Discussion 2: Trauma and Comorbidity

 

It is not uncommon for people who experience trauma to use substances to moderate psychological or emotional pain. Trauma can easily add to the strain that people already feel. In this Discussion, you diagnose and plan treatment for a case provided by your instructor.

To prepare: Review the Learning Resources on trauma treatment for veterans, and conduct research in the Walden Library for additional resources on the topic. Then read case provided by your instructor for this week’s Discussion.

By Day 5

Post a 3- to 5-minute recorded video response in which you address the following:

• Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
• Identify the first area of focus you would address as client’s social worker, and explain your specific treatment recommendations. Support your recommendations with research.
• Explain how you would manage client’s diverse needs, including his co-occurring disorders.
• Describe a treatment plan for client, including how you would evaluation his treatment

 

Required Readings

American Psychiatric Association. (2013r). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm07
American Psychiatric Association. (2013f). Dissociative disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm08
Powers, A., Fani, N., Cross, D., Ressler, K. J., & Bradley, B. (2016). Childhood trauma, PTSD, and psychosis: Findings from a highly traumatized, minority sample. Child Abuse & Neglect, 58, 111–118.
Schnyder, U., Ehlers, A., Elbert, T., Foa, E. B., Gersons, B. P. R., Resick, P. A., … Cloitre, M. (2015). Psychotherapies for PTSD: What do they have in common? European Journal of Psychotraumatology, 6(1), 281–286. doi:10.3402/ejpt.v6.28186
Smith, J. C., Hyman, S. M., Andres-Hyman, R. C., Ruiz, J. J., & Davidson, L. (2016). Applying recovery principles to the treatment of trauma. Professional Psychology: Research and Practice, 47(5), 347–355. doi:10.1037/pro0000105

Required Media

U.S. Department of Veterans Affairs. (2017). PE—Prolonged exposure: A safe place. Retrieved from https://www.ptsd.va.gov/apps/AboutFace/therapies/pe.html

Note: On this page, watch the following videos about veteran Frederick M. Gantt’s experience with prolonged exposure therapy for PTSD.
“I had to make a decision”
“What am I running from?”
“I could see it in color”
“The Middle Eastern restaurant”
“I’m in a safe place”

Optional Resources

American Psychiatric Association. (2013l). Other conditions that may be a focus of clinical attention. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.VandZcodes
Goral, A., Lahad, M., & Aharonson-Daniel, L. (2017). Differences in posttraumatic stress characteristics by duration of exposure to trauma. Psychiatry Research, 258, 101–107. doi:10.1016/j.psychres.2017.09.079
Maercker, A., & Hecker, T. (2016). Broadening perspectives on trauma and recovery: A socio-interpersonal view of PTSD. European Journal of Psychotraumatology, 7(1), 1–9. doi:10.3402/ejpt.v7.29303
McHugh, R. K., Gratz, K. L., & Tull, M. T. (2017). The role of anxiety sensitivity in reactivity to trauma cues in treatment-seeking adults with substance use disorders. Comprehensive Psychiatry, 78, 107–114. doi:10.1016/j.comppsych.2017.07.011
van der Kolk, B., & Najavits, L. M. (2013). Interview: What is PTSD really? Surprises, twists of history, and the politics of diagnosis and treatment. Journal of Clinical Psychology, 69(5), 516–522. doi:10.1002/jclp.21992
Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: This is the same document introduced in Week 1.

Optional Media

University at Buffalo School of Social Work (Producer). (2014b). Episode 141— Tara Hughes: Disaster mental health: An emerging social work practice [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=141
University at Buffalo School of Social Work (Producer). (2015). Episode 180—Dr. Howard Lipke: HEArt for veterans: Identifying the hidden emotion [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=180
 

  

CASE PRESENTATION – JANYCE

INTAKE DATE: July 6, 2019

IDENTIFYING/DEMOGRAPHIC DATA: Janyce is 22-year-old and the oldest child of two working-class parents. Janyce has one younger brother, aged 9. Both parents immigrated from Korea. Janyce lives in San Francisco with her parents. She is finishing up her final year at college.

CHIEF COMPLAINT/PRESENTING PROBLEM: “I am having trouble sleeping since I witnessed a stabbing on the wharf two weeks ago”

HISTORY OF PRESENT ILLNESS: Janice has been waitressing in a restaurant at the wharf since freshman year at a bar/restaurant to supplement financial aid for tuition. She has very good grades (B+ to A) in college. After leaving her shift 2 weeks ago, Janyce was walking to the bus stop and witnessed a man beating up a woman and eventually stab the woman. Since then, her grades started slipping and she began missing classes. She reports not having interest in school any longer but wanted to graduate for her parents knowing she is this close. “This is because I don’t get enough sleep,” Janyce said. Not sleeping is impacting her ability to wake up in time for school, as well as ability to concentrate. She struggles to get to sleep and often wakes up startled. She also reported being so tired during the day “it interfered with everything”. 

When Janyce is at work, she cannot stop thinking about what happened and fears leaving at night to go home. The police have taken her statement several times, but she gets a lot of anxiety when needing to talk about the incident. She believes the police get angry with her because she cannot remember some factors about the incident. 

PAST PSYCHIATRIC HISTORY: Janyce attended some group therapy sessions in college. She had some challenges living an American lifestyle with parents who want her to maintain the culture of the “old country”.

SUBSTANCE USE HISTORY: Janyce drinks on weekends with her college and “bar” friends. Janyce reports beer bloats her, so she drinks vodka and cranberry juice mixed drinks. Janyce denies a problem with alcohol. She stated she has trouble sleeping several nights a week without a drink now.

PAST MEDICAL HISTORY: Janyce reports normal childhood illnesses. She has not had any major illnesses.

CURRENT FAMILY ISSUES AND DYNAMICS: Janyce’s childhood was otherwise unremarkable. She reported that she has always worked hard at school and generally was an “A” student through high school. She ran track and was involved in many activities, socializing with boyfriends, and a wide friendship circle. She reported no particular difficulties with her parents; although since this incident, Janyce has been very irritable. Her mood varies over the week, and she admitted to chronic anxiety and some tendency to get into “arguments” with her friends, parents, and coworkers.

MENTAL STATUS EXAM: Janyce is a well-dressed young lady who looks her stated age. Her mood is depressed, and she lacks eye contact. Her affect is anxious. Motor activity is appropriate. Speech is clear. Thoughts are logical and organized although there seems some confusion at times. There is no evidence of delusions or hallucinations. On formal mental status examination, Janice is found to be oriented to three spheres.