1

Final Draft: Amelia Case Study

Lucynda O’Hara

Southern New Hampshire University

COU-650: Diagnosis: Emotional and Mental Disorders

Dr. Maureen O’Shea-Goss

October 13, 2023

2

Final Draft: Amelia Case Study

Biopsychosocial Summary

Presenting Issues and Client Concerns

The client, Amelia, is a 42-year-old woman of mixed Filipino and African-American

heritage. She is seeking counseling due to a pervasive and debilitating set of challenges due to

her mental and emotional health. Amelia has described experiencing a persistent sense of not

recognizing herself and days when she feels overwhelmed by a lack of energy, which does not

allow her to motivate herself to get out of bed. Additionally, she has had recurrent and distressing

thoughts about those around her in the workplace who may have ill intentions towards her.

Amelia believes these individuals are trying to get her fired and dislike her.

The emotions and thoughts she is experiencing have impacted her daily functioning severely,

causing Amelia to be less effective at work. Due to this, the client has had increased anxiety,

making her need to either miss work or leave early. Amelia’s wife has observed times when she

has been entirely unresponsive, staring into space while not engaging or being able to “come out

of it.” Over the past eight months, Amelia’s situation has risen rapidly, as shown by the

frequency and severity of her symptoms.

The loss of their pet within the last eight months may have triggered Amelia, as there

have not been any other significant stressors in her life recently. She has expressed her wish to be

dead and experienced other suicidal thoughts based on the Columbia Suicide Severity Rating

Assessment that was completed, which can show the severity of Amelia’s emotional distress. As

a result, her primary care physician has prescribed her anti-anxiety medication, and Amelia is

also on Family and Medical Leave Act (FMLA) while working through her anxiety. Due to these
3

challenges Amelia is facing, she is also straining her relationship with her spouse, which is one

reason she is looking for support and guidance with counseling.

Client Symptoms

Behavioral

Amelia’s behavioral symptoms have been displayed in various ways. The client has

exhibited signs of obsessions and compulsions while having difficulties with activities of daily

functioning. Amelia has experienced aggression, making it challenging to be at work, causing her

to miss days or even leave early. She also has a substance abuse history but continues to drink

wine twice to three times a week after three decades as a possible coping mechanism.

Additionally, Amelia has had several days where it is hard to get out of bed and go to work. This

has also impacted her daily activities, such as chores, and her social life with friends.

Cognitive

Looking at Amelia’s cognitive symptoms, several are prevalent in what she is

experiencing. Amelia is experiencing intrusive and irrational thoughts, racing thoughts, difficulty

making decisions, and even concentrating. She has also had periods of dissociation, which makes

it difficult for her wife to snap her out of the state. Amelia also has paranoid thoughts that often

occur at work due to her belief that her co-workers dislike her and would like her to be gone.

The overall cognitive impact on Amelia is shown through memory lapses and disorientation.

Emotional

Amelia has faced a multitude of emotionally distressing experiences. She constantly faces

feelings of worry, nervousness, and overwhelming sadness while losing interest in previously

enjoyed activities. Based on assessments and Amelia’s questionnaire, she mentions guilt,

hopelessness, helplessness, and irritability. These symptoms could be an indication of

4

disturbances in mood, as she has marked severe mood swings for symptoms on the intake form.

Furthering understanding of her emotional distress, the client has also had moments where she

experienced dissociative emotional states. This happens in stressful environments or situations,

which can cause her to disconnect from the environment around her.

Physiological

Amelia has reported feeling various pain based on the Level 2- Somatic Symptom-Adult

Patient assessment. Physiologically, the client’s symptoms have been seen by the changes to her

energy levels, such as at work, constant fatigue, and changes in her appetite. Looking at her

fatigue symptoms, Amelia’s sleep patterns are disrupted, which leads to further disturbances that

magnify her fatigue. She often experiences back pain, headaches, feeling her heart pound and

race, and even feeling nauseate, gassy, or even experiencing indigestion.

