The case study for week six involves a male client who seems to exhibit characteristics of a possible substance-related disorder. However, a definite diagnosis cannot be concluded since the case study presented a lack of information. Furthermore, characteristics indicative of an addiction, possibly a behavioral addiction, seems to be present.
Possible Substance-Related and Addictive Disorders
According to the Diagnostic and Statistical Manual, (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), individuals may be diagnosed with a specific disorder, with intoxication, or withdrawal. Based on the short conversation in the case study, it is possible to diagnose the male client with any of the disorders under this section of the DSM-5.
/> It is important to collect more information on the behavioral patterns of the client. The therapist can focus on his strong objection when he said “Yuck! I hate booze. I don't do drugs, either. I say no every day.” This was likely his way of diverting the conversation. The therapist can further probe about why he “hates booze” as well as what he “says no to every day.” A wealth of information can be uncovered by talking more about different substances.
It would also be very helpful for the therapist to talk to other family members without the client present. This way, the therapist can learn more about the behavioral patterns of the client aside from listening to music and being on the computer and his mobile phone all the time.
A Mental Status Exam (Martin, 1990) would also help in collecting information especially on his appearance and mood. Talking about possible past experiences with substances will also be beneficial.
Possible Behavioral Addiction
Behavioral addictions refer to behavioral patterns and groups of repetitive behaviors which occur in excess (APA, 2013). These excessive and repetitive behaviors activate the rewards system of the individual, causing the individual to display symptoms and experience consequences similar to that of a substance-related addiction (Alavi, Ferdosi, Jannatifard, Eslami, Alaghemandan, Setare, 2012).
The client seems to be exhibiting symptoms to those of an Internet Gaming Disorder (APA, 2013). Although internet gaming disorder is not an official diagnosis since research on it is still lacking, the DSM-5 (APA, 2013) does offer a proposed criteria for this disorder. The client may possibly have a preoccupation with games (Criteria 1; DSM-5; APA, 2013) as he is constantly on his computer and his mobile phone. However, it was not mentioned if he was actually gaming, which can be further looked into. He spends an increased amount of time engaging with his computer (Criteria 3; DSM-5; APA, 2013) to the point that he does not have time to eat. His interest in zombies and in angry music also shows that he may be escaping a negative mood (Criteria 8; DSM-5; APA, 2013). The therapist asked him about times he may have been angry or depressed and he simply stated “because I’m stupid.” Further probing into this statement can again give useful information for diagnosis.
Similar to the diagnosis of a substance-related addiction, more information needs to be gathered. The therapist can talk about the client’s fascination with zombies. She can also find out what exactly it is he does on his computer, what about that activity makes him spend hours doing so, and how he feels when he is not engaged in that activity. It would also be beneficial to explore how such activity has affected his relationship and responsibilities.
Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., &Setare, M. (2012).
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(5th ed.). Washington, DC: American Psychiatric Association.
Grant, J. E., Potenza, M. N., Weinstein, A., &Gorelick, D. A. (2010). Introduction to Behavioral
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Martin D.C. (1990).The mental status examination. In: H. K. Walker,W.D. Hall,& J. W. Hurst
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