Psychopathology

Guidelines: First, review the case vignette carefully. Please respond to the following set of questions.
Label your responses to match original question. For questions 1a and 1b, please refer to official
diagnostic guidelines from DSM-5. If you do not have access to the DSM-5 book, please resort to
class notes and/or online resources outlines DSM-5 diagnostic criteria. For questions 2-5, please
support your responses with theory and relevant literature (from class or other scholarly references).
Finally, consider that I am not looking for “correct” answers only.
— Case 2 Eric Reynolds —
Eric Reynolds was a 65-year-old married Vietnam War veteran who referred himself to the
Veterans Affairs outpatient mental health clinic for a chief complaint of having “a short fuse”
and being “easily triggered.”
Mr. Reynolds’s symptoms began more than four decades earlier, soon after he left the combat
zone in Vietnam, where he served as a field radio operator. He had never sought help for his
symptoms, apparently because of his strong need to be independent. An early retirement led to
greater recognition of symptoms and a stronger desire to seek help.
Mr. Reynolds’s symptoms included uncontrollable rage when unexpectedly startled; recurrent
intrusive thoughts and memories of death-related experiences; weekly vivid nightmares of
combat operations that led to nighttime fright and insomnia; isolation, vigilance, and anxiety;
loss of interest in hobbies that involve people; and excessive distractibility.
Although all of these symptoms were very distressing, Mr. Reynolds was most worried about his
uncontrollable aggression. Examples of his “hair-trigger temper” included confrontations with
drivers who cut him off, curses directed at strangers who stood too close in checkout lines, and
shifts into “attack mode” when coworkers inadvertently surprised him. Most recently, as he was
drifting off to sleep on his physician’s examination table a nurse touched his foot and he leapt up,
cursing and threatening. His involuntary reaction scared the nurse as well as the patient.
Mr. Reynolds said that no words, thoughts, or images intervened between the unexpected
stimulation and his aggression. These moments reminded him of a time in the military when he
was on guard at the front gate and, while he was dozing, an incoming mortar round stunned him
into action. Although he kept a handgun in the console of his car for self-protection, Mr.
Reynolds had no intention of harming others. He was always remorseful after a threatening
incident and had long been worried that he might inadvertently hurt someone.
Mr. Reynolds was raised by a single mother in Atlanta, Georgia. He described himself as having
been upbeat and happy prior to his army induction. He said he enjoyed basic training and his first
few weeks in Vietnam, until one of his comrades got killed. At that point, all he cared about was
getting his best friend and himself home alive, even if it meant killing others. His personality
changed, he said, from that of a happy-go-lucky farm boy to a terrified, overprotective soldier.
Upon returning to civilian life, he managed to get a college degree and a graduate business
degree, but he chose to work as a self-employed plumber because of his need to stay isolated in
his work. He had no legal history. He had married to his wife for 35 years and was the father of
two college-age students. In his retirement, he looked forward to woodworking, reading, and
getting some “peace and quiet.”
Mr. Reynolds had tried marijuana during his early adulthood and used excessive alcohol
intermittently; however, he had not consumed excessive alcohol or used marijuana during the
past decade.
On examination, Mr. Reynolds was a well-groomed African American man who appeared
anxious and somewhat guarded. He was coherent and articulate. His speech was at a normal rate,
but the pace accelerated when he discussed disturbing content. He denied depression but was
anxious. His affect was somewhat constricted but appropriate to content. His thought process
was coherent and linear. He denied all suicidal and homicidal ideation. He had no psychotic
symptoms, delusions, or hallucinations. He had very good insight. He was well oriented and
seemed to have above average intelligence.
Questions
1a. Provide a comprehensive diagnosis based on the information documented in your assessment.
1b. Differential diagnosis is the process of weighing the probability of one disorder versus that of
other disorders possibly accounting for a client’s illness. For this case study, what other diagnoses did
you consider and why did you rule them out to provide the comprehensive diagnosis above?
2. Discuss two biological, behavioral, emotional, psychological, social or cognitive factors that are
relevant to social work assessment or intervention in this case. Make sure to define the factor you
identified and how it is related to assessment or intervention outcomes. Use theory and research to
support your reasoning.
3. Discuss two protective or strength factors in this case. Please make sure to explain how each factor
may be protective. Consider important treatment outcomes (e.g., treatment adherence, treatment
engagement, access to care etc.). Make sure to include references to support your argument.
4. Identify two evidence-based interventions to address the client’s primary diagnosis. Make sure to
include references to support your argument.
5a. Discuss why culture should be considered in the assessment or treatment of this client (refer to
theory to respond to this item). Make sure to include reference.
5b. How might cultural factors affect treatment for this client? Make sure to cite two articles
to support your argument.