Biopsychosocial #7
Utilizing the information learned from this week’s chapter and reviewing the case examples in the text for practice, review the case below to:
a) Identify the Biological, Psychological, and Social variables impacting the client
b) Assess for Competence
Students must complete this assignment using
two formats:
1) Submit the attached form/diagram which is similar to the examples used in the text. The diagram should be completed using applications from the case vignette listed below and provide a “snapshot” of your assessment. Examples from the chapter can be used for reference.
2) Submit written feedback using APA 7th edition format with the 3 variables (bio/psycho/social) and competence utilized as headers. This submission should include an expansion of the assessment diagram and provide support to the assessment given utilizing information from the text and any other empirically supported sources. Submissions for this assignment should include a title and reference page along with proper APA format which includes in-text citations, double space, 12 font, Time New Roman, etc. Excluding the title and reference page, your response should be approximately 1-2 pages in length.
Case Vignette
Jacob, at 9 years of age, was brought by his father to a mental health clinic as he had become increasingly difficult and disobedient at school. After several issues that occurred at school the previous month, the father knew he had to do something about his son’s behavior. After swearing at his teacher, Jacob was suspended from school for 2 days. The previous week, he was chastised by the police for riding his scooter in the street, something his father had repeatedly cautioned him about. The next day he failed to use the breaks and rode his bike into a store window where it shattered. He has not had any other serious offenses, but he had broken a window before when riding his bike with a friend.
Jacob has been a handful since pre-school with issues that have slowly escalated. Without close supervision, he gets into trouble. He has been reprimanded at school for teasing and kicking other children, tripping them, and calling them names. He is described as bad-tempered and irritable, even though at times he seems to enjoy school. Many times it seems like he is purposefully trying to annoy other children but claims others start the arguments. He does not become involved in serious fights but does occasionally exchange a few blows with another child.
Jacob sometimes refuses to do what his teachers tell him to do, and he especially has trouble with his afternoon classes. He argues when being told to do his work. Many of the same issues were experienced last year when he had only one teacher. Despite this, he has good grades and has been getting better over the course of the year, particularly in math and art which are classes taught by the teacher with whom he has the most difficulty.
At home, Jacob’s behavior is quite varied. On some days he is defiant and rude to his father needing to be told to do everything several times before he will do it; however, eventually, he complies. Other days, he is helpful and charming. His father says that his unhelpful days are more predominant. “The least little thing makes him mad which makes him scream and shout.” Jacob is described as spiteful and mean toward his younger sister, even when Jacob is in a good mood.
Jacob’s concentration is typically good, and he does not leave his work incomplete. His father states he seems to always be on the go but is not restless. His teachers have expressed concern over his attitude and not about being restless. His father also states that he tells many minor lies, although when pressed, he is truthful about important items.
Part 2
Diagnosis #7
Students should complete the Biopsychosocial FIRST. After completing, students should utilize the information learned from this week’s chapter and the case examples in the text to respond to the questions listed below. FYI – The biopsychosocial and diagnosis assignments use the
same
case/vignette. Review the case again as listed below to determine the diagnosis for the client utilizing the text, DSM-5, and other empirical support for reference.
Submissions for this assignment should include a title and reference page along with proper APA format which includes in-text citations, double space, 12 font, Time New Roman, etc. It is recommended that students use headers to delineate the various topics outlined below such as: Principal Diagnosis, Prevailing Pattern, Differential Assessment, etc.
1) What is the principal diagnosis or reason for the visit that you would assign to this client? What criteria does this client meet for the diagnosis? – Cite/support in APA format (minimum of 1-2 paragraphs) – 4 points
2) What is the Prevailing Pattern? How prevalent is this disorder? Are there any risk factors to consider such as age, gender, culture, ethnicity, socioeconomic status, etc. that would apply or be important to consider for this client? – Cite/support in APA format (minimum of 1-2 paragraphs) – 4 points
3) What is the Differential Assessment? How are you able to differentiate this disorder from another for this client? Are there any factors of comorbidity to consider? – Cite/support in APA format (minimum of 1-2 paragraphs) – 4 points
4) What is the Assessment Summary? Clearly identify why you feel this client meets the criteria? – Cite/support in APA format (minimum of 2-3 paragraphs) – 4 points
5) What is the DSM-5 diagnosis/F-Codes/ICD-11/Specifiers for this client? – 1 point
*Proper APA format – 3 points
Part Three1) After reading Chapter Ten in the textbook, review the case study on Jessica (found on pgs. 213-214)
2) Answer questions #6, #7, #11, #12, #13 (found on pg. 232)
Psychopathology: A Competency-Based
Assessment Model for Social Workers
Susan W. Gray
Chapter 13
Disruptive, Impulse-Control, and Conduct Disorders
…are distinguished by problems in emotional and
behavioral self-control and tend to have first onset in
childhood or adolescence
The diagnosis is unique in that the individual’s problems
are shown in behaviors that violate the rights of others
(for example, aggression or destruction of property)
and/or bring the person into conflict with societal norms
or authority figures
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Guidelines to Explore Cultural Influences
on the Symptom Picture
Assess lifestyle behaviors, expected standards or behavior, and everyday
activities relevant for cultural adaptation and survival
Comprehend meanings, labels, and interpretations commonly used to
describe a child’s behavior or emotional problems
