Bipolar Disorder or Depressive Disorder or Both, Case Study Example

The client in the video exhibits traits that are characteristic of major depressive mood disorder and well as signs of Bipolar I. The client notes that she has a loss of interest both in her job and in her sex life, and she feels persistently sad. This fits into the DSM criterion A-1, which states that the patient feels depressed for most of the day as noted by her testimony that she cries a lot (APA, 2013). Her overall physical health has deteriorated, triggered by her divorce from her husband who cheated on her. She notes that she has changed her eating and drinking habits, which has resulted in her gaining weight, which fits the third criterion, A-3 in which noticeable weight gain or loss in present as a result of unhealthy eating habits (APA, 2013). As a result, she lost her medical insurance in the divorce, and her work cut all medical benefits along with the number of hours she worked. The client suffers from a pre-existing condition–hypothyroidism–yet she cannot afford to purchase the necessary medications to control it on a monthly basis. Although the client presents with various symptoms associated with a Bipolar I diagnosis as mentioned above, she does not exhibit any manic behaviors nor does she note that she ever experienced such an episode (APA, 2013).  According to the DSM, major depressive disorder manifests itself through manic symptoms–in this client’s case, hypomanic symptoms that occur for a shorter duration of time–or hypomanie.

The client details her recent divorce and her struggles to really get her life back together, so much so that she has a difficult time concentrating and completing certain tasks. According to the eighth criterion, A-8, patients suffering from a major depressive episode have a difficult time concentrating and carrying out tasks they normally are able to do (APA, 2013). The client notes that she does not know what went wrong and why her husband divorced her, especially since he cheated on her and not the other way around. Time and again, she expresses her anguish and confusion over what just transpired in her life, which fits into the seventh criterion for major depressive episode in which patient feels an overall sense of worthlessness and guilt for what went wrong in her life (APA, 2013). If a client presents with a episode of major depression, according to the DSM (APA, 2013), she must corroborate her current depressive episode with past episodes of hypomania or mania. The client notes that when she was in college as a junior, she attended a frat party where she imbibed in large quantities of alcohol. She had been drinking with one guy and one girl, who later took advantage of her when she was too inebriated to care for herself. She was raped, and ended up going to the hospital for a depressive episode and stayed there for six days. Every morning for breakfast, she was forced to take Prozac to help with her depression. Thus, the client testifies that she did experience depressive episodes prior to her current one when she was in college. The diagnostic complexity of depressive episodes and bipolar I and bipolar II persist due to the massive overlapping of each condition.

Beyond her feelings of depression over her recent divorce, the client also suggests that she suffers from severe impairment social functioning, such as family problems as well as difficulties forging meaningful intimate relationships. Such impairment fits in criterion B for a major depressive episode in which the patients is impaired in various facets of his or her life. According to the DSM (2013), individuals suffering from major depressive disorder struggle with their sexual relationships. The client states that she has always been confused about her sexual identity, even after she married her husband. Her husband would complain that whenever they had sex, he felt that she was never “really there,” and was absent. The client admits that when she had sex even before college, she struggled with sexual intimacy, noting that she “always went somewhere else.” This diminished interest in pleasure fits into the second criterion, A-2, for major depressive episodes (APA, 2013).  She conveys her fear that she will never be able to connect to another person because she feels as though she will not be able to “handle it.” Such observations could also fit into a personality disorder the patient may suffer from such as schizoid personality disorder. According to DSM-V, individuals who exhibit very little desire to enjoy close relationships with a romantic partner or family often serves as the first symptom of schizoid personality (APA, 2013).  In addition, the client’s conveyed a sense of apathy towards her job, a sign that her intellectual functioning has also deteriorated because of her depression, which fits into criterion B-1 (APA, 2013).  She stresses that she never used to dislike or complain about her job. However, she conveyed her unhappiness about her job because the people she managed in the department store did not respect her, while her bosses took advantage of her. She went to school for fashion design, and yearned for a job in which she could be creative. Unfortunately, the nature of the fashion design business is difficult to break into it, so she expresses frustration and a sense of worthlessness as though she was not good enough for a job in the fashion industry. Such a feeling of worthlessness and guilt over her career fits the seventh criterion, A-7, for major depressive episodes.

Although patients experience acute feelings of sadness or mellifluous happiness for a particular situation, such emotions are usually ephemeral. Research has demonstrated that diagnoses of mood disorders stress two particular factors: severity and consistency. Clients who suffer from mood disorders may also present with a litany of chronic, maladaptive cognitions, including suicidal ideation, and maladaptive behaviors, such as suicide attempts. Although suicidal ideation and suicide attempts do correlate with some disorders, they are not specific to one disorder or another. This client tells the clinician that she is confused about almost everything that was going on in her life, but the one thing she was certain of was how she would commit suicide. She states that she has planned out her suicide where she has stacks of Ambien, a potent sleep medication, that she would ingest. She states that she needed to figure out which day she carry out her suicide plot. Such high suicidal ideation and preoccupation with death fits in with the ninth criterion of major depressive episode (APA, 2013). This client exhibits many features of Bipolar I disorder according the DCM, but she never mentions experiencing any manic episodes, which is required for a clear-cut diagnosis of bipolar 1 according to the DSM criteria (APA, 2013). The client also never mentions any family history with depression or bipolar mood disorder. Usually, clients who are diagnosed with Bipolar II disorder not a family history of that condition. Because the client does not provide a family history, one would be necessary in order to ensure that she suffers from Bipolar II disorder. Nonetheless, it is quite difficult to diagnose the client as having manic depression versus suffering merely from major depressive symptoms. The client never suggests that she has any manic episodes in which she tries to be the so-called life of the party. Moreover, rather than engage in risky behaviors with others such as seeking out sex, she withdraws and feels both shame and guilt.

References

DSM (2013). Retrieved September 29, 2015 from file:///home/chronos/u-02c710ee7512500a428058227636109084998a5a/Downloads/DSM-5%20(1).pdf