The vignette required for this paper is Casey Weston. Please make sure to use that specific vignette (located below) and nothing else (e.g., individual you know, someone you made up). Please follow along with the organization of the template provided when you are writing your
paper. DO NOT write the entire paper in paragraph format.
Purpose The purpose of this assignment is to have you examine a case vignette, identify symptoms associated with a wide variety of mental health disorders, defend the presence/non-presence of
relevant disorders (to the vignette) and come to an informed decision regarding the diagnosis best suited given the information provided in the vignette. This is an empirically validated
approach to diagnostic decision-making and one that most clinicians use in everyday practice.
The overall benefit of having you complete this assignment is to generate some exposure to the
complexities psychologists encounter in their applied practice. Remember, diagnostic decision-
making processes are not about finding the “right” mental health condition, but about identifying
the most defensible mental health conditions.
Procedure
Below I will provide you with a case vignette to evaluate in terms of diagnostic impressions. I
want you to deconstruct the vignette from a scientifically valid approach. I am going to ask you
to follow an in-depth approach to the diagnostic process. In this exercise, I want you to read the
vignette and complete the following tasks:
1. Identify a COMPREHENSIVE list of symptoms that may be helpful in determining a
diagnosis. This should include all symptoms and signs endorsed within the vignette.
2. Discuss how the symptoms identified meet the three criteria for abnormality (the 3 D’s).
Make sure you provide enough evidence to clearly defend how symptoms are
dysfunctional, distressful, and deviant.
3. Categorize your symptoms by AT LEAST 3 categories that will help you evaluate
potential diagnoses. You may create the labels that you place symptoms under.
a. EXAMPLES OF CATEGORIES: physical symptoms, anxious symptoms, depressive
symptoms, mood-based symptoms, psychotic-based symptoms, social symptoms,
academic-related symptoms, etc.
4. Next, you are to choose three diagnoses that you want to consider in the diagnostic
process. You must evaluate at least three disorders. For each disorder you evaluate, you
must consider converging evidence (evidence that confirms the presence of a specific
disorder) and diverging evidence (evidence that disconfirms the presence of a specific
disorder) based on the DSM-5 diagnostic criteria for the disorder. You will need to
reference the notes and the textbook to determine the specific criteria for the diagnoses
you are considering. You want to match the symptoms to the criteria — a checking off
process. If you have enough symptoms to meet a specific criterion for a disorder — you
want to note that criterion A (for example) is met because of the presence of two more
psychotic symptoms (for example). Clearly defend how EACH criterion for a diagnosis is
met or not met.
5. Construct a confidence assessment based on your defense process. Here I want you to
rate (from 1 to 10 with 10 being a score reflective of great confidence) how confident youare in terms of the diagnosis being present within the case vignette. Do this for each
disorder you consider.
6. I want you to choose one (or more) diagnosis(es) that you feel best characterizes that
symptoms present in the vignette. You may need to consider some specifiers if we
reviewed them in the notes. After making your selection, I want you to write up a small
summary that defends your conclusions. This summary should be approximately one
paragraph in length (5-8 sentences).
7. Given what we have discussed in class regarding treatment, what might treatment look
like for this specific client? Please write at least a paragraphs outlining what specific
approaches to treatment a therapist might take with the given client.
There are no right or wrong answers. However, you will be graded on how you defend your
logic in responding to the designated components of the defense process — as seen directly
above. Please see the grading rubric below for specific grading criteria.
Particulars
The paper must be submitted as a Word document. It must be written in Times New Roman
with a font size of 12. The margins must be set at one inch. Please include only your name in a
header at the top of the page – no need to list the class, date, etc. Violation of any of these
regulations will automatically reduce your grade by 5-20 points depending upon the magnitude
and frequency of the violations.
Case Vignette
Casey Weston is a 36-year-old, European American man who was self-referred to therapy for
difficulties with anxiety and social isolation. Upon entering therapy, Casey indicated that he is
riddled with fear, which prevents him from creating and maintaining relationships with others.
