Your assessment paper on the final Case Study of Danial, Parts 1, 2, and 3 will provide you with an opportunity to consider psychopathology issues from a developmental perspective, and to assess the differences between children, adolescents, and adults. This assessment will provide you with a further understanding of psychopathology and improve your diagnostic skills across the life span.
The Case Study of Danial
provides three scenarios at different stages in his life. These scenarios each include:
A developmental history.
Reason(s) for referral.
Basic assessment results.
Issues in treatment.
After you read each scenario, you will be asked to respond to the same series of questions and to integrate information at each stage of Danial’s life.
Use the Case Study Response Guide to format your assignment for each of the three scenarios. Complete your assessment paper by adding a Part 4 at the end, as described in the instructions.
Respond to the questions below (
The Questions to Address for Danial…
) for each part of Danial’s case study. Be particularly careful to integrate information from each preceding developmental stage into your responses, as they provide you with valuable history. Then answer the final questions as Part 4.
Think of each part of the case study as your first exposure to Danial, but in each successive part, you will be expected to consider all material from the previous scenarios. For example:
Part 1: When you respond to the questions in Part 1, all the information you know about Danial is contained in Part 1. Your answers will relate to only this scenario.
Part 2: When you respond to the questions in Part 2, you will have access to the expanded history. Respond to the scenario presented in Danial, Part 2, but also be aware of his previous history detailed in Part 1. Think of Part 1 as information from a medical record. Be sure to integrate this information into your response to the questions in Part 2.
Part 3: When you respond to Part 3, you will have access to the full history. Respond to the information presented in Danial, Part 3 at that point. Be sure to integrate his previous history from Parts 1 and 2 into your Part 3 answer.
Part 4: This is a separate section designed to integrate important issues from this course.
The Questions to Address for Danial, After Each Part (1, 2, and 3)
What are your diagnostic hypotheses for Danial in this scenario? Justify your conclusions.
Describe what further diagnostic information you need (what further diagnostic evaluation is warranted) at the end of this scenario.
From a diathesis-stress perspective, what impact do the cultural, ethnic, and psychosexual issues have on Danial and his family in this scenario, and what other issues may play a role?
Part 4 Questions and Issues
Given Danial’s family background and his open homosexuality, what cultural and ethnic factors do you need to be aware of at the different stages of his life, and how would you deal with them in arriving at your diagnoses? Give your reasoning with supporting documentation.
Compare and contrast the changing roles of psychosexual diagnoses in the
text since the 1950s.
To achieve a successful final assessment outcome, you are expected to meet the following requirements:
Written communication: Written communication is free of errors that detract from the overall message.
Thoroughness: The paper must address each question completely. Note: Do not restate the questions in your responses.
APA formatting: Resources and citations are formatted according to APA (6th Edition) style and formatting.
Length of paper: Minimum of 12Ã¢â‚¬â€œ15 typed double-spaced pages, excluding title page, table of contents, and reference page.
Font and font size: Arial, 10 point.
Case Study of Danial
Case Study of Danial, Part 1, 2, and 3
Instructions: Respond to the questions at the end of this case study for EACH separate part.
As you progress through the assessment requirements, be careful to integrate information
from both the current and preceding parts into your responses, as they provide you with
Think of each part as your first exposure to Danial, but in each successive part, consider all
material from the previous scenarios. For example:
When you respond to the questions for Part 1, all the information you know about
Danial is contained in Part 1. Your answers will relate to ONLY this scenario.
When you respond to the questions for Part 2, you will have access to the expanded
history. You will be expected to respond to the scenario presented in Part 2, but you
will also be aware of his previous history detailed in Part 1, as if Part 1 was information
from a medical record. Be sure to integrate this information into your response to Part
When you respond to the questions for Part 3, you will have access to the full history.
Respond to the questions with awareness of his previous history, detailed in Part 1
and Part 2. You will be expected integrate this information into your Part 3 answer.
Danial is brought to you by his parents when he is seven years old and just starting second
grade. He is small for his age and moves in a fashion that could be mistaken for a girl. His
mother, Yalda, is 34. She worked as an aide in a pre-school program that Danial attended
until he entered kindergarten, Ã¢â‚¬Å“because Danial liked her to be there.Ã¢â‚¬Â She now works with and
for her 39 year-old husband, Nasir, DanialÃ¢â‚¬â„¢s father. Nasir owns and manages three
Danial has a 15 year old brother, Salim, who is a very good athlete and already the highest
scoring player on a competitive high school soccer team. This Muslim family emigrated from
Pakistan ten years ago. They have since helped YaldaÃ¢â‚¬â„¢s parents move to the U.S.
Assimilation into American culture is somewhat of a struggle from religious and cultural
perspectives, particularly as the parents want to hold on to much of their culture of origin.
Their English language skills are very good.
When they enter your office, Danial sits very close to his mother on one end of the sofa. His
father sits in a separate chair. They speak with a strong Pakistani accent. They are concerned
because Danial has been having stomachaches since the new school year started. They think
he wants to stay home with Yalda, because he behaved the same way in kindergarten and
first grade for the first month or so of school. His complaints about stomachaches, though, are
worse this year. He has always wanted someone to stay with him at night until he falls asleep
but Nasir put a stop to that at the start of kindergarten, Ã¢â‚¬Å“even though Danial cried like a baby.Ã¢â‚¬Â
Danial is a solid Ã¢â‚¬Å“A-BÃ¢â‚¬Â student.