Potential Harmful Behaviors

The client has reported facing verbal aggression in the workplace while expressing that

she does not want to leave her bed. While there is no detailed information on verbal aggression,

her perception of hostility and the intentions she receives from her co-workers, possibly speaking

negatively or making her uncomfortable through words and actions, could be a form of verbal

aggression. It causes more emotional harm than physical harm for Amelia, which can strain

relationships with her wife and family.

Amelia has reported that it is verbal aggression with no report of any physical harm to

others by her. The reported verbal aggression should be monitored and evaluated to ensure it

does not escalate into harm toward other persons. Prolonged verbal aggression has been shown

to have both emotional and psychological effects on individuals within one’s vicinity. While

males and females exhibited comparable overall psychological adjustment and the presence of
5

protective factors, a history of verbal aggression was found to have more adverse psychological

consequences for females (Morimoto & Sharma, 2004). Amelia has also had expressions of

suicidal thoughts and a wish for death, which raises concerns about potential self-harm. While

there is no specific plan, mention of intent, or access to lethal means, her ideation could indicate

a risk to Amelia’s well-being. Given the state of her emotional distress, it is believed there should

be immediate intervention and attention to ensure Amelia’s safety. Further assessments of

potential protective factors are needed to understand and evaluate Amelia’s risks.

Family History

Based on the information within Amelia’s intake form and from the interview document

it shows an intricate family history that presents potential implications for overall emotional

well-being. Before Amelia’s father’s passing at age 12, her father battled with substance abuse.

This is important to know as she also reported emotional abuse towards her mother and siblings

before he died. Amelia also stated that she experienced emotional abuse from her father, mother,

and siblings based on what she wrote and spoke about on the intake form. Having to experience

emotional trauma at a young and formative age may have an impact on her emotional challenges.

It is also important to acknowledge that Amelia’s mother currently faces challenges with

substance use in the form of alcohol. Also, both her mother and two of her siblings (a sister and a

brother) are experiencing both anxiety and depression. While there is no reported official

diagnosis for Amelia, these disorders and emotional challenges within her family could indicate a

family history of both conditions. There could be a potential genetic predisposition to the

emotional challenges that her siblings and mother are experiencing that could increase Amelia’s

susceptibility to the same conditions. Also, a client’s family environment when they were
6

growing up, and in Amelia’s case, she has stated in her intake and during the initial session that

she experienced emotional abuse from her family. Predicting an individual’s disease risk is often

associated with their family history; this is due to the fact that the family members are the closest

representation of the unique genomic and environmental interactions that an individual

experiences (Hernandez & Blazer (Ed.), 2006). This has the ability to impact her well-being and

have an impact on her struggles emotionally. Understanding Amelia’s family’s history will help

look into potential coping strategies and how to support her best.

Evidence-Based Research

While looking at the biological factors in this case, we need to look at evidence-based

research to understand how these factors impact Amelia through emotional challenges.

Biological factors influence an individual’s development throughout life but can also affect

mental health conditions. Research has shown the impact of how genetics can affect mental

health. In this case, the fundamental biological factor in Amelia’s case is anxiety and depression

history within her family. Multiple studies have shown a genetic predisposition to mood

disorders, and those with a family history are at a higher risk of developing the condition

(Sekhon & Gupta, 2023).

Furthermore, it is vital to understand the role of neurotransmitters in regulating mood

disorders. It has been found that dopamine and serotonin can affect one’s moods, such as

depression. This is why it is important that a physician need to look at “an antidepressant based

on the symptom profile of the patient” (Nutt, 2008). It has been found in multiple research

projects that there are often imbalances of the neurotransmitters, which can be part of the

development of anxiety and depressive disorders. Another study found that genetic variations
7

associated with depression may influence the risk of depression by affecting working memory

functions (Buch & Liston, 2021).

