.

Her genetic link to her mother, however, may have created imbalances in certain biochemical structures in the brain, such as serotonin. An imbalance in these chemicals has been proven to lead to depression.

Many people suffer from depression and Allison is not much different from anyone else. On the outside, she appears to have a good life. She has a husband, a daughter, a good job. Yet she still feels depressed on the inside. Heredity could be playing a huge role in her depressive symptoms. Her genetic makeup may be leading to chemical imbalances in the brain which leads to depression.

Psychodynamic theory would account for some of her regressive and repressive actions, such as staying in bed for long periods of time. These could also increase the amount and severity of her symptoms. Her treatment should include antidepressants as well as psychotherapy to help her deal with major depressive disorder.

Section III - Treatment Plan

As this client is suffering from both severe depression as well as back pain, this seven phase treatment plan will be starting with anti-depressant medication to address the client’s depression and a weekly chiropractic session to address the client’s back problem. The chiropractic sessions will be on-going throughout this client’s treatment plan. The anti-depressant medication will also be an on-going process, or until they are no longer required. Phase one and phase two will have a simultaneous effect.

As it usually takes four to six weeks for anti-depressants to take effect, the second phase of this client’s treatment plan will not begin until the client has felt the effects of the anti-depressant medication. Phases three and four, which address this client’s dietary and physical fitness needs will also have a simultaneous effect. These two phases will begin after week six of taking the anti-depressant medication.

Phase five, psychotherapy, will begin after the third week of phases three and four. In this phase of the treatment the client discusses her problems with the psychotherapist. Phase six will address this client’s sleeping habits. In phase seven the psychotherapist will begin the cognitive approach to this client’s treatment plan.

This phase is set to begin after week twelve of the client’s psychotherapy sessions. According to Beck’s theory, the cognitive approach is used to assist the client to change their negative thoughts to positive thoughts. For this client the cognitive approach also includes behavior changes. Behavior changes include, but are not limited to relaxation skills, increase of pleasant activities, and building social skills (Nevid et al; 2005, pp. 244, 246).

The purpose for breaking down the treatment plan in this manner is because when a client is experiencing severe depression they are emotionally shut down. The client does not have any motivation to take steps to change their negative thoughts to positive ones. The client has also lost interest in activities they once enjoyed. The purpose of this treatment plan is to re-motivate the client, and this is a step by step process.

REFERENCES

Section I

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: American Psychiatric Association.

Section II

Nevid, J. S.; Greene, B.; Johnson, P. A.; Taylor, S. (2005). Essentials of Abnormal Psychology in a Changing World, Canadian Edition. Toronto, ON. Pearson Prentice Hall.

Kwon, P. & Lemon, K. (2000). Attributional Style and Defense Mechanisms: A synthesis of Cognitive and Psychodynamic Factors in Depression. J Clin Psychol 56: 723 – 735.

Section III

Note: The treatment plan was based on personal experience and personal knowledge.

Nevid, J. S.; Greene, B.; Johnson, P. A.; Taylor, S. (2005). Essentials of Abnormal Psychology in a Changing World, Canadian Edition. Toronto, ON. Pearson Prentice Hall.