Psychological Disorder Analysis
Rosemary Scheel Creeden
PSY/270
Heather Hensell
July 21, 2012

Today I had a session with a woman named Marla, who is a 42-year-old Hispanic female. She came to my mental health clinic complaining of having trouble sleeping, feeling “jumpy all of the time,” and experiencing an inability to concentrate. These symptoms are causing problems for her at work, where she is an accountant. When I first met Marla I did a patient intake and asked her some questions about her life. I did this in hopes of gaining a better understanding of the root of Marla’s difficulties, what she might be suffering from, and how I could better help her. “Since ancient times, people have tried to explain, treat, and study abnormal behavior,” (Comer, 2011). My first question for Marla was why she decided to seek treatment. Marla told me that she had tried to wait and see if things would get better, but she was becoming very sleep deprived, and she was worried that she would get in trouble at work because of her fatigue and lack of concentration. I asked her how she thought therapy would help her or improve her symptoms. She said that she wasn’t quite sure but that maybe I could help her identify what was causing these symptoms so that she could find some relief. This led me to ask her how she described herself now compared to her current self. She told me that her ideal self was energetic, attentive, and not so edge. She aimed to excel at work and wanted to be content and happy with her life. However, the last couple of years her life had begun to go downhill. She didn’t seem to enjoy anything any more, she was always tired, and was doing worse at her job then she ever had. The fourth question I had for her was who her immediate family members were. She said she had one child, a daughter, who had left for college a year ago a couple of states away. They always had a close relationship, and although she was very proud of her daughter, it was hard not having her around. She was also married for the second time. She had divorced her daughter’s father when her daughter was a baby, and didn’t re-marry until five years ago. She told me her marriage was solid but that they had begun to drift apart due to her irritability and edginess caused by lack of sleep. Other than that she had no immediate family members. Her father and mother lived across the country and she had no siblings. I was curious about her childhood and whether or not she had any troubling experiences while growing up. Marla explained that her childhood was rather pleasant. She was the only child between her parents. Her parents tried for other children but were never successful. Her father worked long hours on the farm and wasn’t overly active in Marla’s upbringing, but supported the family well. Her mother was always there for her and they had a good relationship, but sometimes her mother would be very tired and spend days in her bedroom. She just thought her mother got sick a lot, especially since she sometimes saw her taking medication. I asked Marla how her current environment at home and work was, and the condition of her relationships. She told me that her home life had become tense and lonely. Her daughter was no longer around to keep her company, and her marriage had become strained. Her and her husband use to do everything together but now she never felt like going out or taking part in activities so he went alone. She was always at work because she was afraid of making a mistake and getting in trouble. Her career always had been important to her and she had worked at this business for 15 years. Since I knew that Marla had a job and that she normally found much contentment with it, I asked about the rest of her daily life. She said that she worked five days a week, and would come home, prepare dinner, and usually watch television or read a book. She used to walk her dog but now her husband took over the responsibility as an escape from the house. On weekends she catches up on cleaning and laundry. She looks forward to her weekly call from her daughter on Sundays. I knew that Marla had no close family members, so I inquired about any friends that she may have. Marla explained that she had a couple of close friends but didn’t contact them as much as she use to. One was a close male friend that she had stopped spending time with when she married her husband. Her husband was a bit jealous of their relationship and she decided not to cause friction. Marla’s other friend, Elizabeth, had worked with her for 10 years but accepted a different job across the state. Marla felt she had no one left to talk or spend time with. Marla had mentioned that her mother often slept a large amount of time and that she had seen her taking medication. I asked her about her family’s medical history. She told me that most of her family had been rather healthy. Her grandmother had died of a heart attack, but she was the only one that showed any heart problems. Her grandfather was in a nursing home in her parent’s area, but just