Amelia’s history of alcohol use, potentially employed as a coping mechanism, warrants a

biological investigation. Alcohol, classified as a depressant, directly influences the balance of

neurotransmitters, impacting an individual’s cognition and emotions, which can become

modified behaviors (Mukherjee, 2013). Other studies have found that consumption of alcohol

will disrupt the balance of serotonin and other neurotransmitters, which may play a part in the

symptoms of these disorders (Lovinger, 1997).

Cultural Characteristics

Amelia identifies as a 42-year-old woman, which indicates the middle adulthood stage.

At this stage of life, there may be unique perspectives and challenges regarding family, personal

development, and career. There are no direct mentions of Amelia having a disability, but she

struggles with dyslexia, which started in her childhood and can be considered a learning

disability. She was not diagnosed with dyslexia until she was in her twenties. This condition

could have issues with Amelia’s experiences and self-esteem.

The client was raised in the Catholic Church; however, she no longer practices the

religion despite identifying as a Roman Catholic. Her upbringing in the church may have shaped

Amelia’s perspectives and values. The Client is suggested to be part of the middle class due to

her career as a Counselor with the American School District. Her social status and career

positions may help the Client gain access to resources to support her and create her social

network.

Amelia has stated that she identifies as a lesbian, which could help to influence her self-

identity and how she interacts with others socially and in relationships. Her mixed heritage is
8

Filipino and African American, and there is no mention of having an indigenous heritage. There

is no specific mention of her national origin; she currently lives in the United States in Metro

Detroit, Michigan, based on the information from the session and her intake forms. Amelia’s

experiences with personal identity and societal expectations may extend from her identity as a

cisgender woman.

Cultural Identity

Amelia culturally identifies as a middle-aged woman of mixed Filipino and African-

American heritage. Despite not actively practicing the religion, she holds Roman Catholic values

and identifies as a lesbian. Her career as a counselor may suggest that Amelia has a middle-class

social status. Given her multifaceted cultural background, it will be essential to see how each

part of her identity can interact with both her mental and emotional well-being.

Amelia’s marriage to her wife is important to her as well within her cultural identity. It

signifies an area that significantly impacts her emotional and mental well-being. Understanding

Amelia’s relationship and its dynamics will be important when understanding the cultural

components that influence and interact with her overall mental health.

Diagnosis Justification

Initial DSM-5 Diagnosis

For this paper, Amelia’s initial diagnosis is the diagnosis of Major Depressive Disorder

(MDD). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

(2013), MDD is characterized by persistent feelings of sadness, hopelessness, and a lack of

interest or pleasure in most activities. The severity of MDD of Amelia’s diagnosis is categorized

as severe MDD based on her assessment scores from LEVEL 2—Depression—Adult (PROMIS

Emotional Distress— Depression—Short Form) assessment and recurrent episodes.

9

Diagnosis Criteria

Using the DSM-5 (2013) outlines specific criteria for MDD. To meet the diagnosis of

MDD, an individual must experience at least five symptoms for a minimum of at least two

weeks, including low mood or loss of interest in activities. Other symptoms could involve

changes in appetite, weight, sleep patterns, persistent low mood, psychomotor retardation or

agitation, feelings of worthlessness or guilt, fatigue, and difficulty concentrating (American

Psychiatric Association, 2013). These symptoms listed could cause some degree of impairment

or distress within one’s daily functioning.

Client Behaviors

Amelia’s behaviors give an extensive view of her symptoms, meeting the criteria for

Major Depressive Disorder (MDD) based on what is outlined in the DSM-5. Amelia exhibits

persistent low moods, in which she shows reported symptoms of hopelessness, sadness, and the

loss of the ability to experience pleasure in previously enjoyed activities. She has also

experienced sleep disturbances and changes in her appetite and weight, which align with

physiological symptoms that fall under MDD (American Psychiatric Association, 2013).

Additionally, severe fatigue, psychomotor agitation, feeling worthlessness, and inability to

concentrate meet the criteria.

