diagnostic formulation due 10hrs


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Jessica E. Smith has received psychological evaluation at different times in her life. This has been as a result of various episodes in her life that have highlighted some mental issues she was undergoing. During the psychological evaluation by Bart Jackson of the Division of Vocational Rehabilitation, a number of notable events in her life contributed to some of the most profound mental issues. Physical and emotional abuse from her mother is an important part of her life. The death of her younger sister, who she had help raise, also proves to be difficult for her to deal with. There are also incidences of abusive relationships that she describes have cause her to engage in drug abuse, and seek isolation from people. 

This work provides a primary and secondary diagnosis for Smith, and discusses at a possible alternate diagnosis for primary and secondary diagnoses. It also provides the rationale and justification for the choice of diagnosis.

Primary Diagnosis

The primary diagnosis for Jessica Smith is Dysthymia (Persistent Depressive Disorder). The current DSM code for Persistent Depressive Disorder is 300.4(F34.1) (American Psychiatric Association, 2013). Patients suffering from this disorder have the symptoms of having a depressed mood for most of the day, for most days, and for at least two years. When compared with the closely related major depressive disorder, individuals with persistent depressive disorder have a higher risk for psychiatric comorbidity, anxiety disorder, and substance use disorder.

Since her teenage years, Smith explains that she had to deal with physical and emotional abuse from her mother. She also explains that her father was unsupportive of the family. Her mother used to take out her frustrations on her. From the evaluation by Bark Jackson, Smith’s childhood is seen as the onset of her issues. This is the time she started using alcohol and cutting herself with a straight-edged razor. At such an age, she had to live with a difficult upbringing that included taking care of her younger sisters. One of her sisters would finally pass away, which further pushed her into substance abuse and self-harm. Although she considered school as a safe place, it was not a permanent option.

The decision to make Dysthymia as the primary diagnosis is based on the fact that Smith is subjected to a depressed mood for most of the day, and for most days. She is recurrently abused by her mother, and neglected by her father at a tender age. In children and adolescents, such a depressed mood has to be observed for at least 2 years. She also demonstrates low self-esteem, poor concentration at school, and feelings of hopelessness that causes her to try to commit suicide. This is the primary diagnosis because it appears to the instigator of all other mental issues that Smith has had to deal with.

Possible Alternate Primary Diagnosis

The most probable alternate diagnosis is Major Depressive Disorder DSM Code 296.32(F33.1) (American Psychiatric Association, 2013). Like in patient cases of Persistent Depressive Disorder, Major Depressive Disorder is typified by a depressed mood, and a loss in interest in day to day activities. These symptoms are evident in Smith. Other symptoms that indicate Major Depressive Disorder include; depressed mood for most of the day, nearly every day, feeling of worthlessness, diminished ability to concentrate, and recurrent thoughts of death. Smith has exhibited all these symptoms, and therefore this could have been a possible alternate diagnosis.

However, this was not the selected as the primary diagnosis because it is mostly applicable where there a notable change in previous functioning. It is depression that results from a major occurrence in an individual’s life that causes a major shift in their functioning. When compared to Persistent Depressive Disorder, it represents a temporary incident that has no recurrent contributors. The case of Smith is different; she continually undergoes abuse and her depressive state lasts for years. This means that the continued state of depression conveyed by the Persistent Depressive Disorder is the more accurate diagnosis for Smith.

Secondary Diagnosis

Smith’s secondary diagnosis is Alcohol Use Disorder. This diagnosis is made based on the evaluation made on Smith. For an individual to be diagnosed with this disorder, there have to a number of problematic patterns of alcohol use over a period of twelve months. Alcohol has to be often taken in large amounts than was intended, unsuccessful efforts to cut down on alcohol use, recurrent alcohol use, and recurrent social and interpersonal problems. Specifying the severity of alcohol abuse helps to identify the DSM Code. In this case, Smith can be categorized as a severe case. The DSM Code is hence 303.90 (F10.20) (American Psychiatric Association, 2013).

Now at 41, Smith has been using alcohol for most of her life, and at different occasions. It started when her mother took out her frustrations on her. Like her father, Smith started using alcohol to numb her feelings. In occasions such as breakups, she would resort to using alcohol and isolate herself. She has also tried to stop using alcohol in different instances and failed. Smith explained to Jackson that she had entered different programs trying to remain sober, but this has proved difficult. In fact, she has been arrested three times for driving under the influence while still trying to remain sober. She exhibits more than six symptoms that constitute a severe case of Alcohol Use Disorder.

The decision to make Alcohol Use Abuse the secondary diagnosis is based on the fact that it has been a constant issue for the majority of Smith’s life. She has been using alcohol since she was in high. She has also unsuccessfully tried to cut down and give up the use of alcohol at different stages in her life. Developing an intervention to treat this disorder would significantly assist the patient to overcome her current state.

Possible Alternate Secondary Diagnosis

Another possible secondary diagnosis for Smith would be Other Hallucinogen Use Disorder. The use of hallucinogens impairs and distress the patients in various ways. By the age of eighteen, Smith had begun to rely on crystal meth to regulate her mood. This is a strong and addictive hallucinogen. She did not follow up on a friend’s recommendation to seek outpatient counseling services. Recurrent hallucinogen use is one of the symptoms of Other Hallucinogen Use Disorder. Smith continually used crystal meth for many years before seeking psychological help. The DSM Code for this disorder is 304.50 (F16.20) (American Psychiatric Association, 2013). 

Although Smith uses hallucinogens to moderate her mood, this is not the most used substance. The selected secondary diagnosis was Alcohol Use Disorder because it was the maid substance used by the patient. During the evaluation by Jackson, Smith demonstrated the recurrent use of alcohol from a tender age all through to adulthood. However, the use of crystal meth is only mentioned once, and details are not as detailed as when compared to the use of alcohol. Smith offers information about how alcohol was a go-to substance during many of her problems such as family and relationship issues.

Diagnosis from other Conditions

In many cases, psychologist focus on specific issues that affect a patient. This is because many mental issues arise due to that causes a major shift in the functioning of an individual. However, Smith’s case is detailed and includes many years of mental health issues. From an early age, she begun to develop depression issues that have further worsened her mental health. There is evidence that she suffers from anxiety, trauma, and impulse control disorders. However, these have not been highlighted because they have been viewed as secondary issues. For instance, when Smith breaks up with a partner, she explained that she easily got depressed and engaged in substance abuse.

A diagnosis from other conditions that may require clinical attention is necessary because of the expansive nature of the Diagnostic and Statistical Manual of Mental Disorders. It means that there are conditions with largely similar symptoms. In this specific case, Jessica Smith has developed a habit of substance use that can be attributed to a non-conducive home environment. The DSM can be used to diagnose disorders that may have resulted from the home environment, and it can also be used to diagnose the symptoms that are evident in Smith’s lifestyle. This duality means that diagnosis from other related conditions that may require clinical attention (Boysen, 2014).


American Psychiatric  Association. (2013). Diagnostic and  Statistical Manual of Mental 

Disorders (5th ed.).  Arlington: American Psychiatric Publishing.

Boysen, G. A. (2014).  Expansion of the Concept of Mental Disorder in the DSM-5. The Journal 

of Mind and Behavior, 35(4),  225-243.