needed assistance due to his old age. She never heard of her father complain of anything, and had gone only to the doctor for the occasional broken bone. Her mother had worried her from time to time and she had often asked about her possible ailments. Her mother would brush off her excessive sleeping and tell her that the medication was simply vitamins. My final question for Marla was if she currently, or had ever, taken any medications, drugs, or abused alcohol. Marla told me that she never abused anything because her first husband was an alcoholic and addict, which is what led to their divorce. She explained that the only medication she took was a multivitamin, medicine for heartburn, and the occasional aspirin for a headache. After meeting with Marla and discussing her life I am fairly certain that Marla is suffering from Dysthymic Disorder. She also shows signs of Post Traumatic Stress Disorder and Major Depression, and due to her experiences in the past I would have to talk with her further in order to make a solid diagnosis. However, in the mean time I am going to treat her for Dysthymic Disorder to help her with the negative symptoms she is experiencing. “People suffering from Dysthymic Disorder may describe to their doctor feelings of hopelessness, lowered self-esteem, poor concentration, indecisiveness, decreased motivation, sleeping too much or too little, or eating too much or too little,” (Encyclopedia of Mental Disorders, 2012). Females tend to be at a higher risk for this disorder than males and there is often a family background. From what Marla has disclosed so far it is very likely that her mother could have also suffered from this disorder. Although researchers have not found an exact cause for Dysthymia it seems to have a similar background as Depression. These similarities include a biochemical background, genes, and the person’s environment. “The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in causing Dysthymia,” (The Mayo Clinic, 2012). Other factors related regarding genes is a family history of depression. A person’s environment also can be highly influential, especially if they are coping with stress due to a loss of a loved one or financial issues. At the end of the session I made a few recommendations to Marla and suggested a plan of treatment. I feel it would be in Marla’s best interest to begin Psychotherapy, start medication, and incorporate some lifestyle changes. I feel that the combination of Psychotherapy and medication will serve Marla greatly, and deliver relief from her symptoms. “The best treatment approach for people with Dysthymia appears to be a combination approach-psychotherapy combined with an antidepressant medication,” (PsychCentral, 2012). I will start Marla on a low dose of Paxil. Paxil is an SSRI, selective serotonin reuptake inhibitor, which will help to restore the balance of natural chemicals in her brain. This type of medication can help to improve a person’s mood, assist with sleep problems, and help to increase faulty energy levels. SSRIs are also known to help with a person’s anxiety and irritability. I will also recommend that Marla come back and see me as soon as possible to begin a Psychotherapy treatment plan. I will suggest she become active in cognitive behavioral therapy as well as behavior oriented therapy. “Cognitive behavioral therapy will challenge her thinking, help her to be less critical of herself, and be more optimistic,” (McGraw-Hill, 2007). Behavioral therapy will also serve her greatly by teaching her better coping skills, and how to improve communication with her friends, family, and co-workers. As for lifestyle changes, I feel it is important for Marla to begin walking her dog nightly again. This will help her relieve stress and decrease her edginess. It will give her time to relax, think, and focus on herself. I feel strongly that this treatment plan will prove to be successful for Marla. She may never recover completely, but she will gain back control of her life. “Dysthymia is a particularly insidious disorder. Though some people recover completely, many continue to suffer for years or even their entire life,” (McGraw-Hill, 2007). I am pleased that Marla visited me and sought help. Many people continue to ignore symptoms that can have a negative and lasting impact on their lives. Marla took the first step by coming to my office, and now I will guide her throughout the rest of her journey to recovery.

References

Comer, R.J. (2011). Fundamentals of Abnormal Psychology. (6th Ed.).
New York, NY: Worth.

Encyclopedia of Mental Disorders. Dysthymic Disorder.
Retrieved July 21, 2012: http://www.minddisorders.com/Del-Fi/Dysthymic-disorder.htm/

The Mayo Clinic. (2012). Dysthymia.
Retrieved July 21, 2012: http://www.mayoclinic.com/health/dysthymia/DSO1111

McGraw-Hill. (2007). Faces of Abnormal Psychology.
Retrieved July 22, 2012: http://www.mhhe.com/socscience/psychology/faces/#

PsychCentral. Dysthymia Treatment.
Retrieved July 22, 2012. http://psychcentral.com/lib/2008/dysthmia-treatment/