ptsd

Case Report 1

Identifying data
Name initials
Gender
Age
Education
Marital status
No of sessions
Patient
Date first seen
Date last seen
Source and Reason for Referral
.
Presenting Complaints
Table 1
Presenting Complaints according to the client
(0-10) ‫شدت‬ ‫دورانیہ‬ ‫شکایات‬

Behavioral Observation

Developmental History of the Problem

Mr. A. reported multiple events in his past involving intense fear and humiliation. Some were
indeed traumas as defined by the DSM-IV-TR criterion A for PTSD, where others would more
appropriately be categorized as subjectively distressing events. Regardless of the clinical
classification, each experience Mr. A. recounted evoked vivid and frightful memories. Mr. A.’s
first memory dated back to his toddler years. He was told his mother had to stay in the hospital
for several weeks after giving birth due to complications, and he would stay with his aunt and
uncle. He worried that his mother would die in the hospital and that he would never see her
again. He then recounted experiencing additional “emotional trauma” when his aunt
“humiliated” him in front of a house full of family members by forcing him to rub his nose in the
diaper he had soiled. He linked this memory of shame and disgrace to problems he had in
adulthood with sexual intimacy. Mr. A. also recalled the same aunt and uncle so criticizing him
for eating messily that it “felt like verbal abuse” and produced a severe food phobia. Other early
traumas he revealed at intake included experiencing a hurricane firsthand (age 6) and physical
assault by a group of peers in middle school.

The magnitude of Mr. A.’s horrific experiences had no bearing on the impression they left
behind. For example, the hurricane and physical assault hardly affected his daily routine;
however, his “humiliation” by his aunt (an event not meeting PTSD criterion A) shaped him for
years to come. The trauma that most profoundly affected his functioning (DSM-IV criterion A)
occurred after Mr. A. and his wife separated. He initially continued to see his child regularly.
After several months, however, his wife abruptly abducted Chloe to her native country. Because
she left no word for Mr. A., he had no knowledge of his daughter’s well-being or whereabouts
for two days. Convinced she had been abducted, he feared for her life. Eventually, he learned that
she was safe with her mother, but remained unable to contact or see her.

In the ensuing two years, Mr. A. devoted his life to locating and reconnecting with his daughter.
He quit his job, moved to his ex-wife’s country, and immersed himself in custody and abduction
law. That Chloe’s age was similar to his when he had first been “traumatized” held great
significance for him: his mother had been “taken away,” leaving him fearful and anxious. This
memory deepened his need to remain close to his daughter and never to let feel abandoned. A
two-year international pursuit and custody battle ensued, including at least two threats on Mr.
A.’s life by his ex-father-in law and someone he believed had been hired to kill him by his ex-
wife’s family.

Mr. A. underwent a profound role transition with this life trauma. He often referred to his life
before and after his daughter’s abduction as if describing two separate individuals: Pretrauma, he
reported always having felt “a little mistrustful of others” and acknowledged lifelong “trouble
with love and affection,” but was an active, functioning adult who held a full-time job, pursued
various hobbies, and even, with some effort, participated in his community. Posttrauma, he
struggled to function, to self-regulate, and to find meaning and purpose in his life. His social
withdrawal was worsened, and despite seeking numerous therapies and self-help, his PTSD
symptoms lingered.
Background Information
Personal history. Mr. A., a 48-year-old male, He requested psychotherapy to address
current symptoms of “irritability, sleep disturbance, and interpersonal conflicts.” He reported a
history of multiple traumas that he felt contributed to his current difficulties. Although he
described attempting to “accept the pain and suffering these past ordeals caused” and to “move
on,” he often felt resentful and unable to forgive.

Mr. A. was living with his parents and two younger sisters. He reported feeling tremendous
pressure to excel, which he attributed to his father’s continual dissatisfaction with Mr. A.’s
accomplishments. He had few friends growing up, but was committed and loyal to those he did
call friends,

Pre-morbid personality. he was extrovert and healthily participated in social settings

.Had no conflicts in engaging with others.

