Unit 3: Diagnostic Approaches
COUN-5107- Principles of
Psychopathology and Diagnosis.
Dr. Mary Thomas
Unit 3 Diagnostic Approaches
In reading the Vingette, the assumption that mental
states, behaviors, emotions happen from
brain function and other physical processes is a biological model. As humans we
are constantky learning from one another, we are people who feel, think, and
behave our thoughts and feelings function through us its just an everyday life
something we learn and adapt. There are
normal behaviors and abnormal behaviors.
Once an individual crosses the line of abnormality we find out what
caused it and why its considered abnormal. If it affects your daily living it
becomes abnormal. To date, however, no biological test is available to diagnose
any of the types of abnormality. (Nolen-Hoeksema, S. 2017).
Suzie whom is only 13 years of age the youngest in
her family of four siblings, struggles with fear and anxiety, which may stem
back from the time she was in the hospital for an illness finding herself alone
may remind her of the feelinsg she had while in the hospital. Behaviors and
feelings that cause distress to the individual or to others around him or her
are also likely to be considered abnormal. According to our text The biological
theories have viewed abnormal behavior as similar to physical diseases, caused
by the breakdown of systems in the body. The appropriate cure is the
restoration of bodily health. (Nolen-Hoeksema, S. 2017). The psychological theories
have viewed abnormal behavior as a result of traumas, such as bereavement, or
of chronic stress. According to these theories, rest, relaxation, a change of
environment, and certain herbal medicines are sometimes helpful. The author
will conduct a cultural sensitive assessment using the parents, cross cutting
symptom measure and Family Enviornment Scale to help assist in assessing the
family as a whole. The DSM-5 and ICD will be utilized as well as looking over
the Z and V codes for the family.
Part 1: Examining Models of Psychopathology
With Suzie being an Asian American girl, she was
raised with her cultural background knowing who she is, being she often visits
India with her family. She dominates and prefers the English language, with
suzie struggling with anxiety in school due to high pressures during the exams
and perfection, I believe this stems from her cultural back ground and how she
was raised to excel in what she does, education seems to be very important in
her family being both her parents are teachers. Both are college graduates.
Being the youngest can have its negative effets living up to the other older
siblings who all went away to either school or a career.
Biologically what happened to Susie as a child with
her health has stood with her hence the fears and anxiety she has. We can link
the heart racing and trembling with difficulty breathing can all be a part of
panic attacks and, shes 13 years old, a growing adolescent. Depending on the
relationships with her parents and how they deal with things it can even be a
genetic factor. Is this something that could have been inherited by the
parents? Any biological change can influence what she is feeling and how she is
feeling about herself. With low self
esteem or feelings of not being able to relate to others can lead to anxiety
and depression in certain situations. Seratonin is something our brain produces
and in many cases when we don’t have enough it messes with us psychologically,
Seratonin transmits to different parts of the brain. Serotonin helps with
emotional wellness, when we don’t have enough Dr’s link it to Depressive
disorders. (Nolen-Hoeksema, S. 2017).
To view psychological abnormality we have to see the
family and its function as a unit. Taking
a more cognitive approach to see if perhaps their beliefs and reactions of how
they view Suzie, do they see her as weak, we can see this through interaction
between siblings and parents. Because Suzie remembers being in the hospital her
family may have built a wall around her being seen as the youngest the weakest,
an dprotecting her from that ever happening again. Suzie has a lot of pressure
following her successful siblings. Suzie now feels the need for her parents and
siblings, when she cant sleep at night alone, perhaps she thinks of the past
when she is alone and all expectations required. Conducting a genogram can be
helpful in this situation in seeing who else perhaps have battled with any of
these symptoms, Constructing the genogram often generates a much greater sense
of urgency and willingness to take action, “Constructing the genogram often
generates a much greater sense of urgency and willingness to take action
compared to relying strictly on process questions and a discussion of the
dynamics.” (Gehart, D., 2016).
It would be beneficial for the therapist to work with
the whole family, the therapist will help coach the family to see Suzies
nehavior when it comes to Sociocultural environment in using the
parent-guardian- rated DSM-5 Level 1 Cross Cutting Symptom Measure as well as
utilizing the Family Enviornment Scale. Using these tools will help in
collaborating the environmental needs in this model.
The Sociocultural approach defines us as
individuals. Cultural factors like
language, social norms, and social cultures can have an impact in our lives and
cognitive abilities. What causes a person to behave a specific way? Instead on
just relying on biological factors alone, the approach brings a better
conclusion or picture to the forfront.
The sociocultural approach look at how a persons experiences, influences
and culture shape why they do what they do. (Sue & Sue, 2016). Any stress
can come from the home or outside the home, knowing she is of two descents can
be a factor, when she travels she doesn’t seem to speak the language much so
she may feel as if shes not a part of her own culture because she cant relate
fully, and when shes in the United States, she feels she cant fully relate as
wel because her family has imbeeded the culture in her, its how she is raised.
What is her role? At this point it would be vital for her to know.