Evaluate the cultural context of what, on the face of it, appears as illness
behaviors to determine whether they essentially support DSM diagnostic
criteria
Determine whether DSM diagnostic criteria are valid for the specific
population to be assessed
Consider the child’s and the parents’ (and significant others in the child’s life)
threshold of stress and how they cope with the child’s behavioral problems
Recognize how the client perceives the practitioner’s social position
Be self-aware and pay full attention (avoid stereotypes) to the client’s cultural
background
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Oppositional Defiant Disorder (ODD)
Characterized as an ongoing pattern of disobedient, hostile and defiant
behavior toward authority figures which goes beyond the bounds of
normal childhood behavior
Must show at least 4 symptoms from any of 3 categories;
➢ Angry/irritable mood – frequent loss of temper, touchy or easily
annoyed, or often angry and resentful
➢ Argumentative /defiant behavior – arguing with adults or other
authority figures, being noncompliant, annoying others, or blaming
others for mistakes or misbehavior
➢ Vindictiveness – spiteful or malicious at least twice within the past 6
months
Behaviors must cause some level of impairment in key areas of
functioning such as interpersonal relationships or in school
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Symptoms of ODD Continued
These behaviors can be seen on most days for at least 6
months for children under 5 years of age
For those who are 5 years of age and older, the behavior
should occur at least once a week for at least 6 months
A psychotic, substance use, depressive, or bipolar disorder
does not better explain the symptom picture
Severity – mild, moderate to severe
The case of Jerry Sheppard illustrates ODD
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Intermittent Explosive Disorder (IED)
Essential feature of IED is distinct episodes of failure to resist aggressive impulses
that are evident in verbal aggression (such as temper tantrums, tirades,
arguments) or physical aggression (fighting with others) and:
➢ Seen in explosive outbursts wherein the person is unable to control his (or less
often her) aggressive impulses
➢ Happens about twice a week for at least 3 months
➢ Person may be involved in more serious assaultive acts that may cause injury or
destroy property (over the past year)
Are out of proportion to any provocation or precipitating stressor
Not premeditated
Causes distress
Seen in individuals as young as 6 years of age
And not better explained by another mental disorder
Refer to Tommy Lusk’s story
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Conduct Disorder (CD)
Essential feature of CD is a consistent pattern of violating the rights of others or
major age-appropriate societal norms or rules are violated – tend to be seen
before age 15 (Note: if 18 years or older, criteria not met for antisocial disorder)
Requires the presence of any 3 of the following 15 symptoms (from 4 major
categories) for at least 12 months – one symptom present over the past 6
months:
➢
➢
➢
➢
Aggression to people and animals – 7 symptoms
Destruction of property – 3 symptoms
Deceitfulness or theft – 3 symptoms
Serious violation of rules – 3 symptoms
Causing social, occupational, or occupational impairment
Specifiers – onset, severity, and “with prosocial emotions”
Refer to the case of Norman Gibson showing CD
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
A Lesser Known Disorder – Pyromania
Essential feature is the deliberate and purposeful setting of a fire on more than one
occasion and experiences of :
Tension or emotional arousal before setting the fire
Fascination, interest, curiosity about or attraction to fire and its situational contexts
A sense of relief experienced when setting fires, witnessing its effects, or participating in
its aftermath
No motivation for setting a fire
And not better explained by conduct disorder, a manic episode or antisocial personality
disorder
The nonfiction book, Fire Lover: A True Story, features someone with pyromania
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Another Lesser Known Disorder Kleptomania
Central feature distinguishing kleptomania – a rare disorder is the individual’s inability to resist stealing something that
has no personal use nor any monetary value and:
Experiences a sense of tension just before the theft
Feels a sense of relief or gratification at the time of the
theft
Not done to express anger or vengeance or part of a
delusion
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Comparing the DSM-IV-TR Multiaxial
System and the DSM-5
Oppositional defiant disorder and conduct disorder were moved
from the DSM-IV chapter “Disorders Usually First Diagnosed in
Infancy, Childhood, or Adolescence”
Intermittent explosive disorder, pyromania, and kleptomania
were moved to this chapter from the DSM-IV chapter of
“Impulse-Control Disorders Not Otherwise Specified”
While antisocial personality disorder is listed in this chapter, it is
further elaborated in the chapter on “Personality Disorders”
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Comparing the DSM-IV-TR Multiaxial
System and the DSM-5
Symptoms for oppositional defiant disorder are of three types:
angry/irritable mood, argumentative/defiant behavior, and
vindictiveness; the conduct disorder exclusion has been deleted;
criteria were also changed with a note on frequency requirements;
and specifiers are included for severity
For the most part, diagnostic criteria for conduct disorder remain
unchanged from the DSM-IV but a specifier was added for individuals
with limited “prosocial” emotions
Individuals over the minimum of at least 6 years of age may be
diagnosed with intermittent explosive disorder without outbursts of
physical aggression that are not better explained by another mental
disorder, attributed to a medical condition, or the effects of a
substance; criteria were added for frequency
© Susan W. Gray – Chapter 13 Disruptive, ImpulseControl, and Conduct Disorders
Assessing for Competence
Psychological
Biological
Social
Feminist Perspectives on Social Work Pra…
CASE STUDY
Jessica is a 39-year-old Latina
woman who grew up in the
Hunt’s Point neighborhood of
the South Bronx. Raised in a
loving family of first-
generation immigrants from
the Dominican Republic
Jessica grew up attending
church and volunteering in her
local hospital. Diagnosed with
a set of learning disabilities
related to reading
receptive language at age ten,
Jessica always struggled in
school, but she managed to
obtain her high school degree.
