Childhood Psychopathology Case Study
At our clinic, a counselor interviewed Cassandra and her mother in order to assess her needs. A child psychologist was also scheduled to determine if Cassandra met any diagnostic criteria.
Cassandra arrived with her mother for her first appointment at the clinic, neatly dressed and well groomed. Her mother appeared stern and eager as she began describing her concerns regarding her daughter. Cassandra symptoms had caused her to miss enough school to impact on her academic performance, and her parents were beginning to worry that this may have a longer affect on her academic future.
Throughout the interview, Cassandra remained quiet and reserved, allowing her mother to do much of the talking. When the therapist tried to directly engage Cassandra, she appeared timid and nervous and seemed to struggle to find responses to the therapist’s questions. Often, Cassandra mother would become impatient and interrupt, which caused Cassandra to further withdraw.
It was understood by Cassandra mother that her medical tests had turned up negative In regards to her reported physical symptoms.
Cassandra mother expressed that she was frustrated that their family doctor had found nothing, and hat she suspected Cassandra was faking her symptoms to gain attention and rebel against her parents. Cassandra seemed upset by her mother’s accusation, but did not make an attempt to protest. Cassandra mother pointed out that she was wasting valuable vacation days to accommodate Cassandra, and that she felt irritated at what she perceived was Cassandra acting out. When it came time to see the Child Psychologist, Cassandra mother was instructed to wait in the waiting room.
Cassandra seemed apprehensive about the separation, but did not appear too concerned.
The interview session began with Cassandra interpretation of her symptoms. Cassandra explained that for as long as she could remember, she would get mild stomach cramps in the morning, before going to cocoons. However, ten cramps would eventually sudden Dye ten time seen arrived in class. Nonetheless, there were times where the stomach pains would get so intense, to the point where she felt too ill to leave the house.
Although these episodes did not occur too frequently, Cassandra felt bothered by them because they would cause her to stay home from school.
At the start of the school year, Cassandra recalled an incident in class where she suddenly felt very dizzy and lightheaded like he was going to pass out. An intense nausea washed over Cassandra, and she was terrified that she would be sick in front of her classmates. However, when she got up to run to the bathroom she momentarily blacked out and fell to the floor. Cassandra remembers feeling like she couldn’t breathe and that her heart pounded so hard she thought she was going to die.
A few moments later, Cassandra vision returned and the nausea passed. Cassandra was taken to the school nurse, where she waited for her mother to pick her up.
Although she was shaken, by the time Cassandra mother arrived at the school Cassandra felt okay again. Cassandra saw the doctor the following day, but they could not find a reason or cause for her illness. This incident profoundly frightened Cassandra, and she admits that she is very worried it will occur again. In order to avoid another incident, Cassandra has become hyperventilating in regards to noticing how she is feeling.
Cassandra makes certain to remain at home if she feels there is any chance that she may feel ill that day. When she does go to school, Cassandra insists on sitting near an exit or a door in case an incident were to occur again.
Cassandra has also refused to go out to family outings on the weekends cause she is afraid that she might have an episode and be unable to escape. Although staying at home makes Cassandra feel somewhat safe, Cassandra is deeply concerned about her absence from school and is feeling immense pressure to catch up on her studies.
Cassandra also expresses concern about her mother who is becoming increasingly agitated by her behavior, and the added tension of the relationship is making Cassandra symptoms worse. Social History Cassandra lives at home with her biological parents and younger sister who is currently 10 years old. Cassandra father is the owner of a small restaurant and her other works as a receptionist for a small office. Cassandra parents immigrated from Taiwan in the early sass’s and both Cassandra and her younger sister were born in Canada.
When asked to describe her relationship with her father, Cassandra characterized it as a close one, despite the fact that she does not get to see him often because of his long and erratic schedule. Cassandra gets along well with her father, and enjoys spending time with him as much as she can because she finds him easier to talk to than her mother. Cassandra describes her mother as very strict and hard to please. As a result, Cassandra and her younger sister try to fulfill their mother’s expectations in order to avoid displeasing her.
However, Cassandra states that even when they do as teeny are told, tenet mother still seems Alleles Walt n teem.
Cassandra also explained that her mother has a habit of drinking 3-4 glasses of wine each night, starting from when she got home from work. Although her mother would not get drunk, Cassandra explained that she would often become unpredictable – sometimes seemingly to be in a very good mood, other times becoming excessively irritable, to he point of even getting violent towards the children. Both Cassandra and her sister are frightened by their mother’s behavior, which often causes quite a bit of distress and uncertainty.
