I want to give some instructions with the diagnosing cases.

 I have come up with a to-do list of

how to organize yourself to do the diagnosing part as it seems to be the part that is the most

overwhelming. Make sure to allow enough time. It is written how I learn – you may need to

tweak this for your learning style.

 1.Read case

2.Read case again and highlight symptoms

3. Write down all the symptoms

4. Go to DSM 5 TR and read specific diagnosis that could encompass some of the symptoms. 

5. Read that diagnosis all the way through to the end. 

6. Write down the criteria met next to symptoms on your paper

7. Write down additional diagnosis mentioned in the differential section.

8. Go to the other diagnosis in the DSM that you wrote down and read all the way through -

write the criteria in a different color (or highlight) for this diagnosis on your symptom list

9. Once you have completed this - look to see what makes the most sense based on the symptoms

and criteria you wrote down

Do 4-9 repeatedly until all symptoms are accounted for. 

10. This is your tentative formal diagnosis.  Now - go back through each diagnosis listed re-read

the entire section under that diagnosis in the DSM 5 TR. Note any questions you have. 

11. Discuss with a classmate the questions you have AND/OR let it sit for a day and come back

to it. Re-read the diagnosis in the DSM 5 TR for anything you may have missed. 

 
Here is an example of how to write the case discussion posts where you are giving a formal

diagnosis:

Lois P. is a 41-year old, divorced, African American mother of three referred to a

psychiatric hospital with depression and suicidal tendencies.  She has a long history of

persistent and complicated psychosocial issues.  Following is an analysis of her case.

Formal Diagnoses

DSM 5 Diagnostic Impression

F43.10 Post Traumatic Stress Disorder

F33.0 Major Depressive Disorder, Severe, Recurrent

F14.20 Severe Cocaine Use Disorder

Z62.810 Personal History of Sexual Abuse in Childhood

Z65.4 Victim of Crime

Z59.6 Low Income

Z56.9 Other Problem Related to Unemployment

 Diagnostic Criteria

PTSD

Criteria was met for PTSD with a significant number of symptoms present.  Lois has

experienced several traumatic events in her lifetime as follows: Sexual abuse perpetrated

by her father beginning at the age of 7 until the age of 12; in adulthood, being the victim

of multiple muggings and attempted sexual assaults; her son experiencing gun violence

when he was grazed by a bullet in a drive-by shooting; residence in a neighborhood where

violence occurs frequently; multiple relationships with men plagued by verbal and/or

physical violence (criteria A1, 2, 3).  Additionally, she has been experiencing dissociative
reactions in the form of flashbacks (criteria B3).  Lois engages in behaviors as a way of

avoiding distressing feelings associated with her trauma through drug use, suppression of

memories, and alienating herself from most of her family members (criteria C1,

2).  Criteria D1, 2, 3, 4, 5, and 6 are met as evidenced by the suppression of some

memories of the abuse, persistent feelings of guilty ruminations, loss of interest or

pleasure in activities, feelings of distrust, and estrangement from her family.  Criteria E1,

2, and 6 are met as evidenced by Lois’ irritable behavior and outbursts toward therapists

and staff at the hospital, her self-destructive behavior (drug use, sexual promiscuity,

involvement in unhealthy relationships) and her sleep disturbances.  Lois’ symptoms have

been present for several years (criteria F).  Though Lois’ symptoms cause significant

impairment in her social and occupational functioning, her persistent drug use cannot be

ruled out as a factor, therefore she does not meet criteria G or H.

Major Depressive Disorder

Criteria was met for Major Depressive Disorder, Severe, Recurrent with at least 8

symptoms present.  Depressed mood (sad, empty) most of the day nearly every day,

diminished interest or pleasure in activities, weight loss, insomnia, fatigue, restlessness,

low self-esteem, and frequent suicide attempts (A1, 2, 3, 4, 5, 6, 7, 9) are all

present.  These symptoms cause significant distress and impairment in Lois’ social and

occupational functioning therefore criteria B was met.  These symptoms are not

attributable to a substance or a medical condition therefore criteria C was met as well.

Criteria D and E were met, as Lois does not meet the criteria for any of the schizo- or

psychotic disorders and there has never been a manic or hypomanic episode.  The

specifiers of severe, recurrent were included due to the significant number and duration of
symptoms, as well as the severity of the symptoms and the significant negative impact

they have on Lois’ social and occupational functioning.

Severe Cocaine Use Disorder

  Lois has a history of abuse of multiple substances, including alcohol, benzodiazepines,

and cocaine.  Currently, she reports cocaine use and meets the DSM criteria for Stimulant

Use Disorder, Cocaine, Severe.  Lois reports using increasing amounts of cocaine over

time; numerous unsuccessful attempts to control stimulant use as evidenced by attending

drug rehab programs repeatedly; a strong desire to use cocaine; and recurrent use which

has resulted in the suspension of her nursing licensure and loss of employment (criteria

A1, 2, 4, 5, 6, 7).  The specifier of cocaine, severe was added due to cocaine being her

current drug of choice for the past 12 months and she has 6 or more symptoms.

Other DSM 5 Diagnoses That Were Considered

F14.24, Cocaine/Medication-Induced Depressive Disorder With Use, Moderate or Severe

was ruled out due to Lois’ symptoms of depression did not develop during or soon after

substance intoxication, withdrawal, or after exposure to a medication (criteria B1).

F60.7, Dependent Personality Disorder was considered because of her history of seeking

out relationships with men as well as being described by previous therapists as being

“dependent”. This diagnosis was ruled out because Lois did not meet the minimum five

criteria necessary for a Dependent Personality Disorder diagnosis.

General Personality Disorder (no F code provided in DSM-5) was considered due to Lois’

behavior that deviated from her cultural norms in her interpersonal functioning and

impulse control (criteria A3, 4).  She also appeared to meet criteria B, C, and D with

regard to pervasiveness, impairment in important areas of functioning, and duration,

however these patterns could not be ruled out as manifestations of other mental disorders

or the effects of a substance (criteria E, F).  Full criteria for General Personality Disorder

was not met.

F23, Brief Psychotic Disorder was also considered based on Lois’ history of experiencing

the sensation that her vaginal area was emitting a foul odor. Lois met criteria A1, presence

of delusions, and likely met criteria B, duration of episode was at least one day but less

than 1 month (though the exact time frame is unknown) and she returned

to premorbid level of functioning.  Additionally, the delusion could not be explained by

MDD, bipolar disorder with psychotic features, or another psychotic disorder or effects of

a substance (criteria C).  However, this diagnosis was ruled out because Lois is not

currently experiencing any delusions.  Likewise, other psychosis-related diagnoses such as

F20.9 Schizophrenia and F25.1 Schizoaffective Disorder Depressive type were

considered; however, Lois does not present with symptoms of disorganized speech or

delusions lasting for at least 6 months and delusions have not occurred in the absence of a

major mood episode (depressive in Lois’ case).