Amelia’s anxious distress, including excessive worry and feelings of nervousness, while

often indicates Generalized Anxiety Disorder (GAD), can be related to her depressive symptoms.

It is vital to acknowledge the anxiety Amelia is experiencing is reflective of her depressive

struggles. The anxiety Amelia experiences generally revolves around her challenges with daily

work responsibilities and getting out of bed, which leads to her feeling restlessness, muscle

tension, and sleep disturbances.

10

Her symptoms indicate a severe form of Major Depressive Disorder (MDD) due to

symptoms and how these episodes can be reoccurring. Her low mood, pronounced loss of

interest in activities, severe fatigue, and other associated symptoms significantly impair her daily

functioning. There is a complex comorbidity stipulation that Amelia’s depressive symptoms

crossed with anxious distress, which emphasizes the need for a comprehensive treatment

approach to address her emotional struggles. It is essential to recognize the severity of her MDD

as it guides the development of a tailored treatment plan (American Psychiatric Association,

2013).

Cultural Limitations

Cultural factors are significant in how people experience and express their symptoms and

diagnosis. There are cultural limitations that align with Amelia’s diagnosis of Major Depressive

Disorder (MDD) with the reflection of anxiety triggers. Amelia’s cultural background is that she

is a middle-aged woman of mixed descent of Filipino and African American, which may be a

part of how she understands and communicates about her symptoms. Cultural stigmas can

impede the acknowledgment of challenges, and stereotypes offer a quick way to navigate

situations without delving into individuals’ unique experiences (Rossler, 2016). Amelia’s beliefs

and values, such as Roman Catholicism, could change her coping strategies and even affect her

ability to seek help from professionals. These aspects can affect the availability and acceptance

of treatment modalities.

Looking at gender and sexuality can also change how Amelia may express her symptoms.

She identifies as a lesbian, which will affect her experiences within the African-American and

Filipino communities compared to those identifying as heterosexual. This can also influence

Amelia if she talks and discloses any emotional challenges or reaches out to any support around
11

her. It will be essential to tailor her treatment plan to respect her beliefs, values, and challenges

while allowing collaboration.

Developmental Patterns

The development pattern for Amelia has shown to be complex, which may have played a

role in her challenges with both Major Depressive Disorder (MDD). A critical loss that affected

her development was the loss of her father from a work accident at the age of 12 years old. Due

to it occurring in her adolescence, Amelia was in the Identity vs. Confusion stage of Erickson’s

developmental theory, a period in a child’s life filled with emotional and physical changes.

Identity refers to the cognitive model through which individuals process and analyze information

that is relevant to their identity (Rageliene, 2016). Experiencing the sudden loss of a parent can

have long-term emotional repercussions with feelings of grief and abandonment. When assessing

grief, key differential diagnosis encompass MDD, PTSD, and normative or acute grief; studied

risk factors include demographic features, preexisting psychiatric conditions, the nature of the

death, and insufficient social support, with sudden losses potentially heightening the likelihood

of prolonged grief (Szuhany et al., 2021).

Before and after her father’s passing, the emotional abuse within her family could suggest

a challenging family environment during the development years. Further complicating

development, it has been shown that emotional abuse can be damaging to both emotional well-

being and self-esteem. Although devoid of physical evidence, these emotionally abusive actions

inflict pain, disempowerment, and trauma on the partner enduring the abuse (National Domestic

Violence Hotline, 2023). Amelia’s dyslexia was not diagnosed until her early twenties, which

may have affected her academic challenges and development. Dyslexia can often impact an

individual’s self-confidence and overall academic progress with reading, spelling, and writing.
12

Another vital aspect of Amelia’s development was coming out as a lesbian when she was

in her early twenties. Amelia likely had some emotional challenges during this time as she came

to terms with how she wanted to identify sexually. Research suggests that a positive LGBTQ+

identity is linked inversely to depressive symptoms and positively to emotional self-awareness,

self-compassion, emotional intimacy, social well-being, psychological well-being, and life

satisfaction (Hall et al, 2021). This period may have some influence over her relationships and

self-identity. Experiencing the various challenges within her life more than likely contributed to

her emotional challenges, which could have presented the symptoms of MDD.