Cassandra reveals that her mother often uses physical means as punishment, particularly towards her younger sister. Cassandra also reveals that sometimes her mother will use threats to scare the children and that they do not always know what they are being punished for. Cassandra feels guilty when she is forced to watch her sister being punished, and she admits that she is often fearful for her sister’s and ere own safety.
Cassandra also describes significant marital troubles between her parents. She explains that they often fight about money and that their relationship is severely strained.
Cassandra admits that she finds the arguments between her parents extremely disturbing as they often occur in front of herself and her sister, and have sometimes escalated to such extremes that authorities were called. Cassandra recalls one night when the police were called in because her father physically threatened her mother. Her father was arrested by the police officer and was absent from home for a few days. Cassandra reveals that during the time she felt helpless and frightened that her father may go to Jail, but that she concealed her anxiety because she feared that showing it would make her younger sister afraid as well.
Cassandra acknowledged that she was very protective of her younger sister, and felt that she had a responsibility to take care of her. As a child, Cassandra remembers being very shy and reserved. Nevertheless, she remembers being reasonably well liked by her peers and teachers, and has never recalled having troubles getting along with her classmates. By elementary school, Cassandra had a few best friends and was doing very well academically. Cassandra admits that the transition from elementary school to high school was difficult for her because she had to move to a new school where she did not know anyone else.
However, Cassandra was able to make the adjustment and was able to quickly form attachments with her new classmates. Academically, Cassandra was accepted into the Incentive Program at her high school where she received exceptional grades for her Grade 8 and 9 year. Cassandra attests that although she enjoys school, she feels somewhat of a pressure to maintain her good grades. She reveals that she feels insecure and often compares herself against her high performing classmates and she worries that she may not be able to continue performing at the level that she is currently at.
She admits that her main motivation to do well in school is to please her parents, particularly her mother.
Cassandra explains that her parents place heavy emphasis on school and how she should be a good role model for her younger sister. Cassandra takes tons responsibility very seriously Ana NAS a somewhat perfectionist attitude towards her role as an older sister. Diagnosis Cassandra appears to suffer from the affects of anxiety triggered by parental behaviors, conflicts and her general environment. She displays characteristics such as excessive worrying, rigid and high, self-imposed standards.
Given her persistent worry, somatic symptoms, and change in behavior, the child psychologist diagnosed Cassandra primarily with Panic Disorder with Agoraphobia.
According to the current version of the Diagnostic Statistical Manual of Mental Disorders criteria for panic disorder requires that the individual experience both “recurrent, unexpected panic attacks” (American Psychiatric Association, 2000) allowed by at least 1 month in which there is persistent worry or concern regarding the possibility of another attack, or “significant change in behavior related to the attacks” (American Psychiatric Association, 2000).
Although Cassandra has only presented with one major panic attack, the ADSM-IV-TRY does not require a minimum number of attacks to meet diagnosis. The ADSM-IV-TRY defines a panic attack as “a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: Palpitations, pounding heart, or accelerated heart rate
Sweating Trembling or shaking Sensations of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded, or faint Deterioration (feeling of unreality) or diversification (being detached from oneself) Fear of losing control or going crazy Fear of dying Parenthesis (numbness or tingling sensations) Chills or hot flushes (American Psychiatric Association, 2000). ” Cassandra change in behavior following her panic attack, meets the criteria for Agoraphobia.
Her persistent fear of experiencing another episode led her to be apprehensive and avoiding of public places in which escape might be difficult.
The ADSM-IV-TRY defines Agoraphobia as an exaggerated fear “about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected… Panic Attack or panic- Like symptoms” (American Psychoanalyst Association, 2000). As a result, ten Uninominal avoids such situations or endures them with great distress. Anxiety disorders have an overall prevalence of 5.
7 – 10. 8% in adolescence (Powers & Western, 2011), while
Panic disorder is estimated to affect approximately 1-5% of adolescents (Allendale, Mat’s & King, 1994) and is regarded as one of the most debilitating anxiety disorders given the severity of functional impairment (Gallo, et al. , 2012). The average age of onset is later, with greater variability in age range than other anxiety disorders at around the ages of 16-26 (Kessler et al. , 2005). Panic disorder is also highly combine, with up to 90% of sufferers diagnosed with another psychiatric disorder (Droller et al.
, 2007). Etiology Cassandra condition has become severe enough to cause significant impairment n her daily activities.
Due to the high number of risk factors in her environment, Cassandra condition is likely to worsen without immediate intervention. Cassandra possesses individual risk factors as well as situational risk factors. Cassandra environment contains many factors that may contribute to her condition. Her family shows traits of dysfunction with evidence of inter-parental hostility as well as harsh discipline and possible abuse.
Family dysfunction is shown to increase levels of child anxiety (Drake & Carney, 2008), as does authoritarian parenting and controlling parental behavior (Design, Lamas & Fox, 2010).
