Case Study on "Diagnosis of S. Johnson Diagnosis and Treatment"

Case Study 6 pages (1526 words) Sources: 2

[EXCERPT] . . . .

Diagnosis of S. Johnson

Diagnosis and Treatment Plan

Ms. Sandra Johnson presents both a typical as well as a complicated profile as she enters therapy. All too typical because so many children (especially girls) are molested as well as are treated carelessly by the foster care system. And complicated because the layers of abuse, neglect, and breach of trust over the years have compounded each other in ways that have made her turn on her own body as well as her own psyche. This paper provides a diagnosis for her current condition and then proposes a therapeutic approach to treating her.

We are told that Sandra Johnson is a 36-year-old African-American woman. She entered the foster care system at age 12 and has an 8th grade level education. This suggests that she made little is any educational progress during the six years that she was in foster care, which in turn suggests that her foster parents were not attentive. It may also indicate that (as is extremely common) she was moved from placement to placement quite frequently. She never received either her GED or high school diploma and has received no vocational training. This information leaves us wondering how she has been able to support herself in the 18 years since she left foster care.

Her life was disrupted in important ways before she entered foster care, having been abandoned by her birth parents when she was six. She then lived with a paternal uncle her sexually molested her as well as at least one other girl; he was jailed for this latter molestation.

Sandra, who is not currently in therapy, has few friends and no intimate relationships. She has also recently begun exhibiting symptoms of an eating disorder.

Sandra's diagnosis includes a range of different but related mental disorders, although some must be assumed from her background rather than derived from the symptoms described here.

The first diagnosis would be Posttraumatic Stress Disorder. PTSD is found in individuals who have been subjected to a situation or event that is extremely stressful and anxiety producing. Sexual and physical abuse of a child are common causes of PTSD, as are any number of other terrible events, such as being in a natural disaster, being either a soldier or a civilian in a combat zone, being raped or assaulted, or losing a family member to a violent crime. The key symptoms of PTSD are flashbacks to the event(s) that caused the original trauma. These flashbacks can come about during dissociative episodes while the individual is awake or during nightmares.

When the individual with PTSD is re-experiencing the trauma, her body will react as if she were actually in danger, with raised blood pressure and heart rate and increased respiration. She will also be likely to experience the same level of fear or terror that she originally felt. The Diagnostic and Statistical Manual IV-TR (which is the current standard reference for diagnosing mental conditions) notes that Sandra meets the conditions of those who are likely to be diagnosed with PTSD given that she had repeated serious trauma over a long period perpetuated by someone in a position of trust and that she had no strong support system during the time that she was being traumatized.

The severity, duration, and proximity of an individual's exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence the development of Posttraumatic Stress Disorder. This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme. (309.81 Posttraumatic Stress Disorder)

We are not told that Sandra is experiencing typical symptoms of PTSD such as nightmares. However, it seems far more than likely that someone who experienced what she did as a child would have PTSD. This assumption is further supported by the fact that her uncle did not go to jail for molesting her but for molesting another child. This suggests that he may have threatened her not to tell what he was doing (thus causing more trauma) or that she told someone of the abuse that she was experiencing and that person failed to act (thus increasing the betrayal of trust).

Sandra may also have some sort of learning disability or mental retardation. Again, we are not given enough details in the description to determine this. The fact that she has only a middle school education and no vocational training may mean that she was badly neglected in the foster care system (which would hardly be unusual) or that she has been unable to benefit from educational opportunities. One very important set of questions that should be asked during the initial therapy session(s) is her economic status. Is she able to hold down a job? Is she able to make enough money to provide for a stable living situation, etc. Does she have access to regular health care, including mental health services? It is likely that she is also suffering from one of the depressive disorders and/or one of the anxiety disorders. Her isolation and inability to form close relationships may well reflect her PTSD but they may also reflect current depression or anxiety.

