Case Study Assignment Abnormal Psychology Ashley R. Worlock 3 March 2003
Lamanda
Lamanda is a 22 year old woman who suffers from avoidant personality disorder as described in the DSM-IV with a comorbidity of the anxiety, generalized social phobia and adjustment disorder with depressed mood. AXIS I – Generalized Social Phobia AXIS II – Avoidant Personality Disorder Adjustment Disorder with Depressed Mood AXIS III – No diagnosis on this axis AXIS IV – Problems with social, occupational, and school environment: living alone, avoids coworkers and loss of interest in school. Problems with primary support group: parents are different races. Problems with past sexual experiences: nightmares from sexual advan ce from a coach that occurred during adolescence and advances from boys. Problems with partner: boyfriend criticizes her. AXIS V – GAF: 60 (moderate difficulty in social and occupational functioning).
Upon assessment of this case study, it is shown that Lamanda suffers from several disorders. On Axis I, the clinical syndrome, she suffers from Generalized Social Phobia. The personality disorders, found on Axis II that she suffers from are Avoidant Personality Disorder, a comorbidity of social phobia, and Adjustment Disorder with Depressed Mood. There are no general medical conditions that are relevant to the comprehension or management of her case. However, there are several contributing psychosocial and environmental problems that have an
input into Lamanda’s conditions, listed on Axis IV. An overall global assessment of Lamanda is in that out of 100 she falls around a 60. All of these conditions and problems are described and discussed in the following evaluation of Lamanda. Lamanda is a 22 year old female of mixed race who has had several recent difficulties in her life. These difficulties are thus inhibiting her ability to function normally in her social and occupational environments. The most prevalent disorder Lamanda suffers from is the avoidant personality disorder. According to the definition outlined in the textbook, Abnormality Psychology and Modern Life, “Individuals with avoidant personality disorder have a pattern of extreme social inhibition and introversion leading to lifelong patterns of limited social relationships and reluctant to enter into social interactions,” (Carson, 2000). Lamanda portrays this basic definition. First of all she stated that she does not like her job and is unwilling to look for another one. This is clearly a sign that she does not like the social interactions within her occupation. In addition, her refusal to look for another job suggests that she does not want to interact with others in any other social atmosphere. The anxiety over this is apparent when she says that she feels “very jittery” over getting ready for work and will make excuses in order not to go. The second evidence portrayed is that Lamanda refuses to associate with fellow employees. She reports of having gotten “very nervous” when she was given a surprise birthday party. Lamanda clearly demonstrates that she is not fond of social settings. Besides her work and social settings she also has lost an interest in her education. There is no reason given, she just continues to exhibit a pattern of extreme social inhibition. More of the textbook definition states that, due to the individuals over sensitivity and fear of condemnation and rejection they do not seek out other relationships; however, they “desire affection and are often lonely and bored,” (Carson, 2000). In Lamanda’s case she has a boyfriend yet she avoids seeing him and as far as
her primary support group, her parents, she avoids them too in “fear” of disapproval. It is Lamanda’s inability to relate to other people that cause her avoidant personality, which in turn provides for a reason of her low self-esteem and self-consciousness. In accordance with the textbook, Lamanda’s condition shows comorbidity with the anxiety disorder, generalized social phobia (Carson, 2000).. This is quite common and can be seen in her by her “very jittery” and “very anxious” feelings stated above in certain social situations. Overall Lamanda’s behavior is not normal and shows signs of a textbook definition of the personality disorder, avoidant personality disorder, with a comorbidity of generalized social phobia. In addition to the avoidant personality disorder and social phobia, Lamanda also suffers from a mild mood disorder known as adjustment disorder with depressed mood. The textbook defines this mild form of depression by stating that it does not exceed six months in duration and that a defined stressor is identified within three months before onset of depression. The justification for the diagnosis is that the individual has “impaired social or occupational functioning” and a remittenance within six months (Carson, 2000). Lamanda definitely has impaired social and occupational functioning; she refuses to go to work and she avoids her boyfriend and parents. She also has lost interest in cleaning and cooking for herself and attending to her personal hygiene. Lamanda’s adjustment disorder with depressed mood could stem from previous environmental factors that over the prior three months have caused her to exhibit the previous behavior. Overall her symptoms show a mild level of this type at this stage in her life; she has just begun to demonstrate these characteristics. Due to the fact that her symptoms are mild, remittenance should occur with treatment within the required time. However, if no treatment is obtained, she could develop a more severe mood disorder.
Lamanda, at this time does not show any signs of a general medical condition that would be relevant to her diagnosis. Instead she has several problems that are included on Axis IV that contribute to her current condition. Some of her obvious problems such as, her living alone, avoiding coworkers, and stating that she has “lost interest in further education” contribute to he r avoidant personality disorder and social phobia. She also has a clear problem with her primary support group. This problem has persisted throughout her whole life due to the fact that she is mixed and as a child she was “shy and unattractive.” She recalls that she is close to her mother but that she goes to her dad with the big problems: possible avoiding any confrontation with her identity and wanting to avoid people. Another issue within her environment that could be an underlining issue with her problems is the fact that as an adolescent she reported “frequent anxiety” when trying to deal with sexual advances from boys. She also has had continuing nightmares of a coach that displayed some sexual advances during this period of adolescence. This too can be some explanation as to why she feels insecure around people and why she is critical about what others think of her. Lastly is the current issue with her boyfriend. Lamanda says, “that he tries to be positive but always ends up criticizing her.” This type of behavior demonstrated from her boy does not help her or her self-esteem. On the contrary he reinforces her inability to take criticism and hence, go into seclusion. These environmental factors show a path that has led Lamanda to her current conditions and her overall global assessment. Lamanda’s global assessment of functioning of 60 is b ased on the fact that she reveals clear signs of moderate difficulty in her social, occupational, and school functioning. She does not mention any friends and her boyfriend she now avoids. On the other hand she demonstrates some mild symptoms, she still goes to work even though she changed her hours from the daytime shift to the nighttime shift. Also she has started to evade her daily house chores. The
most damaging fact is her desire not to tend to herself personally with her grooming. With a combination of this and both mild and moderate symptoms she still can function; nevertheless, her condition is getting worse and as mentioned above without help it could get severe in all aspects. Her overall assessment is fair enough not to give her the benefit that she is better than she really is right now in her life. In conclusion, Lamanda clearly suffers mainly from avoidant personality disorder with a comorbidity of social phobia and not so distinguished, from adjustment disorder with depressed mood. There are many factors that contribute to her condition. Since the avoidant personality disorder and social phobia are quite similar in criteria except that avoidant personality disorder is more “severe”, Lamanda’s recent behavior warranted a more severe diagnosis. With medication and therapy Lamanda can definitely improve her life and deal with her past so that a relapse does not occur. Her time is critical and by her getting help now she has hopefully broken the path to a more severe condition overall.