Meanwhile, inter-parental hostility and parental harshness increases adolescent internalizing problems (Bubbler et al. , 2006). Individual risk factors include a likely behavioral inhibition tendency as well as high neurotics. Behavioral inhibition is a temperamental style seen in early childhood that is characterized by the tendency to be cautious and withdrawn in social situations, as well as possessing a high negative reactivity to unfamiliar or novel situations (Design, Lamas & Fox, 2010). It is estimated that approximately 15% of developing children display this temperament (Fox et al.
005) and studies suggest that behavioral inhibition may be a possible risk factor, placing children at risk for developing anxiety disorders and internalizing problems later in life (Design, Lamas & Fox, 2010). Neurotics is also shown to be directly related to behavioral inhibition as well as anxiety (Linden, Breeze & Murmurs, 2012), and can be defined as a vulnerable sensitivity to negative stimuli (Grilling et al. , 2005). The vulnerability/resilience model assumes that temperamental traits either protect or creates a susceptibility towards certain types of psychopathology.
Under his model, behavioral inhibition would be considered a risk factor only under certain environmental characteristics that may lead to disorder such as anxiety (Nigh, 2006). In essence, behavioral inhibition and high neurotics can be see as the beginning of a vulnerable pathway .
The behavioral conditioning model would interpret Cassandra avoiding behavior, as a fear response learned through an association of previously neutral stimuli with a painful, frightening event. Cassandra first panic attack traumatized her enough to alter near Detonator to Aviva any salutation In wanly ten event may occur again.
I Nils avoidance, which momentarily reduces anxiety, only serves to reinforce the fear associated with the neutral stimuli. However, this model does not adequately explain the original onset of fear which triggered her first panic attack. On the other hand, cognitive perspective approaches emphasize the interpretation of information by the individual suffering from anxiety.
Many who suffer from anxiety symptoms, view the world in a distorted manner where the bias is always towards themselves.
This negative interpretation of events will eventually form a habit of persistent thoughts and feelings that revolve around threat and insecurity. A cognitive theory of panic disorder argues that catastrophic misinterpretations of bodily sensations are the cause and maintenance of the disorder (Clark et al. , 1997). When someone who suffers from panic attacks focus their attention towards their bodily sensations, they become hyper vigilant and may easily misinterpret anything as a sign of a symptom taking place.
Thus, they anticipate another attack, causing their bodies to react to the anxiety, creating a never-ending feedback loop.
Treatment We cannot treat Cassandra anxiety without first addressing the obvious problems occurring in her immediate environment. Cassandra mother was separately interviewed regarding her alcohol usage and marital troubles. During the interview, Cassandra mother seemed reluctant to admit that her drinking was a problem, despite admitting that she depended on alcohol to help her sleep at night.
Cassandra mother most likely suffers from her own psychopathology problems that need separate diagnosis and treatment. Marital counseling between the two parents was also advised as well as general family counseling.
Due to the fact that the mother is the primary caretaker for the children, it is imperative that she adopts roper coping mechanisms during stressful times, in order to minimize the distress imposed on the children. As for Cassandra, the child psychologist suggests a combined treatment of Cognitive Behavioral Therapy in conjunction with medication to help control the panic and somatic symptoms.
This combination of CB therapy with pharmacological therapy has proven to be one of the most effective forms of intervention for treating patients diagnosed with panic disorder (Barlow et al. , 2000). In addition, Cassandra may benefit from participating in other therapeutic techniques like Psychodrama, which uses group role-playing techniques to practice real-life situations through reenactment, allowing an opportunity to evaluate thoughts and behaviors (Soakings & Dock, 2013).
Psychodrama relies heavily on spontaneity which is an important skill that can allow the rediscovery of new solutions to old problems, reducing anxiety by building confidence from within.
For now, Cassandra parents seem willing to try the individual and marital/family tentacles Tanat nave Eden set up Tort teem. We nope Tanat Turner coeducation regarding Cassandra condition will allow more understanding for the parents regarding their ole in Cassandra recovery. Priority for treatment will be placed on Cassandra and her mother, who both exhibit low levels of functioning in comparison to the other family members.
Cassandra is highly motivated to engage in treatment in order to learn coping mechanisms to deal with her panic attacks. Cassandra mother still seems reluctant, but has agreed to give therapy a try. At this point, protective factors for Cassandra lie in her close relationship with her father, as well as her connections with her friends at school.
Combined, they offer good support for Cassandra as she works on her anxiety. If Cassandra mother stays in therapy and reduces her drinking and impulsive behavior, it will serve to protect Cassandra progress as well as protect the mental health of her younger sister.