The case of Bill presents various issues requiring application in order to arrive at an appropriate diagnosis. The most prevalent symptoms according to Bill’s own description of himself include pain over loss, constant feeling of being low, anger over feelings of being inadequately cared for and feelings of guilt and worthlessness.
From the case description, Bill may be suffering from depression. The case features that point towards depression include feelings of being low, sadness, and lack of enjoyment for formerly fun activities. The fact that Bill has been of Prozac before also make this a core diagnostic possibility for the case. The case description clearly indicates these as well as the feeling of worthlessness and the desire to die. The desire for death in depressed individuals often results in suicidal thoughts. To evaluate the possibility of depression, it may be necessary to ask questions such as:
- How frequently does Bill think about death?
- Has he ever thought of committing suicide?
- How often does the feeling of being low prevail?
- Which activities does he enjoy now and does he still have the same interest in fun activities that he had before developing these feelings of being low?
- Has he experienced significant weight loss over the period he has felt low?
- Does Bill have other problems such as sleeping or eating difficulties?
These questions will be useful in the evaluation of the possibility of depression to various extents. According to Melgar and Rossi (2010), depression presents through symptoms such as recurrence in suicidal thoughts or thoughts of death, feeling low throughout the day and on a daily basis, lack of interest in formerly enjoyable activities, eating and sleeping problems such as excessive eating and minimal sleep, and feelings of worthlessness or guilt. Asking the above questions will therefore help in determining the existence of these symptoms in the patient. If the answers indicate that the patient exhibits the described symptoms, further testing and/ or treatment for depression will be recommended, while if the answers indicate otherwise, other diagnostic possibilities will be evaluated. The most important symptoms are however constant feelings of being low, thoughts about suicide and death and feelings of guilt and worthlessness. A combination of the three will lead to a conclusion that Bill suffers from depression.
Social Anxiety Disorder
Another diagnostic possibility in Bill’s case is social anxiety disorder (SAD). While the manifestation of the symptoms of SAD have been minimal in the general context of Bill’s life, indications of the fear of rejection by family members and other loved ones is prevalent. This is indicated through the fear that Bill displays in interacting with his siblings by reducing communication to superficial aspects, and fearing being vindicated for failing to initiate communication. Similarly, Bill hides his true emotions from his close family members for fear of being rejected. Brook and Schmidt (2008) asserts that SAD is characterized by a fear of situations in which one supposes that they would be considered socially inept. For instance, the fear of initiating communication and coping with certain situations while under extreme distress. The latter symptom presents through the ability to hide true feelings from those who are socially close to the client. To ascertain the existence of this possibility, the following questions will be asked:
- Do you also fear being rejected by those who are not your family members?
- How do you feel when you interact with persons in positions of authority?
- How long have you felt this fear of being rejected for showing your emotions?
- Do you feel distressed when you have to hide your true feelings from your family?
From the answers to these questions, it will be possible to evaluate the possibility of SAD. Based on the answers to these questions, it will be appropriate to match the answers to the respective symptoms described by the questions. An indication of these symptoms points towards social phobia while where these symptoms are minimal, the possibility is discarded.
The existence of symptoms such as hallucinations, irritability, and impulsiveness are indicative of a possibility of schizophrenia. From Bill’s case description, the qualities he associates with his father as well as with his military superior and himself are all signs that he is probably hallucinating. Moreover, social difficulties such as the fear of communication and rejection are also signs of schizophrenia. To evaluate this possibility, it may be important to ask the following questions.
- How frequently does Bill give falsified/ enhanced/ wrong descriptions of people and situations?
- How do the feelings of irritability and anger affect Bill’s relationships with others?
- Has Bill ever engaged in disorganized behavior?
- Does he display symptoms of cognitive deficiency?
From these questions, it will be possible to evaluate Bill for this diagnostic possibility. An indication of symptoms associated with schizophrenia such as hallucinations, disorganized behavior, delusions, and reduced emotional expression all point towards schizophrenia (Tandon et al., 2013). If none of these symptoms exist, the patient will be declared free of the diagnosis.
Brook, C. & Schmidt, L (2008). Social Anxiety Disorder: A review of environmental factors. Neuropsychiatr Dis Treat, 4(1), 123-143.
Melgar, N. & Rossi, M. (2010). A cross- country analysis of the risk factors for depression and the micro and macro level. IDB Working Paper series No. IDB-WP-195. Inter- American Development Bank
Tandon, R., Gaebel, W., Barch, D., Bustillo, J., Gur, R., Heckers, S. et al (2013). Definition and descriptions of Schizophrenia in the DSM-5. Schizophrenia Research, xxx.