Differential Diagnosis Response 1

This assignment is designed to expose you to the process of determining a diagnosis according to DSM-5 criteria. Many disorders share similarities or even co-occur, making it difficult to arrive at a diagnosis. Clinicians have to identify the behaviors and thoughts that fit the established diagnosis criteria, ruling out alternative diagnoses.

For this exercise, you will read the clinical case excerpt presented below and assign a primary diagnosis based on the available evidence. Evidence from the passage that you may cite to support your diagnosis includes specific behaviors, patterns of thinking, and symptom duration. Cite at least 4 examples from the excerpt that align with the specific DSM criteria for your primary diagnosis. Each criteria should be supported with a specific behavior/cognition displayed by the individual. Please also identify distress and impairment to daily living. Then, you will engage in a process of eliminating two alternative diagnoses. You will offer two diagnoses that a clinician may consider based on the presented case and then use evidence from the case to state why these alternative diagnoses are not correct. For example, later in the semester we will learn that Post-traumatic Stress Disorder (PTSD) requires symptoms to be present for longer than one month. A similar diagnosis known as Acute Stress Disorder presents with similar features (e.g., distressing and intrusive thoughts about the trauma, flashbacks, inability to experience positive emotions, hypervigilance), but it has a duration of 3 days to 1 month. A clinician may consider an alternative diagnosis of PTSD but ultimately rule that the primary diagnosis should be Acute Stress Disorder if the client has only experienced symptoms for 2 weeks. Another clinician may be seeing a client who is in a current depressive episode. If this same client has experienced an episode of mania in the past, however, they would not meet criteria for Major Depressive Disorder (MDD). The clinician may consider MDD as an alternative diagnosis but ultimately, bipolar disorder would be the appropriate primary diagnosis. For each alternative diagnosis, please provide one reason for and one reason against that diagnosis based on DSM criteria.


Now, please read the case below and write your response, providing a primary diagnosis and two alternative diagnoses, in paragraph form.

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Grading Rubric:

15 points:

  1. correct diagnosis (5 points)
  2. at least 4 criteria from the DSM supported with evidence from the passage (8 points)
  3. identify distress and impairment in functioning (2 points)

10 points:

  1. Alternative diagnosis #1 (1 point)
  2. Reason for and reason against Alternative #1 (4 points)
  3. Alternative diagnosis #2 (1 point)
  4. Reason for and reason against Alternative #2 (4 points)

10 points:

  1. Times New Roman 12-point font
  2. 1” margins
  3. Spelling
  4. Grammar
  5. Structural organization and clarity
  6. Full sentences

Clinical Case Excerpt:

Henry is a 23-year-old male attending New York University. He finally decided to seek psychological services at the suggestion of his friends and family who were worried about him because he rarely left his apartment. In discussing his symptoms and lifestyle with his therapist, he reported that he experienced intense anxiety at the thought of leaving his apartment and interacting with a large number of people. Being in crowds caused Henry to sweat profusely, his hands to shake, his stomach to feel nauseous, and his chest to pound. He reported that experiencing this intense anxiety made him feel like the world was not real or like he was dying. The first time Henry experienced this intense reaction to a crowd was at a concert when he was 20 where he felt panicked and was overcome with fear that he could not receive help if he needed it. Since that time, he experienced similar feelings at sporting events. The intense anxiety about being in crowds now prevented him from attending class lectures, and his grades were suffering tremendously. Additionally, Henry used to go out in NYC with all of his friends during his first two years at school, but now he could no longer bring himself to board the subway and only shopped at the nearby grocery store late at night when the fewest number of people were present. He also feared having a panic attack while on the subway and not being able to escape and get help. Because of his fear of public transportation, he did not apply for internships on the opposite side of the city. His relationship with his girlfriend from freshman year also ended because he could no longer tolerate participating in activities where they would be in a large groups. Henry was worried about his grades, future job prospects, and his social life. This constant worry was also causing problems with sleep.