Observable Behaviors

Amelia’s signs of irritability and anxiety at work are evident through multiple sources. In

her self-report, as per the LEVEL 2- Anger- Adult assessment, Amelia acknowledged feeling

irritated and annoyed. This self-disclosure aligns with her reported struggles in getting out of bed

and going to work, impacting her daily routine as noted in her intake form. Additionally, her

observable behaviors, including body language, communication, and overall demeanor around

coworkers, could manifest signs of irritability and anxiety. In terms of emotional distress, Amelia

has reported physical symptoms in the form of headaches and back pain. These indications give

tangible evidence of the impact of her mental health challenges on her overall well-being. Her

withdrawal from activities that she enjoyed has been noticeable by the individuals in her life,

which shows she has experienced a loss of interest and pleasure, which is connected to

depression. This behavioral change is observable by those around her, further emphasizing the

pervasive impact of her psychological state on her daily life and interactions.

Diagnosis to Rule Out

13

When assessing and diagnosing, ruling out alternative diagnoses is essential. Given

Amelia’s symptoms, several conditions come to mind, and ruling them out will be necessary to

diagnose her appropriately. The first condition is bipolar disorder, with the report of both severe

mood disturbances and mood swings aligning with this disorder. Her primary symptoms of

hopelessness, excessive worry, and persistent sadness about the events in her life do not align

with the primary criteria to diagnose bipolar disorder, which makes it less likely for a diagnosis.

Another critical aspect of ruling out bipolar disorder is looking to see if a client has experienced

a hypomanic or manic episode (American Psychiatric Association, 2013). Amelia has an absence

of the episodes, significantly decreasing the likelihood of this disorder. Post-Traumatic Stress

Disorder (PTSD) is another condition to rule out for Amelia. Amelia does have a history of

emotional abuse along with stressful experiences, which is why PTSD could be considered. It is

also important to note that PTSD also involves having intrusive symptoms, such as nightmares

and flashbacks, which Amelia does not exhibit based on what was reported (American

Psychiatric Association, 2013). PTSD symptoms are more likely to be prevalent and unceasing.

Even though her symptoms are aligned with mood and anxiety disorders more than

personality disorders, it is still important to consider the possibility. As stated previously, while

her symptoms fit the criteria of a mood or anxiety disorder, it will be essential to complete a

more comprehensive assessment. While she is also experiencing heart palpitations and panic

attacks, which could be signs of a panic disorder, she also experiences other symptoms that do

not align (American Psychiatric Association, 2013). These are having chronic feelings of

hopelessness, sadness, and consistent anxiety, which align better with the criteria of MDD

(American Psychiatric Association, 2013). Lastly, substance use disorders will need to be ruled

out due to Amelia’s reported history of alcohol use. Amelia’s primary concern is related to
14

symptoms of anxiety and mood disorders. It would be recommended that further evaluation be

completed to understand and see if her use of alcohol is a factor in her symptoms.

Limitations with Diagnosis

Several limitations could be seen with a diagnosis of severe Major Depressive Disorder

(MDD). There is potential for comorbidity or overlapping symptoms with other conditions that

introduce a layer of complexity. A study published in Scientific Reports found that the recorded

epidemiological information showed that 59.0% of individuals who are diagnosed with GAD

simultaneously meet the criteria for MDD, and the coexistence of both disorders signifies the

prevailing pattern of comorbidity comprised of both anxiety and depression (Zhou et al., 2017).

