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Diagnosis is an important tool in the medical profession and it is used in a broad spectrum of settings. In psychology, diagnosis precedes treatment and management of mental disorders. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has been providing guidelines for making diagnoses of various mental disorders (Lloyd-Richardson 3; Muehlenkamp and Gutierrez 62).
The latest edition is DSM-V, which has made great improvements in enhancing the diagnosis of children and mental disorders that affect adolescents.
The newly published edition of DSM made important updates on the disorder criteria in a way that better deals with the experiences and symptoms of children. Instead of separating childhood disorders, it demonstrates how they can develop further in life and affect the developmental continuum.
Nonetheless, some children and adolescent disorders have not been captured in the new edition manual. Given a chance to be in the committee for a new edition of the Diagnostic and Statistical Manual of Mental Disorders, I would include non-suicidal self-injury (NSSI) as a new child/adolescent disorder.
The rationale for my diagnosis would be that NSSI is a personality disorder that affects adolescents and young adults. This rationale is based on the recent increase of this disorder in many adolescents and the lack of diagnosis criteria for use by mental health practitioners.
New Child/ Adolescent Diagnosis
Non-suicidal self-injury could be termed as an act of causing injuries to oneself, which is not intended to lead to death. About one-third of adolescents in the United States is said to have engaged in non-suicidal self-injury (Lloyd-Richardson 4). This is a common disorder that makes individuals in the adolescence stage to exhibit self-harming attributes.
NSSI is characterized by cutting or burning oneself, hitting, pinching, banging or punching walls and other objects. Thus, it has been found to induce pain, break bones, ingest toxic substances, and interfere with the healing of wounds (Lloyd-Richardson 3).
Patients with NSSI report feeling minimal or no pain when carrying out these self-harming behaviors. Patients also report that the self-harming behavior becomes addictive and the person is unable to control or stop his or her impulses for self-harm.
The following characteristics should be the basis of diagnosis of NSSI in adolescents (Muehlenkamp and Gutierrez 64):
- Eating disorders
- Substance use disorder
- Elevated rates of emotional reactivity, intensity and hyperarousal
- Increased avoidance behavior
- Decreased emotional expressivity
- Scars caused by self-harming behavior
Other associated disorders are the following:
- Developmental disabilities
- Eating disorders
- Borderline personality disorder
Adolescents with NSSI are likely to report being bullied by their peers, experiencing confusion with their sexual identity, undergoing stress within their social environment, for instance, in the family or at school.
Factors such as family conflicts, child molestation, and drug and substance abuse could lead to NSSI cases. Thus, it is important for parents and/or guardians to assess their children to ensure that they are not exposed to situations that could result in self-harm.
Lauren is a 16-year-old girl who was sexually abused by her uncle when she was 10. She was afraid to tell anyone of the ordeal, but her mother, Kimberly, discovered that her daughter was walking in a funny way and had become withdrawn.
She asked Lauren what was going on and she told her about what her uncle had done to her. Her mother took her to hospital immediately and reported the case to the police. The perpetrator was charged and jailed for 20 years. Lauren underwent therapy and attained full recovery.
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However, her abuser was recently released because of good behavior and Lauren saw it on the news. As a result, she has been withdrawn and prefers to be locked up in her room upstairs for long hours. Her mother noticed that she wears long sleeved clothes recently and one time she noticed some wounds on her wrist. This prompted her to bring Lauren in for therapy. During the session, Lauren is quiet and withdrawn.
She is not willing to share her experiences with me. When I ask her if she has done anything to harm herself, she appears defensive. After several attempts and getting Lauren to come alone to sessions, she opens up about the abuse. Her mother is a single parent. They live in a suburban neighborhood and she is afraid that if her uncle would attack her again, her mother would not be able to defend her.
Lauren says that she has been experiencing panic attacks, especially when she is alone in the house. She describes it as a paralysis where she is unable to move, sweats profusely and feels like she is having a heart attack. She has also had sleep difficulties because she has nightmares and flashbacks of her rape ordeal. She says that cutting her wrists calms her down and makes her forget her fears.
My diagnosis is post-traumatic stress disorder and non-suicidal self-injury. Post-traumatic disorder is triggered because of her perpetrator’s release from prison, which has been a reminder of the original effect.
This can be inferred from the patient’s panic attacks, nightmares and insomnia. Non-suicidal self-injury has been the patient’s mechanism for dealing with PTSD. Cutting herself removes her from the situation and helps her to remember that she is still alive.
My recommended treatment is trauma-focused cognitive-behavioral therapy, combined with family therapy for PTSD and providing alternative strategies for coping with stress as a treatment for NSSI. I will also encourage Lauren’s mother to make a report to the police of any attempts by the perpetrator to see Lauren again or any threats.
She should also give Lauren a sense of security by ensuring that she feels safe within their home and in school. I will encourage Lauren to take self-defense classes so that she feels more secure and in control in case of an attack.
I chose to analyze the article on ‘Diagnosing the wrong Deficit’ based on the two concepts of the need to carefully examine developmental history and to ‘look for a horse not a zebra when you hear the hoof beat’ (Thakkar par. 1). In the article, the author describes a patient who came to him to confirm if he had attention-deficiency hyperactivity disorder (Thakkar par. 2).
He had the typical symptoms of the disorder, including procrastination, forgetfulness, a propensity to lose things and the inability to pay attention consistently. However, the patient’s case was a violation of one important criterion of A.D.H.D, which is the symptoms. The patient’s symptoms dated back to the day when his job required him to wake up at five in the morning.
However, he was a night owl. The therapist diagnosed him with sleep disorder and the patient made a full recovery (Thakkar par. 7). This was a difficult condition to diagnose, but the experience of the therapist helped him to make the right diagnosis.
From this case, the importance of examining the developmental history of a patient is seen. In fact, all psychologists based in learning institutions should always aim at establishing developmental histories of their clients in order to arrive at the right diagnoses.
It can be established that, if the therapist had failed to study the patient’s developmental history, he could not have noticed that the most important criterion for diagnosis of A.D.H.D was not met.
As a result, the therapist could have made a misdiagnosis, which could have led to the lack of the patient’s recovery. Treating the wrong disorder may cause frustration in both the patient and therapist and may even lead to the development of other disorders.
Another lesson can be learned on the need to ‘look for a horse not a zebra when you hear the hoof beat’ (Thakkar par. 12). It is important not to make a diagnosis based on probability. Occasionally, one may make a diagnosis because the patient had several symptoms that matched a given illness or disorder. In this case, if the therapist had based his diagnosis on probability, he could have made a misdiagnosis of sleep disorder.
It is also important to analyze all probable diagnoses in detail before making a conclusion, but in most cases, the simplest diagnosis is usually the correct one. If the therapist had over analyzed the symptoms looking for the ‘zebra’, he could have misdiagnosed the patient.
Lloyd-Richardson, Elizabeth E. “Non-Suicidal Self-Injury in Adolescents.” Prevention researcher 17.1 (2010): 3-7. Print.
Muehlenkamp, Jennifer J., and Peter M. Gutierrez. “Risk for suicide attempts among adolescents who engage in non-suicidal self-injury.” Archives of Suicide Research 11.1 (2007): 69-82. Print.
Thakkar, Vatsal G. Diagnosing the wrong deficit. 2013. Web. <https://www.nytimes.com/2013/04/28/opinion/sunday/diagnosing-the-wrong-deficit.html?_r=0>