Discussion Forum Unit 5

Read the following case study. 

Rebekah is a 28-year-old married female. She has a very demanding, high-stress job as

a second-year medical resident in a large hospital. Rebekah has always been a high

achiever. She graduated with top honors in both college and medical school. She has

very high standards for herself and can be very self-critical when she fails to meet them.

Lately, she has struggled with significant feelings of worthlessness and shame due to her

inability to perform as well as she always has in the past.

For the past few weeks, Rebekah has felt unusually fatigued and found it increasingly

difficult to concentrate at work. Her co-workers have noticed that she is often irritable

and withdrawn, which is quite different from her typically upbeat and friendly

disposition. She has called in sick on several occasions, which is completely unlike her.

On those days she stays in bed all day, watching TV or sleeping.

At home, Rebekah’s husband has noticed changes as well. She has shown little interest

in sex and has had difficulties falling asleep at night. Her insomnia has been keeping

him awake as she tosses and turns for an hour or two after they go to bed. He has

overheard her having frequent tearful phone conversations with her closest friend,

which have him worried. When he tries to get her to open up about what’s bothering

her, she pushes him away with an abrupt “everything’s fine”.

Although she has not ever considered suicide, Rebekah has found herself increasingly

dissatisfied with her life. She has been having frequent thoughts of wishing she was

dead. She gets frustrated with herself because she feels like she has every reason to be

happy, yet cannot seem to shake the sense of doom and gloom that has been clouding

each day as of late.

From what you have learned in this unit, what is this patient’s likely diagnosis? Be

specific and explain what drove you to that conclusion and why.

After reading the articles in this unit and also based on the knowledge that I had from

other courses of study as well as personal experiences with my mother, I believe that the

likely diagnosis for Rebekah’s condition is depression, more specifically she has a Major

Depressive Disorder. The constant struggle with feelings of inappropriate worthlessness and

shame in the first paragraph of the case study gave me my first clue. According to the

National Institute of Mental Health (2022), “depression, which is also known as major

depressive disorder or clinical depression, is a common but serious mood disorder.” The

symptoms of depression can be so severe that they affect the person’s way of handling daily

living such as their jobs and home life. This is clearly the case with Rebekah. The way she

feels about herself literally disrupts every facet of her way of life.

According to the American Psychiatric Association (2013) in the section entitled

Depressive Disorders, for a person to be diagnosed as having a Major Depressive Disorder,

they must exhibit at least five or more of the nine listed symptoms during the same two-week

period which would represent a change in the way they usually function. The nine listed

symptoms in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

are:

 Depressed mood for most of the day, nearly every day.

 Marked diminished pleasure or interest in activities that would have once been

interesting to the person

 Significant weight loss or gain

 Experiencing insomnia or hypersomnia almost every day.

 Psychomotor agitation or retardation that is observable by others

  Fatigue or loss of energy nearly everyday

 Feelings of worthlessness or excessive or inappropriate guilt almost daily

 Diminished ability to think or concentrate that is observable by others

 Recurring thoughts of death, suicidal ideations without a specific plan or an actual

suicidal attempt

In terms of Rebekah, she demonstrated feelings of worthlessness and shame, she felt

fatigued and struggled to concentrate at her job. She was irritable and withdrawn, lacked

interest in being intimate with her husband, suffered from insomnia and was generally

dissatisfied with her life. She was even having thoughts of wishing that she was dead

although though she hadn’t made any attempts to end her life. The symptoms that she was

experiencing were significantly impairing her daily life and she was not experiencing these

symptoms because of any side effects from any substances that she has been taking or

because of another medical condition. When I compared what Rebekah was experiencing to

the criterion listed according to the American Psychiatric Association (2013), it led me to the

definite conclusion that she was suffering from a Major Depressive Disorder.
 References

American Psychiatric Association. (2013). Depressive Disorders. In Diagnostic and statistical

manual of mental disorders (5th ed.). Washington, DC: Author.

National Institute of Mental Health (2022). Depression. Retrieved from

https://www.nimh.nih.gov/health/topics/depression