Symptoms such as emotional distress and consistent sadness, are common in various mood

disorders, which makes it difficult to analyze symptoms which are specific to MDD. This could

lead to a misdiagnosis or even overlook challenges within her life and condition. Furthermore,

the factors within Amelia’s life can influence what she is willing to share symptoms-wise and

affect the clarification of the symptoms by a mental health professional. The diagnosis accuracy

could also be affected by Amelia’s perception and description of the experiences that may

prevent her from mentally seeing the intricacy of her challenges. This can affect the accuracy of

the diagnosis given by a professional. Lastly, Amelia’s cultural factors could play a significant

role in expressing emotions and challenges, negatively affecting the diagnosis process. The

Center for Mental Health Services (2001) wrote a report stating that culture can be considered

when discussing the discrepancies in how clients communicate their symptoms and which

symptoms are chosen to be disclosed to a professional. In her case, the cultural nuances could

introduce a level of subjectivity that cultural norms may influence, potentially introducing bias

into the assessment.

 15

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.

Buch, A. M., & Liston, C. (2020). Dissecting diagnostic heterogeneity in depression by integrating

neuroimaging and Genetics. Neuropsychopharmacology, 46(1), 156–175.

https://doi.org/10.1038/s41386-020-00789-3.

Department of Health and Human Services, U.S. Public Health Service. (2001). Chapter 2 Culture

Counts: The Influence of Culture and Society on Mental Health. In Mental health: Culture,

race, and ethnicity: A supplement to mental health: A report of the surgeon general.

Hall, W. J., Dawes, H. C., & Plocek, N. (2021). Sexual Orientation Identity Development

Milestones Among Lesbian, Gay, Bisexual, and Queer People: A Systematic Review and

Meta-Analysis. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.753954.

Hernandez, L. M., & Blazer, D. G. (Eds.). (2006). Genes, Behavior, and the Social Environment:

Moving Beyond the Nature/Nurture Debate. PsychEXTRA Dataset.

https://doi.org/10.1037/e719722007-001.

Lovinger, D. M. (1997). Serotonin’s Role in Alcohol’s Effects on the Brain. Alcohol health and

research world. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826824/.

Morimoto, Y., & Sharma, A. (2004). Long-Term Outcomes of Verbal Aggression. Journal of

Emotional Abuse, 4(2), 71–99. https://doi.org/10.1300/j135v04n02_04.

 16

Mukherjee, S. (2013). Alcoholism and its Effects on the Central Nervous System. Current

Neurovascular Research, 10(3), 256–262.

https://doi.org/10.2174/15672026113109990004.

Nutt, D. J. (2008). Relationship of Neurotransmitters to the Symptoms of Major Depressive

Disorder. The Journal of Clinical Psychiatry, 69.

https://pubmed.ncbi.nlm.nih.gov/18494537/.

Rageliene, T. (2016). Links of Adolescents Identity Development and Relationship with Peers: A

Systematic Literature Review. Journal of the Canadian Academy of Child and Adolescent

Psychiatry, 25(2), 97-105. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879949/.

Rössler, W. (2016). The Stigma of Mental Disorders. EMBO Reports, 17(9), 1250–1253.

https://doi.org/10.15252/embr.201643041.

Sekhon, S., & Gupta, V. (2023). Mood Disorder. National Library of Medicine.

https://www.ncbi.nlm.nih.gov/books/NBK558911/.

Szuhany, K., Malgaroli, M., Miron, C., & Simon, N. (2021). Prolonged Grief Disorder: Course,

Diagnosis, Assessment, and Treatment. FOCUS, 19(2), 161–172.

https://doi.org/10.1176/appi.focus.20200052.

What is Emotional Abuse. The Domestic Abuse Violence Hotline. (23, July 4).

https://thehotline.org/resources/what-is-emotional-abuse/#:~:text=Over%20time%2C

%20emotional%20abuse%20can,and%20second%2Dgussing%20you%20constantly.
17

Zhou, Y., Cao, Z., Yang, M., Xi, X., Guo, Y., Fang, M., Cheng, L., & Du, Y. (2017). Comorbid

generalized anxiety disorder and its association with quality of life in patients with major

depressive disorder. Scientific Reports, 7(1). https://doi.org/10.1038/srep40511.