How Bereavement May Complicate and Existing Client PTSD Diagnosis, Essay Example

Description of the Patient’s Condition

After being exposed to traumatic events in Afghanistan, posttraumatic stress disorder (PTSD) and depression are often reported amongst military members who have returned to civilian life and their families. (Sayer et al., 2010), Unfortunately, the diagnostic procedures for PTSD may be complicated by the presence of grief in the patient’s life. In the case provided, an existing client, who has just returned from Afghanistan, is suffering from PTSD. He has been seeking for treatment for the condition and in the process has revealed that he has had difficulties adjusting in the society. Additionally, he has experienced “nightmares due to traumatizing events  experienced while in Afghanistan”. At some point during therapy, he reveals that his wife had left him, so he is grieving for that as well.

How Bereavement May Complicate an Existing Client Diagnosis

Given the case details, I believe that bereavement might complicate the client’s diagnosis in many ways. Bereavement refers to the grief reaction associated with the loss of a loved one (Fox & Jones, 2013).  Since the patient is already suffering from PTSD, the pain and lost of his wife may progress to a complicated bereavement as opposed to normal grief. According to Zisook et al. (2012), individuals suffering from complicated grief with another comorbid disorder may reflect symptoms of MDE which can make diagnosis and treatment difficult especially when trying to differentiate MDE from bereavement. It must also be noted that the patient has sleep disturbances due to his PTSD. Nightmares are defined as traumatizing, lengthy, story-like sequences of ream imaginary that seem real and indicate anxiety, fear or other dysphoric and traumatic emotions that are associated to experienced trauma. Therefore , comorbid nightmares must be addressed in treatment planning and management (APA, 2013).

Sleep disorders are also indicators of depression. However, initially, in this client case, the patient’s nightmares were due to the traumatic events previously experienced during the war in Afghanistan. Larson (2007) indicates that grief is normally under-recognized and under-treated, which further causes impairment and distress. Yet, grief requires targeted treatment. Zissok, Corruble, Naihua, and Iglewicz (2012) add that grief occurs after a major loss and may be a risk factor for a Major Depressive Episode (MDE).

Though the symptoms of grief, depression, and the stress-related disorders are comparable, grief has unique characteristics. This is especially true days or weeks after the loss when a patient may experience positive or negative emotions, making it difficult for a health practitioner to offer the necessary help. Episodes of major depression occur after stressful life events such as loss, humiliation, and/or separation from a significant other (Zisook et al. 2012). On the one hand, they may have “pangs” of grief, while they might sometimes, experience humor and positive emotions towards their loved ones (Larson, 2007). However, due to the initial diagnosis of PTSD Comorbid Nightmare Disorder, the patient in the case above is likely to experience consistent and pervasive sadness and be prone to onset of MDD if not addressed properly. Under such circumstances, the clinician may fail to diagnose a depressive episode if the symptoms are encountered better by grief.

The patient’s suggestion that he is experiencing grief maybe sometimes be overlooked. Larson (2007) offers a similar view by indicating that a pessimistic view of grief counseling has occurred in the last decade because of the notion that the method is ineffective. Bereavement and grief has been taken out of the DSMV to help clinicians identify normal grief such as loss of a loved one and MDE. Zisooket al. (2012) states that bereavement is a unique character and is to be expected in an individual lifespan. However, there are complications to this statement when the bereavement is complicated such as comorbid to another disorder or witnessed violent death combined with PTSD. Normal bereavement can be distinguished as well from complicated bereavement by its duration, severity, and the impairment of the individual (Zisook et l. 2012). For a physician, being able to distinguish MDE from grief can be a challenge and therefore requires good clinical judgment. Another complication is that grief and bereavement result in anorexia or insomnia, among other things.

My Position on Change of the Client’s Diagnosis

Since the client has been having persistent symptoms for more than two weeks and depressed mood very day most of the day it will be appropriate to change the diagnosis to PTSD comorbid night terrors, major depression, and substance use (alcohol). However, the client might have been suppressing these feelings since he stated that “losing his wife triggered a traumatic event while in Afghanistan when he lost his good friend”. It is apparent the client is suffering from complicated bereavement, but meets the criteria from MDE. According to the APA (2013), PTSD is highly comorbid with major depression, especially among veterans. In this case, clinical judgment and consulting with other co-workers/supervisor would be essential in accurate diagnosis and treatment. In my opinion, client diagnosis does not have to be changed, however, the complicated prolonged grief needs to be stressed for possible comorbid depression. A clinician must consider the symptoms of grief in the patient and those of the post traumatic stress disorder differently before recommending any treatment plan. On that note, as Fox and Dayle (2013) indicate, it is vital to consider each unique person on a case to case basis. Therefore, patient diagnosis should be entirely objective and unbiased. When these steps are followed thoroughly, accurate diagnosis and treatment will ultimately be able to improve the patient’s overall quality of life.

References:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Association.

Fox, J. & Dayle, J. (2013). DSM-5 and bereavement: the loss of normal grief? Journal of Counseling and Development, 91, 1; ProQuest Central, 113.

Larson, D. G. (2007). What has become of grief counseling? An evaluation of the empirical foundations of the new pessimism. Professional Psychology: Research and Practice, 38(4), 347-355

Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care.  Psychiatric Services, 61(6)

Zissok, S., Corruble, A., Naihua, D. & Iglewicz, A.  et al (2012). The bereavement exclusion and DSM-5. Depression and Anxiety 29, 425-443