DSM-5 Diagnostic Impressions Vignette
Students are asked to provide the following in this paper:
DSM-5 diagnostic impressions for the provided vignette. HINT: Nadine has more than one
diagnosis!!! Students should provide a thorough explanation for their diagnosis, including the
consideration of any cultural factors. Please feel free to “talk through” your diagnosis to
demonstrate your knowledge. Don’t forget to include diagnostic specifiers, if relevant (i.e., mild,
moderate, severe, with XYZ features, etc. The DSM will indicate when specifiers are required for
a specific diagnosis).
Please clearly indicate your diagnosis in your paper. When talking through your ideas, it’s easy
for your actual diagnosis to get “lost” in the paper. Please clearly write it out.
For example, “My diagnosis is 1) Schizoid Personality Disorder, 2) Gambling Disorder, moderate,
persistent, and 3) Insomnia Disorder, episodic.” It does not have to look exactly like this. But please just make it clear to read.
Next, students are asked to identify a potential theoretical orientation for treatment of this
disorder. You may need to do a brief literature review or review of your textbooks to determine
what orientations might be best suited for this diagnosis. Please discuss the central tenets and a
brief overview of the effectiveness of this orientation as cited in the research.
Often, clinicians will select an orientation that is best fit for the primary diagnosis (i.e., the
disorder that the clinician deems to be most significant). You do NOT need to select a different
orientation for each disorder that you diagnose. Just think about the FIRST steps you would take
with the client and what evidence-based treatment orientation you would utilize.
Lastly, students are asked to make suggestions for 2-3 MAPS goals for the client (see below for
reminders about how to set MAPS/SMART goals). Push yourselves to ensure that the goals are
measurable and specific.
This paper should be 3-4 pages and utilize APA style. Please remember to include a Reference
page.
Please use subheadings for this paper: Diagnosis, Treatment Orientation, Goals
See attached rubric for more complete details.
Reminder:
MAPS = measurable, attainable, positive, specific.
Another common acronym for goal-setting is SMART = specific, measurable, attainable, realistic,
tangible.
Both of these methods are helpful tools to use when you’re designing treatment goals. You can
keep these general “rules” in mind when you’re thinking about the goals that would be best
suited for your client from the vignette.
Vignette:
“Nadine was a 15-year-old girl whose mother brought her for a psychiatric evaluation to help with
her long-standing shyness.
Although Nadine was initially reluctant to say much about herself, she said she constantly felt
tense. She added that the anxiety had been ‘really bad’ for several years and was often
accompanied by episodes of dizziness and crying. She was generally crippled with fear about
interacting with others outside of her home or school classes. She refused to leave her house
alone for fear of being forced to interact with someone. She was especially anxious about other
teenagers. She said it felt impossible to walk into a restaurant and order form ‘a stranger at the
counter’ for fear of being humiliated. She also felt constantly on her guard, needing to avoid the
possibility of getting attacked, a strategy that really only worked when she was alone in her
home.
Nadine tried to conceal her crippling anxiety from her parents, typically telling them she ‘just
didn’t feel like’ going out. Feeling trapped and incompetent, Nadine said she contemplated
suicide ‘all the time.’
Nadine had always been ‘shy’ and had been teased at recess since she started kindergarten.
The teasing had escalated to outright bullying by the time she was in seventh grade, leading to
intense fear for her own safety. For two years, day after difficult day, Nadine’s peers turned on
her ‘like a snarling wolf pack,’ calling her ‘stupid,’ ‘ugly,’ and ‘crazy.’ Not infrequently, one of them
would stare at her and tell her she would be better off committing suicide. One girl (the
ringleader, as well as former elementary school chum) hit Nadine in the face on one occasion,
giving her a black eye and a bloody nose. Nadine did not fight back. This event was witnessed
by an adult neighbor, who told Nadine’s mother. When Nadine’s mother asked her about the
incident, Nadine denied it, saying she had ‘fallen’ in the street. She did, however, mention to her
mother ‘in passing’ that she wanted to switch schools, but her delivery was so offhand that, at the
time, her mother casually advised against the switch. Nadine suffered on, feeling terrified of
school and sobbing herself to sleep most nights.
Full of hope, Nadine transferred to a specialty arts high school for ninth grade. Although the
bullying ceased, her anxiety symptoms worsened. She felt even more unable to venture into
public spaces and felt increasingly embarrassed by her inability to develop the sort of
independence typical of a 15-year-old. She said she had begun to spend whole weekends
‘trapped’ in her home and had become scared to even read by herself in the local park for fear of
what would happen if she was out in public alone. She had nightly nightmares about the bullies
in her old school and of being attacked. Her preoccupation with suicide grew
Her parents had thought she would outgrow being shy and sought psychiatric help for her only
after a teacher remarked that her anxiety and social isolation were keeping her from making the
sort of grades and doing the sort of extracurricular activities that were necessary to get into a
good college.
Nadine described her mother as loud, excitable, aggressive. Her father was a successful tax
attorney who worked long hours. Nadine described him as shy in social situations (‘He’s more
like me’). Nadine said she and her father sometimes joked that the goal of the evening was to
avoid tipping the mother into a rage. Nadine adding that she ‘never wanted to be anything like
her mother.’”