Sexual history. He was sexually disturbed because of problematic symptoms .He

described his love for her wife diana as strictly platonic, however. They hadn’t been sexually intimate in
years, and he saw her more as a “best friend”
Marital history. he was once briefly married, and had a daughter, Chloe, who was currently
in her twenties. He described bis marriage as “agreeable,” despite feeling the couple shared no common
interests and lacked any “passionate connection.” He reported being strongly attached to Chloe from her
infancy until age 2. During that interval, he carried out most parental duties while his wife recuperated
from a serious back injury. He described his attachment to his daughter during this time as “the most
harmonious bond I ever experienced with another human being.”Mr. A remarried with a women named
Diane, age 38. Mr. A. exhibited ambivalence about this relationship (and any long-term commitment). He
was extremely loyal and devoted, described her with affection, respect, and warmth.

Mr. A.’s description of his interactions with Diane reflected several characteristic behaviors of
PTSD (Markowitz et al., 2009). He depicted interactions at home as tense and at times explosive, and
attributed these interpersonal struggles to an overall aversion to any “intense feelings.” He would get
angry at Diane for intruding on his work space or on his chance to “relax” or “meditate in solitude.” .He
had created a work environment void of almost all social interaction and found Diane’s presence
disturbed his plan, which was to distance himself enough from others so there would be no
conflict. His general mistrust in others, another characteristic behavior of PTSD, also added to
his uncertainty in his relationship with Diane. For example, Mr. A. had severed ties with Diane’s
father over a failed business venture, but Diane continued communicating with him. As a
consequence, Mr. A. questioned her fidelity.

Educational history. He held a master’s degree in computer science

Occupational history. worked from home as a freelance software engineer. and had
worked successfully for many years as a computer programmer, but was currently working
sporadically and struggling financially.
History of family psychiatry/medical illness.
Provisional Formulation

Assessment
The assessment was carried out in different dimensions. Following is the list of
assessment techniques which were carried out with the client.
• Behavioral Observation
• Clinical Interview
• Mental Status Examination
• Subjective Ratings
Behavioral observation.
Clinical interview. A clinical interview is a conversation between a clinician and a client
that is intended to develop a diagnosis. It is a "conversation with a purpose" that can be
structured, semi-structured, or unstructured. Emphasis is placed on open-ended questions with
the focus being on the patient and not the clinician. Clinical interviews are used with other
measures and methods to diagnose the patient. There are many different types of clinical
interviews: diagnostic, termination, orientation, selection, intake, case history, and mental status
exams are all examples (Balu, 2015).

Mental status examination. Mental status examination was a method for assessing
cognitive and functional impairment of the patient. By assessing metal status of the patient, the
structured data about the functioning of the patient was obtained (Molloy & Standish, 1997).

Subjective rating. Subjective rating scales are widely used in almost every aspect of
ergonomics research and practice for the assessment of workload, fatigue, usability, annoyance
and comfort, and lesser known qualities such as urgency and presence of any behavior (Annett,
2010). In subjective rating based on any rating that a person gives that is based on their
subjective reaction or opinion, their feelings, desires, priorities. The subjective rating used to
assess the client current level of functioning and rating the client symptoms which helpful to
managed the client behavior need to be managed.
Table 2
Patient’s Symptoms and their Ratings by the Client

Symptoms Ratings (0-10)

Case formulation

Suspected problem

According to DSM-5 (American Psychological Association, 2013) the client

was suspected to be with PTSD
Intervention Plan
According to the results drawn from multidimensional assessment of the client the
intervention plan of the client was planned and the goals were identified.
• Rapport was established and maintained with the client to establish therapeutic
alliance with the client.
Establishing and maintaining rapport. Rapport is defined as a ‘harmonious
relationship’ between a client and a therapist (Spink, 1987).
Proposed Management