Explain how diagnosing a client with a personality disorder may affect their treatment.

Provide the full DSM-5 diagnosis. 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 need 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.
• Support your decision by identifying the symptoms which meet specific criteria for each diagnosis.
• Identify any close differentials and why they were eliminated. Concisely support your decisions with the case materials and readings.
• Explain how diagnosing a client with a personality disorder may affect their treatment.
• Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorders.
• Identify how trauma affects the case, either precipitating the diagnosis and/or resulting from related symptoms or treatment of diagnosis.
• Please provide a reference page and references throughout the discussion.
• Make sure the discussion is Zero percent plagiarism.CASE of OLIVIA

  Intake Date: September 2020

  DEMOGRAPHIC DATA:

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  This was an emergency, voluntary admission for this 28-year-old single white female. This was her fourth psychiatric hospitalization. Olivia lives with a 24-year-old female roommate in New York City. She has a bachelor’s degree in art history and is employed by a major New York Museum.

  CHIEF COMPLAINT: “My therapist said I was decompensating because I broke my leg, and I was despondent.”

  HISTORY OF PRESENT ILLNESS:

  Olivia stated that approximately one month prior to admission, she started to “decompensate” and had difficulty maintaining control at work. She had several altercations with coworkers. One week prior to admission, Olivia reported that her NA sponsor “said something nasty, and I lost it.” According to her mother, the sponsor made a reference to Olivia being overweight. Olivia reported that she was angry and “hit everything I knew I could—but that did not help.” She then kicked a brick wall, fracturing her right leg.

  Olivia complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. She believed the police had her under surveillance. Olivia also complained of a fear of dirt, taking time to frequently bathe and brush her teeth.

  PAST PSYCHIATRIC HISTORY:

  Olivia’s mother reported that Olivia saw a clinical social worker briefly when Olivia was 10 years old. Olivia reported that she was hospitalized at a New York hospital 3 years ago for 3 months. Six months after that, Olivia took an overdose of Xanax and was treated at the same hospital, and then was transferred to a state hospital. After discharge in the next month, Olivia attended a partial hospitalization program for drugs and alcohol every day for 5 weeks. Since then, Olivia has been seeing a clinical social worker and psychiatrist and continues to the present with them.

  MEDICAL HISTORY:

  At 17 years old, Olivia suffered from bulimia with bingeing, purging, and the use of laxatives. She reported she had not purged for 3 years until she began the diet 3 months ago. Although Olivia is currently not bingeing, she admitted to purging and using laxatives. Olivia is allergic to penicillin and has a lactose intolerance. She wears glasses for reading.

  Olivia reported that she began a new diet and although she was supposed to be eating 600 calories a day, she was only eating between 200 and 400 calories a day. She also admitted to purging and frequent use of laxatives. Olivia reported her weight was being monitored, and she had lab work done to be sure she remained healthy. In the past 3 months, Olivia lost approximately 80 pounds.

  Olivia complained of panic attacks and reported that she controlled them by taking Klonopin, but there was no evidence of this.

  SUBSTANCE ABUSE HISTORY:

  Olivia reported a history of drug and alcohol use, but she stated that she has been clean and sober for two years. She had gone to partial hospitalization two years ago and currently attends Alcoholics Anonymous and Narcotics Anonymous meetings. Olivia admitted to using marijuana, cocaine, opiates, and hallucinogens in the past. Valium was her drug of choice in addition to the alcohol. She denied IV drug use but admitted to “skin popping” cocaine.

  PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY:

  Olivia’s parents were married when her mother was 19 years old, and Olivia was born the following year. Olivia’s mother described Olivia as a wonderful, even-tempered, and happy baby. Two years later, Olivia’s sister was born; mother stated Olivia’s personality changed; she became stubborn and difficult. Olivia’s mother said that Olivia began biting and having temper tantrums and has been moody since then. Olivia’s mother stated her marriage was conflicted because she has a communication problem with her husband and he was “never an active parent.” Olivia’s mother reported that Olivia “adores her father” because he is not the disciplinarian. Olivia frequently caused conflict between her parents. When Olivia was 12 years old, her parents separated for 2 weeks. Olivia reported her mother quit college after Olivia’s birth and returned to college after her sister’s birth. She said her father worked all the time, and there was a housekeeper who cared for the children.

  Olivia reported that the family moved to Arizona when Olivia was in sixth grade, where she began using marijuana that she reported stealing from her parents. The family returned to New York when Olivia was in seventh grade.

  Olivia’s mother reported that when Olivia was in high school, her maternal aunt, who was dying of cancer, came to live with the family and that this was very stressful for Olivia. During those years, Olivia told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Olivia had a temper tantrum and there was no further investigation.

  Olivia reported she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Olivia stated that in college she had a 3.8 GPA and was on the Dean’s list.

  Olivia reported that in high school, most of her friends were athletes. She stated that she had one close friend. She changed her friendships often in high school, never keeping a best friend for so long. Currently, Olivia is friendly with her roommate but never keeps friends for long.

  Olivia’s mother reported that when Olivia returned from college she moved in with her parents. Olivia has always been very moody and this was apparent again for the short time she lived with her parents again. Conflict increased in the household, and Olivia’s parents began marital therapy. Olivia’s mother stated that she and her husband became united and finally asked Olivia to move out.

  Olivia reported that she has a very stressful job. Olivia reported that she currently has financial problems because she does go on spending sprees periodically to feel better. Olivia also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend.

  MENTAL STATUS EXAMINATION:

  Olivia presented as an overweight, somewhat disheveled, white female who had a cast on her right leg. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Olivia’s speech was pressured and often circumstantial or tangential, and she spoke in a loud voice. At times her thinking was logical, and at other times it was illogical. Olivia denied hallucinations but complained of hearing policemen outside her door prior to admission. She denied homicidal ideation and initially admitted to suicidal ideation and noted that is not new since she has thought about suicide since she was a teenager.

  Olivia was oriented to person, place, and time. Her fund of knowledge was excellent. Olivia was able to calculate serial sevens easily and accurately. Olivia repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Olivia was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate.