The Case of Stan, Essay Example

Stan’s behavioral patterns, as reported in his Life Sketch, would suggest that he is suffering from an avoidant personality disorder that manifests itself through social anxiety, feelings of inferiority, and general depression.  In an attempt to self-medicate, Stan has exacerbated these issues through intense and prolonged alcohol abuse.  The DSM-IV locates personality disorders on Axis II, and avoidant personality disorder falls into Cluster C, which covers anxious or fearful disorders (American Psychiatric Association [DSM-IV-TR], 2000).  People experiencing this personality disorder often experience social inhibition and the subsequent avoidance of social situations and interactions, a heightened sensitivity to criticism, and feelings of inadequacy (DSM-IV-TR, 2000).

Throughout his Life Sketch, Stan uses words like fear, scared, anxiety, and terror to express his belief that his shortcomings make him unappealing to other people, especially strong and attractive women.  He states that his fears cause him to drink heavily, “mostly when I feel all alone and scared that I’ll always feel as lonely and isolated as I do now” (Midterm Assignment, 2011, p. 2).  Stan’s behavior has become cyclical:  he abuses alcohol because he is lonely and isolated, and becomes further isolated and anxious when he drinks. Like many people with avoidant personality disorder, Stan has a difficult time believing that other people might find him appealing.  Although he dislikes his self-imposed isolation, it is emotionally safer for him than running the risk of being rejected.  While he would like to be less lonely, he states that “It is very difficult for me to get close to anyone–and I can’t say that I have ever loved a person and I surely know that I have never felt fully loved or wanted” (Midterm, 2011, p. 2).

Stan’s low self-esteem, chronic shyness, and feelings of self-loathing are offset by his newfound interest in becoming an active participant in his own recovery.  Thus, although behavioral therapy is often used to work with those suffering from avoidant personality disorder (Alden, 1989), I would choose a person-centered therapeutic approach because of its emphasis on empowerment and self-expression.  Stan’s ability to talk openly about his family history and his complicated relationship with women and his interest in working in the field of counselling indicate that he is ready to move beyond his feelings of inadequacy and fear.  A therapeutic setting in which the counsellor acts as a guide, allowing Stan to discuss his conception of his issues in order to determine a successful way to move beyond them will be helpful in facilitating his recovery (A.D.A.M. Medical Encyclopedia, 2010).

Paroxetine (Paxil) could benefit Stan since this SSRI also assists in dealing with anxiety symptoms and disorders, both of which Stan has reported.  Some of the side effects Stan might expect include weight gain, nausea, and sexual dysfunction (Young, 2011).  This last would be something to monitor given Stan’s existing belief that he isn’t “much of a man” (Midterm, 2011) and his previous experiences with his ex-wife, who constantly undermined his sexual abilities.

Sertraline (Zoloft) has been noted to contain fewer side effects than many other SSRIs (Young, 2011), which could be beneficial for Stan as he would be better able to focus on the counselling aspect of his therapy.  As with Paxil, this drug can cause sexual dysfunction, which should be monitored.  This drug can also cause anxiety, which could be a problem for Stan, since further anxiety may trigger his pattern of drinking as a means of self-medication.  Alcohol is not recommended for individuals on SSRIs as it can lower the efficacy of the drug and exacerbate many of their side effects (Young, 2011).

References

A.D.A.M. Medical Encyclopedia. (23 Nov 2010). Avoidant personality disorder. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001936/

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4^th ed.). Washington, DC: Author.

Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology, 57(6), 756-764. Retrieved from http://homepage.psy.utexas.edu/HomePage/Class/Psy394Q/Behavior%20Therapy           %20Class/Assigned%20Readings/Personality%20Disorders/Alden89.pdf

Preston, J. (2011). Quick reference to psychotropic medications. Retrieved from http://www.psyd-fx.com/Quick_Reference_bw_2011.pdf

Midterm Assignment. (2011). The case of Stan.

Young, L. (2011). The pros and cons of some common antidepressants. Best Health Magazine. Retrieved from http://www.besthealthmag.ca/embrace-life/mental-health/the-pros-and-cons-of-some-common-antidepressants