Case Study: Jeremy Christian Counseling

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JEREMY

CHRISTIAN COUNSELING

What is the client's most prominent presenting issues (that is, what seems to take priority as being wrong)?

As a child under the age of 18 exhibiting a persistent pattern of antisocial behavior, Jeremy would likely be diagnosed with a conduct disorder. According to the DSM, this is a "repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated" (Summary of DSM-IV diagnostic criteria, 2013, Intermountain Healthcare). Fighting, aggression, minor criminal behavior, theft, substance abuse, and truancy are all common signs of this disorder. Although a certain amount of 'acting out' is normal in adolescence, conduct disorder may be diagnosed if the behaviors are deemed to significantly interfere with normal family, school and work relationships.

Q2. What else do you feel you need to know (or, what might be some areas you may ask about in order to determine what is going on and how severe the problem may be)?

A diagnosis should not be given hastily. For many adolescents, Jeremy's age is the in which serious disorders such as bipolar disorder or schizophrenia manifest themselves. Bipolar disorder manifests in sharp shifts in mood between mania and depression. During manic episodes, sufferers may become aggressive and act out in some of the ways in which Jeremy has been doing, such as engaging in substance abuse and showing uncharacteristic anger. This is alternated with periods of withdrawal, a lack of energy and depression (which could account for Jeremy's moodiness and apathetic presentation when examined). It needs to be ascertained if Jeremy's change in behavior is consistent or manifests the typical highs and lows of bipolarity. Also, schizophrenia (which is characterized by delusions, hallucinations, and disordered thinking) may also present itself to the outside world with the type of 'lashing out' that Jeremy is exhibiting, given the internal struggles experienced by the patient.

Q3. What do you think may be your initial diagnosis based on the information given in the case study? Why?

Although a number of alternative possibilities are suggested, given the setup of the case study, conduct disorder seems to be the most plausible diagnosis. Jeremy does not seem to have the overzealous self-confidence which tends to be characteristic of manic periods of bipolarity, nor is his depression and apathy extreme and in distinct contrast with his misbehavior. There is no direct evidence of delusional thinking. "Significant acting out frequently occurs among children and adolescents with major depression and dysthymic disorder. Patients with early-onset bipolar disorder may exhibit impulsive violations of rules and aggression. However, mood disorders typically include disturbances of sleep and appetite and pronounced affective symptoms, as well as significant alterations in energy and activity levels not found among children with conduct disorder" (Searight,… [END OF PREVIEW]

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