American Psychiatric Association (APA) (2013) states that PTSD (DSM-V code 309.81 (F43.10)) develops when one is exposed to one or more traumatic events. However, the disorder has different clinical manifestations in a different individual. Some individuals may express arousal and reactive-externalization symptoms (APA 2013). In this case, the patient exhibits symptoms such as agitation, aggressiveness, impulsive behavior, and recklessness, which can be interpreted as consistent with arousal and reactive-externalization symptoms.
Consistent with DSV-V criterion A, the patient has experienced a direct traumatic event by falling 500ft from the side of a mountain. Besides, he directly expressed abuse and neglect from the stepfather and mother when he was between 5 to 16 years of age. Besides, the patients move to use alcohol and smoke at an early age fulfills DSM-V criterion B of PTSD diagnosis. Use of alcohol and smoking can be interpreted as his attempt to evade intrusion symptoms include memories of neglect and abuse right from the early age. He also fulfills DSM-V criterion C of PTSD diagnosis supported by the argument that severe agitation and aggressiveness may be interpreted as his attempt to avoid harm or be susceptibility to abuse. Besides, lack of remorse may be his attempt to shield-off thoughts and feelings that may arouse childhood memories of abuse and neglect (APA 2013).
The patients symptoms are also consistent with DSM-V criterion D of PTSD diagnosis based on the feelings of detachment, feeling of estrangement from others, and persistent negative emotions such as anger and aggression. He keeps on hurting others and self without justification or expression of remorse (APA 2013). By DSM-V criterion E of PTSD diagnosis, he often expresses instances of recklessness and impulsive behavior, and self-destructive/harming behavior. Regarding DSM-V criterion F of PTSD diagnosis, his symptoms have persisted for more than one month and also consistent with DSM-V criterion G of PTSD diagnosis since his symptoms are clinically significant and have affected his social relations with others. Lastly, he also fulfills DSM-V criterion H of PTSD diagnosis since his symptoms are not a direct effect of alcohol use but instead, alcohol use and smoking is secondary to PTSD (APA 2013).
ASPD Diagnosis Based on DSM-V
APA (2013) defines ASPD (301.7 (F60.2)) as failure to adopt ethical and lawful behavior. It is characterized by egocentricity, deceitfulness, insensitivity towards the concerns and feeling of others, irresponsibility, risk-taking, and manipulative behaviors. Key features include self-direction, identity issues, lack of intimacy, and lack of empathy (APA 2013).
The patient's symptoms and manifestation of this condition satisfy DSM-V criteria A and B of ASPD. Regarding DSM-V criterion A, the patient should express two or more of the following pathological personality traits. These include identity issues, self-direction regardless of going against others interests or feeling, lack of empathy, and lack of intimacy. The patient exhibits egocentric attitudes, self-direction based on self-gratification regardless of hurting others, lack empathy of concerns on how other think of feel about his behavior, and use of aggression to achieve dominance (APA 2013). He derives pleasure and power by hurting and intimidating others. Besides, he does not show remorse or having justification for hurting others or the self.
The DSM-V criterion B of ASPD diagnosis affirms that a patient must exhibit six or more the following seven pathological personality traits. The first pathological symptom is an expression of manipulative behaviors. In this case, the patient employs aggression to manipulate, control, and achieve dominance towards others. The second pathological symptom is callousness. Callousness is defined as not showing concern for the interest, feelings, or issues of others. It is characterized by lack of remorse or guilt about the harmful or negative impacts of ones actions or behaviors on others, which is evident in this case. The affected individual tends to express sadistic or aggressive behaviors (APA 2013).
The third symptom prescribed by DSM-V criterion B for diagnosis of ASPD is deceitfulness, which is not evident in this case. However, he manifests with the fourth symptom that is characterized by hostility in which case the patient is aggressive and easily agitated. Besides, he presents with the fifth symptoms characterized by recklessness putting self in danger, and self-harming behaviors. The patient impulsive behavior is consistent with the sixth symptom, which is an exhibition of impulsivity. Lastly, the patient exhibits the seventh symptom characterized by irresponsibility in the sense that he does not shows a sense of responsibility for hurting the self, hurting others, or putting himself in danger through his reckless behavior (APA 2013).
The patient is diagnosed with both PTSD and ASPD based on DSM-V criteria specific to each disorder. Neglect and abuse by the stepfather and mother during the early childhood years seemed to have had the impact that is more significant to his psychiatric state the impacts of falling over a mountain cliff. The patient's symptoms satisfy all the diagnosis criteria for the diagnosis of the two disorders. Thus treatment intervention shows equally focus on both PTSD and ASPD.
American Psychiatric Association 2013, Diagnostic and Statistical Manual of Mental Disorders, 5th edn., American Psychiatric Association, Washington, DC.
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