Soon after obtaining work in a
school cafeteria, Jessica
became pregnant, starting her
life as a mother with her long-
term boyfriend. Eventually, she
would become the mother of
and
nine children. When she was in
bar lata Hantian
laaniad
and
Feminist Perspectives on Social Work Pra…
her injury in a time before
doctors were aware of the
dangers of opioid addiction.
Soon, Jessica was no longer
able to get her pain medication
from her doctors and was not
offered alternative pain-
management treatments. With
time, Jessica became
dependent on heroin, leading
her to earn money as a sex
worker, the combination of
which led to the removal of her
children and a series of
arrests. Over the next few
years, Jessica was able to
enter methadone treatment
and regain custody of her
children, but she also
succumbed to what is very
common in substance use
recovery-relapse. During her
last relapse into heroin use,
she became infected with both
Feminist Perspectives on Social Work Pra…
incarceration program
that
both provides substance use
disorder treatment and can
accommodate Jessica’s
disabilities, health conditions,
and two youngest children.
Your goal is to obtain a
sentence for a two-year, long-
term residential drug
treatment program and eight
years of probation in place of a
ten-year sentence.
After the standard two
weeks that social workers are
given to locate alternative
placements during the
mitigation phase of
sentencing, you have found
that no program will accept
her due to Jessica’s special
needs. The judge on the case
has offered an extension, but
he says if no program is found
soon, he will have to give her
the full ten voar contence even
Feminist Perspectives on Social Work Pra…
the human immunodeficiency
virus (HIV) and hepatitis C.
When Jessica was next
arrested for the sale and
possession of a large amount
of heroin, she faced a ten-year
prison sentence.
You note that a white
woman with a similar criminal
history record and set of
challenges who was on your
colleague’s caseload was
recently offered
a
much
shorter sentence. Your job as
Jessica’s defense team’s legal
social worker is to present the
court with mitigating
information about Jessica’s
life in order to argue for an
equitable sentence that would
address the underlying
challenges leading to her court
involvement. This means that
you must find an alternative to
innarnarotinn
that
nrnerom
Feminist Perspectives on Social Work Pra…
soon, he will have to give her
the full ten-year sentence, even
though others without
disabilities, medical problems,
and children receive
alternatives to incarceration.
Jessica is despondent and is
losing hope fast. Jessica’s
family are very worried about
her and also feel overwhelmed
with the care of her children,
who are acting out due to
missing their mother.
DEFINING DISABILITY
215
Defining the term disability is
not a clear-cut process, as
disabilities can vary widely and
be related to vision, hearing,
motor skills, or cognition-or a
combination of any of these.
People with visual disabilities
include those who have
blindness, low vision, or color-
blindnaan
Taarina
A: Lil:i: –
9:17
4
U »
1
x X :
Q Aa D
11. What topics might you
need to learn more about
in order to engage in
effective social work
practice with Jessica
(e.g., bereavement,
parenting supports,
criminal justice, disability
culture, substance use
disorder treatment,
recovery,
HIV/AIDS
discrimination)?
12. Which
theoretical
frameworks discussed in
this chapter might be
helpful to
you
in
approaching your work
with Jessica (e.g.,
access, feminist theory,
disability rights, etc.)?
13. Thinking
multi-
systemically as a social
1
232 of 313
9:17
4
x X :
Q Aa ♡ ♡ »)
Situation!
6. How
does
intersectionality manifest
in Jessica’s life?
7. How would you foster
Jessica’s
self-
determination in the
course of your
of your social
work practice with her?
8. How does the dignity of
risk play into Jessica’s
life situation?
9. What
human
service
systems is Jessica
involved in?
10. How might you engage in
action in these systems,
and why?
11. What topics might you
need to learn more about
in order to engage in
effective social work
232 of 313
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