INSTRUCTIONS:

Start by considering the broad category of the client’s presenting issues. What words would you use to describe the client’s presenting concerns and the types of thoughts, feelings, and behaviors the client is experiencing? What broad categories in the DSM-5 do these words relate to (i.e., depression, anxiety, trauma, et cetera).

Next, look at the case study and review the specific symptoms the client is reporting. Compare these symptoms to those listed in the broad categories you have considered. In what area of the DSM do the client’s symptoms seem to fit best?

Select the DSM-5 diagnosis that you believe is the best match for the symptoms that the client is presenting and be sure to include the numeric ICD 10 code along with the name of the disorder.

Support your choice of diagnosis by listing the diagnostic criteria in the DSM-5 and noting for each one how the client has expressed this. Does the client meet all criteria for this diagnosis or are there some areas that you are not fully sure about?

If you do not have enough information about some symptoms that are required criteria for the diagnosis you have selected, what additional questions would you need to ask the client, or what other information would you need to obtain from other sources so that you could support an accurate diagnosis?

CASE STUDY:

James

James is a 43 year old Caucasian male who has made his first appointment with you for counseling, saying he “just feels awful” about himself lately and he has “no energy to do anything”, although he does not know why. James has been married for 18 years, and reports that his relationship with his wife is generally satisfactory, although their sexual relationship has significantly declined in terms of frequency and satisfaction over the past two years. James and his wife have two teenaged children who are reportedly healthy, active in school and other activities, and earning good grades.

James has a BA in Business, and has worked in a middle management positon at a bank for 15 years. He reports that he earns a good salary, but he is bored with his job, and does not foresee any ability to move up to a more interesting position without an MBA. He’s thought about going back to school for another degree, but he can’t get himself motivated to start this process.

James reports he is in generally good health, and takes no medications. He stopped running and going to the gym to lift weights about a year ago, although he can’t say why. Exercise used to give him a lot of pleasure, but he has lost interest in it. Although he has always been slim and fit, James has gained 25 pounds in the last year or two. James states that his appetite has increased dramatically, which partially explains the weight gain. He also reports that he is experiencing insomnia. It is very difficult for him to fall asleep most nights, and he tends to wake up in the middle of the night or very early in the morning, so he averages about 5 hours of sleep per night.

James has been in the habit of consuming one or two beers each evening when he comes home from work. His wife has always joined him with a glass of wine before dinner. In the past 6 months, James reports he has increased the number of beers he drinks to an average of 4 after work and before dinner. He states this helps him relax and fall asleep, although his wife has commented that his drinking concerns her.

Although James expresses his unhappiness with himself, he denies that he has had thoughts about suicide. He says that he sometimes thinks it would be nice to “not wake up tomorrow morning”, but he is not actively contemplating taking his life.

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