Case Diagnosis Hints

Case Diagnosis Hints
1. Use the Case Diagnosis Form document to post weekly case assignments.
2. Narrow you classifications of symptoms first. This means that you should narrow the
symptoms down to anxiety, mood, schizophrenia, dissociative, somatoform, children or
youth, personality, sexual paraphilias, sleep….you get the idea.
3. Do not be surprise that you encounter two or more classes of symptoms.
4. Next, rule out disorders from the chosen class. For example, let’s say that you feel a
person’s symptoms fit the anxiety class. Now you have several subtypes of disorders to
choose from. My approach is not to decide for a disorder but to rule out disorders that
clearly cannot fit the description of symptoms. So with anxiety you have PTSD, GAD,
Panic, OCD, Social phobia, Agoraphobia, simple phobia….
5. PTSD requires that there is a trigger for the anxiety symptoms. The trigger must be
traumatic. What do I mean by traumatic? Like a victim of serious crimes, war, natural
disasters, or terrorism. GAD has no trigger — or the person worries about 5 different
things like knee problems, kids at school, money problems… they always worry about
something. Panic attacks and anxiety symptoms overwhelm a person for 20-45 minutes.
They come and go. There is no trigger. The person senses doom of the next attack but
no environmental trigger. Agoraphobia usually goes with panic attacks/disorder but not
always. For instance, it is the fear of an inescapable situation like being in a grocery line
and having a panic attack in public! So this person becomes afraid to leave the safety of
the home environment.
6. The bottom line is the disorders will sound alike. The hardest skill a student has to
develop is to learn to differentiate between the disorders. Diagnostic differentiation is the
focus of this class. Students must learn to rule out wrong diagnoses in order to narrow
down possible choices.
7. The rule of thumb is if you cannot rule out the diagnosis, then you have to consider it as a
viable diagnosis.
8. In real life, we would use the multi-axial system. In this class I focus on axis one, and
axis two. Stick to the Case Diagnosis Form (provided earlier). When you post your
comments, type on the form and attach it as an .rtf or .txt file. Do not be afraid if you
differ from other peoples’ diagnosis. Argue your point to others with follow up posts to
their diagnosis. Do not feel afraid to disagree and do not take it personally when others
do not agree. Welcome to the club of disagreement!
Once I was asked during a court trial how many psychologists, out of 10, would agree
with my diagnosis and I replied, “Your Honor, maybe 5 out of 10 would agree.” The
judge responded, “I thought psychology was supposed to be a social science…” I
responded, “Psychology is a science of probability not absolute certainty…but I am
absolutely certain that not all 10 psychologist would agree with my diagnosis.” Even the
Judge laughed (a little). TRUE STORY! My point is diagnosis is subjective, to a point.
I hope this helps!