Part 2: Assessment Instruments to Aid in Diagnosis
Collaboration is so important to
therapy sessions, in administering the Parent/Guardian- rated DSM-5 Level 1
Cross Cutting Symptom Measure for Suzie being shes 13, this assessment has 25
questions, the assessment will basically assess 12 psychiatric areas to include
anxiety, depression, mania, sleep disturbance, and irritability. The parents
can then see their childs behavior over a two wee time frame. The parents get to look at the childs
behavior and become more intune and observant, now that the parents have the
information they turn it into the therapist and the therapist can work forward
from there. Depending on how the parents
view the depression at a level 1 or level 2, then the therapist can follow up wthi
the Cross-Cutting symptom measure. This will allow the parents and siblings to
see progress. (Sue & Sue, 2016)
best to collaborate both assessents The Cross Symptom Measure and the Family
Enviornment Scale which is a 90 question true or false self reporting
assessment. The assessment will help measure the family environment. There are three forms of the FES, The real
form (Form R) measures preferences for an ideal family environment, and the
Expecation form (Form E) measures expectations about a family environment
(E.G., prospective foster parents expectations). (Whinston, 2017). Examining the differences of
the results from the Real Form and those of the Ideal Form, sometimes will have
amazing similarities between the family members amongst themselves on results
from the Ideal Form, which can be an effective intervention for unifying the
direction for the counseling. (Whinston, 2017)
family interview is the most frequent assessment used assessment, while
interviewing the counselor should observe the family to note any factors like
family structure, compostion, family process, any relationship patterns. Using
the genogram can help significantly in this area. Assisting the family in
avoiding destructive patterns is vital to laying out a genogram. The instrument
yields a snapshot of the major dimensions that differentiate family
enviornments. In behavioral health settings, the instrument is used to diagnose
problems or to identify risks in family functiooing to promote and monitor
change in families, and to understand how famileis adapt to life transitions
and crisis. The FES provides a non threatening way to identify specific
behaviors that support or erode family function. (Teufel-Shone, N., Staten, L.
K., Irwin, S., Rawiel, U., & al, e. (2005).
Part 3: Systemic Perspectives for Diagnosis
using the Z and V codes it can provide some more information in regards to
diagnosis. The DSM-5 does not approve of
diagnosis codes when trying to form a diagnosis on Suzie. More so the codes are
used to help in the scenario given. The DSM and ICD don’t consider V or Z codes
as mental disorders. The codes can be
documented to help perhaps another clinician. Z codes are used for the reason
of the encounter instead of the V codes,
a corresponding procedure must accompany a Z code if a procedure is
performed. Z codes can be used in any healthcare setting it can beused as a
first or secondary code. Z codes aren’t procedure codes. ICD
coding for reimbursement is a vital part of health care operations. Health care
facilities use ICD codes for workload and length-of-stay tracking as well as to
assess quality of care. Medical and health services researchers commonly
use ICD codes as inclusion and exclusion criteria to define sampling frames, to
document the comorbidities of patients, report the incidence of complications,
track utilization rates, and determine the case fatality and morbidity
must always remain culturally sensitive with those we work with, not trying to
understand the culture in its entierity but seeing the individual and trying to
understand whats going on in the family circle. Getting it from a dysfunctional
standpoint to functional. Diagnostic
approaches such as biological, psychological, and sociocultural are ways an
individual functions outside and inside the family circle. The Parent/Guardian
cross-cutting symptom measure can help the therapist determine how to work
further with the client. Utilizing the
FES, Family Environmental Scale, it will help the therapist in the areas that
aren’t similar to the cross cultural method.
These two compelemnt each other, an example of DSM-5 codes and ICD codes
would be , the diagnostic codes for Separation Anxiety Disorder “309.21
(F93.0)” (First, Michael B (08/01/2015).
anyone with issues relating to the family, the use of DSM and ICD provide
different codes that can be utilized alittle more specific to the needs of the
client and the family. DSM and ICD go hand in hand with billing as well its
important to go over the codes. Both the DSM and ICD do not go over the codes
for Z and V as mental disorders, but it is used more for documentation
purposes. Its vital that documentation
is present at all times.
Nolen-Hoeksema, S. (2007). Abnormal psychology. Boston:
American Association for Marriage
and Family Therapy. (n.d.). AAMFT code of ethics.
Whiston, S. C. (2000). Principles
and applications of assessment in counseling. Australia: Brooks/Cole.
Teufel-Shone, N., Staten, L. K.,
Irwin, S., Rawiel, U., & al, e. (2005). Family cohesion and conflict in an
american indian community. American Journal of Health Behavior, 29(5), 413-22.
O’Malley, K. J., Cook, K. F.,
Price, M. D., Wildes, K. R., Hurdle, J. F., & Ashton, C. M. (2005).
Measuring Diagnoses: ICD Code
Accuracy. Health Services Research, 40(5 Pt 2), 1620–1639.
First, Michael B (08/01/2015).
“What you need to know about DSM-5 and ICD-10-CM (Hint: there are no DSM
codes)”. The Psychiatric times (0893-2905), 32 (8), p. 4.
Sue, D.W., & Sue, D. (2016).
Counseling the culturally diverse. Hoboken, NJ: Wiley & Sons.
Gehart, D. (2016). Theory and
treatment planning in family therapy: a competency-based approach. Boston, MA:
Bitter, J.R. (2014). Theory and
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