Casey further noted that his inability to create relationships has engendered “heavy feelings of
loneliness.” He noted that his loneliness is marked by persistent concerns that he will always be
alone, frequent bouts of crying, perceptions of low self-worth, and difficulties falling asleep.
When asked about his inability to create and maintain relationships, he cited his fear as the
major deterrent.
Casey indicated that as far as he can remember (at least 20 years), he has always been fearful
of being “trapped or suffocated by people.” When queried further, Casey indicated that he is
fearful about being stuck in a place where he will not be able to escape or find help. In the past,
Casey stated that he had difficulties going to crowded concerts and movies because of the
overwhelming amount of people who “seem like they are on top of him.” In addition, Casey cited
difficulties carpooling with co-workers. Specifically, he noted that carpooling makes him feel so
restricted because there are often at least four people in a car and (unless you are the driver)
few people are in control of the door locking system.
When asked about when these fears first appeared, Casey noted that he “had no idea.” However,
he did indicate that as a child he often had a number of medical difficulties (e.g., asthma,
impetigo) that were severe in presentation. When fits of asthma or impetigo would occur, Casey
noted that he would often feel a strong need to find aid quickly. Casey distinctly remembers one
instance where he came down with a bad bout of asthma (“I thought I was going to die.”) and he
was fearful that he would not be able to find help because it occurred at recess where few
teachers would monitor the students. He recalled that his friends tried to help him, but every
time that they got closer, he felt like his symptoms became worse. Casey indicated from that
point on, he would try to avoid large groups of people for fear of having an asthma attack with
no means of seeking immediate aid. Casey indicated that his asthma and impetigo difficulties were successfully treated and have
remained under control for a long period of time. However, he noted that he still fears being
trapped. Casey added that when he finds himself in a situation where there is no obvious point of
escape, he experiences a number of debilitating symptoms of anxiety. Specifically, he reported
consistent difficulties with extreme restlessness/irritability, muscle tension, heart palpitations,
trembling and shaking, chest pain, dizziness, and nausea when placed in situations where he has
felt trapped. Moreover, Casey indicates that his fear has gotten worse over the last ten years.
Specifically, Casey indicates that he experiences his anxiety symptoms more severely. Because
of this escalation in symptoms severity, Casey admitted that he vigilantly avoids “most social
interactions.” Specifically, he now has difficulty going to the grocery store, riding in a car (even
by himself), going to a work meeting, etc. In fact, Casey admitted that his symptoms were so
severe that he had to quit his job and find a new job that allows him to work from home. For a
long time, Casey believed that the only true safe place was his home. Whenever he was forced
to leave his home, he would experience an overwhelming feeling of dread that is accompanied by
different physiological symptoms associated with anxiety, based on self-report.
Finally, Casey noted that his symptoms peaked to such an extent that he does not even feel safe
in his home all of the time. Based on Casey’s recent memory, he cited difficulties going to the
dentist for his annual cleaning approximately 2 months ago. Upon arriving at the dentist’s office,
he indicated that he became incapacitated by fear to such an extent that he could not enter the
dentist’s office. After experiencing a substantial amount of anxiety related turmoil, Casey
reported feeling an intense surge of fear that was marked by difficulties breathing and
accelerated heart rate. Casey admitted that during the intense anxiety episode he felt like he
was going to die. Despite feelings of dying, Casey did note that the most severe symptoms
dissipated within a few seconds. Once Casey was able to function, he walked slowly to his car
and returned home. From that point, Casey reported that he has been concerned about
experiencing those specific types of symptoms again. To ward off the onset of similar symptoms,
Casey noted that he has stopped working out, venturing from home (he now has his groceries
delivered to his house), and watching scary movies (movies that he once found enjoyable).
Template/Example
Please follow the organization and format of this template/example document when
writing your final paper. The document deconstructs a different case vignette – do not copy
and paste anything from the template, as the information provided is not relevant to this
case. The paper does not need to be in paragraph format. Simply follow the format of the
template provided on Folio.