While both depression and anxiety disorders are amenable to treatment with therapy, in general therapeutic treatment of these disorders is more effective when combined with medication. Such medications can be expensive and so whether or not Sandra has health insurance is important to know in terms of possible psychiatric referrals.

Sandra is also exhibiting clear symptoms of an eating disorder. She is somewhat older than is typical for the onset on an eating disorder. The fact that she is just now presenting with these symptoms suggests that she may be also experiencing an increase in symptoms from her PTSD. We are not told whether or not she has a distorted body image (in which she believes herself to be fat while others know that she is of average or below-average weight), but we can assume that this is the case or she would not be acting the way she is.

Sandra exhibits a number of the typical symptoms of anorexia nervosa. The typical anorexia patient will:

Obsess about food, weight, and dieting.

Strictly limit how much they eat. For example, they may limit themselves to just a few hundred calories a day or refuse to eat certain foods, such as anything with fat or sugar.

Exercise a lot, even when they are sick.

Vomit or use laxatives or water pills (diuretics) to avoid weight gain.

Develop odd habits about food, like cutting all their food into tiny pieces or chewing every bite a certain number of times.

Become secretive. They may pull away from family and friends, make excuses not to eat around other people, and lie about their eating habits (Anorexia nervosa).

Therapeutic Approach

Sandra's case presents a complex set of therapeutic questions. The most complicated is that eating disorders generally require a specific therapeutic approach. Eating disorders are extremely serious and can in fact lead to death. Because of the high potential lethality and the complex interaction of the physical, emotional, and cognitive factors involved in an eating disorder, a team approach is usually required that combines medical professionals, a nutritionist, a therapist that is trained in cognitive behavioral therapy as well as other modes of therapy, and education for the family so that they can provide support. In Sandra's case, there is no family to provide this support so she might also need help from a social worker or other professional (Anorexia nervosa).

Because of the potential for long-term physical harm that exists with an eating disorder, this issue should be approached first and foremost. However, her other mental… READ MORE

How to Reference "Diagnosis of S. Johnson Diagnosis and Treatment" Case Study in a Bibliography

Related Papers:

Diagnosis of Famous Person With Disorder Term Paper

Diagnosis of a Famous Person

Vincent Van Gogh (Famous Person with Disorder)

Vincent Van Gogh -- a Case History

Vincent Van Gogh was a Dutch artist born in 1853 in… read more

Term Paper 10 pages (3288 words) Sources: 1+ Topic: Psychology / Behavior / Psychiatry

---

Treatment of Acute Myeloid Leukemia Research Proposal

Treatment of Acute Myeloid Leukemia

As a person ages, his/her prospect of contracting Acute Myeloid Leukemia (AML)

increases. Children and adults of any ages, however, may develop AML This qualitative… read more

Research Proposal 35 pages (11568 words) Sources: 3 Topic: Disease / Virus / Disorder / Injury

---

Alzheimer's Disease: The Onset as Alzheimer's Diseases Term Paper

Alzheimer's Disease: The Onset

As Alzheimer's diseases is believed to be the "dementing order" because of the recognized changes in the behavior and line of thinking of the person with… read more

Term Paper 8 pages (3283 words) Sources: 33 Topic: Disease / Virus / Disorder / Injury

---

Best Therapeutic Treatment for Adolescents Term Paper

Adolescent Depression

Best Therapeutic Treatment for Adolescents

More and more studies support treatment for depression in adolescents to prevent adult formation of chronic or major depression (Jacqueline & Margo, 2005;… read more

Term Paper 3 pages (1004 words) Sources: 0 Topic: Child Development / Youth / Teens

---

Standardized Coding Systems Essay

Standardized Coding Systems and Nursing Informatics

As the pace of technological progression increases at a seemingly exponential rate, with the introduction of computer mainframes in the 1980's having paved the… read more

Essay 2 pages (666 words) Sources: 3 Topic: Nursing / Doctor / Physician

---

View 100+ more related papers  >>