Me.K.d case study

Ms. K.D. is a 39-year-old professional reporter. She was referred by the Employee Assistance Program at her workplace. Several weeks ago, as part of her job, she witnessed an execution of a person convicted of murder. For several years she had been following the story of this prisoner as the execution date approached. The execution itself was remarkably protracted; along with colleagues, she maintained a deathwatch for several hours while various last-minute reprieves were gained and then set aside by judicial bodies. At one point the prisoner was actually strapped into a chair when the phone call from a federal judge, literally at the last minute, reprieved him. When the execution finally occurred, Ms. K.D. and her colleagues watched from a distance of about 10 feet through the windows to the death chamber. The actual death took over five minutes and it appeared that the prisoner suffered.

Ms. K.D. tells you, “Once you see a person die, you don’t forget what it looks like.” She felt that her professional role as an objective recorder was helpful to her initially in that it separated her from her emotional response. She recalled, for example, the sensation of her mouth going dry just at the moment of execution, but this was unaccompanied by an emotional response. A feeling of detachment which she described as “surreal and macabre” persisted for some days after the event. For a week after the execution, she continued to be detached from her feelings and was “in a daze and not my usual self.”

For the last few weeks, since the execution, she has felt unexcited about her work. She was surprised at her unwillingness to cover a riot that occurred shortly after the execution, a story about which she normally would have been every enthusiastic. She was becoming irritable, with angry outbursts at her husband that prompted him to suggest that they see a marriage counselor. Ms. K.D. has had trouble staying asleep and often has nightmares. She says that she thinks of the event every day and has “vivid” images of the scene. She feels that she can’t stay focused on her work and that she feels “odd” and “out of it”.

Ms. K.D. denies having any problems with alcohol or drugs. She says she has been drinking “a little more than usual” since she witnessed the execution and has used marijuana to relax after work. She says that she isn’t interested in doing much on the weekends and she stays at home. She missed work on three Monday mornings because she wasn’t able to get up and get going.

Adapted from Spitzer, R.L., Gibbon, M., Skodal, A., Williams, J. & First, M. (1994) DSM-IV Case Book: A learning companion to the diagnostic and statistical manual of mental disorders-Fourth Edition. American Psychiatric Association: Washington, D.C. p.35-36.

Question 1

Use the competency-based assessment model diagram as shown on page 23 of the Gray text. Please list the biological/psychological/social considerations appropriately for this client. Include your assessment of competence (strengths and resources) as shown on the diagram.

Question 2

How might the strengths and resources of this client be used in assessing this client?

Question 3

Please provide a diagnosis for this client. List the numerical code and the DSM 5 diagnosis.

Question 4

What are possible diagnoses requiring additional information for this client?

What information is needed and how might you obtain it?

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