• Identify the correct DSM-5- TR diagnosis(es)I believe the correct DSM-5- TR

I believe the Identified correct diagnosis for this case study is Persistent Depressive Disorder. Am I wrong? and are there others I’m missing?

Client Name: DAVID CRUZ Date of Interview: __8/17/2023_______________

Clinician Completing Interview: ____MSW STUDENT______________

Date of Review: __8/17/2024_______________

Referral Source:  PCP  Psychiatrist  Case Manager XX Self  Other __________________________________

Demographic Information: Biological Sex: XX Male  Female  ______________

Current Gender Identity: XX Male  Female  Trans____________  ______________

DOB: __2/22/99_______ Age: __24 yrs old_________ Birthplace: _Phoenix, AZ______________________________

Housing:  Homeless X Lives alone  Lives with other(s) _________________________________

Presenting Problem(s): Ct self-referred for psychotherapy due to multiple stressors and mood issues. Ct reported a recent breakup with his boyfriend Mike on 8/1/23. Ct stated his boyfriend broke up with him and moved back to Florida to be with his exboyfriend. Ct stated he attempted to propose to his boyfriend Mike on 7/31/23 because they had been dating for 2 years but he said no. Ct stated Mike ended the relationship the next day on that day on 8/1/23 and moved of their apartment on 8/5/23. Ct recalled Mike telling him, “You smother me and you are too needy”. Due to his Ex-boyfriend Mike moving out of the apartment they have shared since 2/1/22, Ct is worried he will not be able to afford the rent. Ct stated “This entire experience has been devastating and I am crushed by the break up and I have to move out of the apartment I love”. Ct reported no previous mental health issues but he is currently feeling daily anxiety, agitation and worry which affects his ability to sleep. Ct stated he is not able to fall asleep or stay asleep several times a week since the relationship ended on 8/1/23. Prior to 8/1/23 he was able to sleep 7-8 hours per night and felt rested. Ct stated he has daily racing thoughts about is ex-boyfriend Mike and is having difficulty concentrating on his work or daily activities including not showering every day and not cleaning his apartment. Ct stated, “I don’t want to do anything but play video games all day so I am not doing my dishes or laundry which is different for me because I like a clean apartment”. Ct did state even though he is needing to move at the end of October 2023 he is keeping up with his budget and financial responsibilities. Ct stated he will get up and complete his work remotely since he works from home but is not finishing his work on time or thoroughly which is also different for him since he always did “great work and completed work on time and efficiently”. Ct stated due to missing a crucial deadline on a project that was due on 8/8/23 he was put on a Performance Improvement Plan (PIP) on 8/10/23. Ct recalled no history of work difficulties until recently. Ct stated, “I was looking forward to the future but I feels confused as to what the future will look like without Mike. Ct denies current and history of DTS, DTO and substance use.

History of Presenting Problem(s): Stressors or precipitating factors leading to need for services: Ct recalled 2 other relationships ending “badly”. Ct stated he dated 2 other men who also broke up with him. He dated Brian in 2020 and Lou in 2019. Ct dated Brian while he was in college, “I thought everything was fine but then it ended”. Ct stated he dated Lou in high school, “I knew that relationship was going to end, I was not surprised”. Ct stated his parents, Jeff & Linda divorced when client was 10 years old which “was awful but my parents were not good together they fought all the time”. Ct denied any abuse or neglect but felt the fighting was difficult to witness as a child. Ct expressed, “Growing up I looked forward to having a healthy relationship because I grew up watching my parents fight all the time”. Mother remarried Step-father Guy when client was 15 years old and client lived fulltime with mom and step-father until he went to college. Father has not remarried but has had several girlfriends. Ct did not provide any further information given at this time. Ct declined to include any further details regarding his childhood.

Frequency/Intensity/Duration/Cycling of Symptoms: Ct stated he experiences moderate daily anxiety, agitation, worry, racing thoughts, and lack of concentration since August 1, 2023.

Onset of Presenting Problem: Month August Year 2023

Was there a clear time when symptoms worsened and/or Event(s)/Situation(s) that lead to symptom(s) worsening? Ct stated, “Everything went to hell when Mike broke up with me on August 1, 2023”. Ct feels the need to move out of his apartment was another event that contributes to his symptoms and issues.

ANSWER

“DSM-5-TR Diagnosis for a Client Experiencing Relationship-Related Stress and Mood Issues”

Abstract

This paper examines a case study of a client, David Cruz, who sought psychotherapy due to multiple stressors and mood issues following a recent breakup. The primary objective is to identify the most appropriate DSM-5-TR diagnosis(es) based on the client’s presenting symptoms and history. While Persistent Depressive Disorder appears to be a relevant diagnosis, other considerations will be explored to ensure a comprehensive understanding of the client’s condition.

DSM-5-TR Diagnosis Considerations

David Cruz’s case presents several symptoms indicative of mental health distress following a significant relationship breakup. The central diagnostic consideration is Persistent Depressive Disorder (PDD), commonly known as dysthymia, characterized by chronic depressive symptoms lasting for at least two years. While PDD may seem plausible, other diagnoses should be considered based on the clinical information provided.

Persistent Depressive Disorder (Dysthymia)

PDD is characterized by chronic low mood, loss of interest or pleasure, fatigue, low self-esteem, poor concentration, changes in appetite or weight, and sleep disturbances. Mr. Cruz reported feeling devastated by the breakup, daily anxiety, agitation, racing thoughts about his ex-boyfriend, difficulty concentrating, and sleep disturbances since August 1, 2023. These symptoms align with the criteria for PDD.

However, it is essential to assess whether these symptoms have persisted for at least two years, as per the DSM-5-TR criteria. The case information only mentions symptoms dating back to August 1, 2023, and further exploration of the client’s history is necessary to confirm a PDD diagnosis.

Major Depressive Disorder (MDD)

Major Depressive Disorder is another potential diagnosis to consider. While PDD involves chronic, low-level symptoms, MDD is characterized by the presence of more severe symptoms that meet specific criteria for a defined period (typically two weeks or more). David’s daily anxiety, sleep disturbances, low mood, and changes in functioning since the breakup may align with MDD criteria.

It’s crucial to assess whether the client’s symptoms meet the criteria for a major depressive episode and whether there have been previous episodes in his life. Further clinical evaluation will help determine if MDD is a more accurate diagnosis.

Adjustment Disorder

Given the temporal relationship between David’s symptoms and the breakup (occurring on August 1, 2023), an Adjustment Disorder is another consideration. Adjustment Disorders encompass emotional and behavioral symptoms resulting from identifiable stressors. David’s emotional distress, changes in work performance, and daily functioning difficulties may align with this diagnosis.

To diagnose an Adjustment Disorder, it is essential to establish a clear link between the symptoms and the specific stressor, which, in this case, is the breakup with his boyfriend.

Conclusion

Based on the information provided, Persistent Depressive Disorder (PDD) appears to be a potential diagnosis for David Cruz. However, further clinical assessment and exploration of his mental health history are necessary to confirm this diagnosis. Additionally, Major Depressive Disorder (MDD) and Adjustment Disorder should be considered and differentiated during the assessment process. The choice of the most appropriate diagnosis will depend on the duration, severity, and context of the client’s symptoms, ensuring a comprehensive understanding of his mental health condition.