Since kindergarten, Danial has awakened frequently at night. He has been found sleeping
outside his parentsÃ¢â‚¬â„¢ bedroom door on a number of nights because he has nightmares about
his mother being kidnapped. They are concerned, too, because it was always a battle to get
Danial to stay with a babysitter when he was a toddler. Eventually, they could only leave him
with YaldaÃ¢â‚¬â„¢s parents for an evening because he wouldnÃ¢â‚¬â„¢t stop crying if left with anyone else.
Case Study of Danial
Throughout the interview, Danial holds tightly to his motherÃ¢â‚¬â„¢s sweater or hand, despite her
obvious attempts to get him to sit up straight and to move away from her.
You ask Danial if he feels frightened, to which he nods, and says in a soft and somewhat
breathy voice, Ã¢â‚¬Å“I worry all the time that something will happen to my mom.Ã¢â‚¬Â He and his brother
speak without accent. You ask if you can talk to him by himself. He responds by clinging to his
mother, shaking his head, and saying, Ã¢â‚¬Å“I donÃ¢â‚¬â„¢t want to. DonÃ¢â‚¬â„¢t make me, please, mommy.Ã¢â‚¬Â To
which his father says, Ã¢â‚¬Å“Good lord,Ã¢â‚¬Â rolls his eyes, and turns further away from Danial.
DanialÃ¢â‚¬â„¢s personal history, and his familyÃ¢â‚¬â„¢s history on both sides, is unremarkable for mental or
medical concerns or for physical or substance use or abuse disorders. There is no history of
physical abuse, neglect, or domestic violence. All of DanialÃ¢â‚¬â„¢s developmental signs fall within
the norm. Other than his concerns of being away from his parents, he has no other behaviors
of concern, except, his father says, with another eye roll, Ã¢â‚¬Å“He likes to play with girls and dolls
and canÃ¢â‚¬â„¢t stand getting dirty. HeÃ¢â‚¬â„¢ll never be the soccer player his brother is.Ã¢â‚¬Â
Danial is now 16 years old. His mother accompanies him to the interview and tells you about
DanialÃ¢â‚¬â„¢s evaluation and successful treatment when he was seven. Ã¢â‚¬Å“He was fine after that
treatment worked,Ã¢â‚¬Â Yalda says, Ã¢â‚¬Å“but lately heÃ¢â‚¬â„¢s taken staying to himself all the time. HeÃ¢â‚¬â„¢s
always been a little different, too sensitive, you know. He gets tearful now and then. But lately
heÃ¢â‚¬â„¢s just been nasty to everyone, irritable. And he just canÃ¢â‚¬â„¢t sit still. HeÃ¢â‚¬â„¢s like a cat on a hot tin
roof. He canÃ¢â‚¬â„¢t remember half of what I tell him. ItÃ¢â‚¬â„¢s as if heÃ¢â‚¬â„¢s forgotten how to think,
sometimes. He canÃ¢â‚¬â„¢t keep his mind on anything.Ã¢â‚¬Â SheÃ¢â‚¬â„¢s also concerned because he only
weighs 130 pounds and has lost twenty pounds in the last six weeks without trying. Ã¢â‚¬Å“He eats
like a bird,Ã¢â‚¬Â she says. Ã¢â‚¬Å“HeÃ¢â‚¬â„¢s lost his appetite.Ã¢â‚¬Â
Danial appears agitated. He sulks, wonÃ¢â‚¬â„¢t make eye contact, sits as far away from his mother
as he can, and rolls his eyes when she talks. Again, his history is unremarkable for medical
concerns, or physical or substance use or abuse disorders, and there is no history of abuse,
neglect, or domestic violence. His only psychological history of note is his treatment at age
seven. He expresses irritability with his mother for Ã¢â‚¬Å“trickingÃ¢â‚¬Â him into coming to see a shrink.
His mother thinks he is angry because he isnÃ¢â‚¬â„¢t sleeping well at night, and hasnÃ¢â‚¬â„¢t been sleeping
well for several months. Further questions about that do not reveal any manic behavioral
When you talk with Danial alone, you learn that he has only one male friend, Ã¢â‚¬Å“More of a good
acquaintance,Ã¢â‚¬Â he says. Ã¢â‚¬Å“But heÃ¢â‚¬â„¢s like me.Ã¢â‚¬Â The only other people he has spent time with are a
couple of girls who are loners, too, and who Ã¢â‚¬Å“acceptÃ¢â‚¬Â him. Ã¢â‚¬Å“We donÃ¢â‚¬â„¢t really trust people much.
IÃ¢â‚¬â„¢m a lot more like them than I am like Ã¢â‚¬Å“the guys.Ã¢â‚¬Â He rolls his eyes. Ã¢â‚¬Å“You know the ones who
think theyÃ¢â‚¬â„¢re better than everyone.Ã¢â‚¬Â He studies his fingernails, which you notice have been
polished with a clear nail polish. You ask him about his relationships with Ã¢â‚¬Å“the guysÃ¢â‚¬Â and he
snaps angrily at you. Ã¢â‚¬Å“TheyÃ¢â‚¬â„¢re like my older brotherÃ¢â‚¬â„¢s friends. A bunch of jocks. To them, IÃ¢â‚¬â„¢m a
worthless piece of garbage.Ã¢â‚¬Â He laughs. Ã¢â‚¬Å“And maybe I am. Ha! Maybe!? Who am I kidding?
IÃ¢â‚¬â„¢m not worth the dirt on the bottom of my brotherÃ¢â‚¬â„¢s running shoes! Just ask my old man. My
brother was a college jock! DaddyÃ¢â‚¬â„¢s star! The big college soccer player!Ã¢â‚¬Â
For the last two months Danial has not wanted to spend time with anyone, and withdraws to
his room whenever he can escape the family. He has withdrawn from his already small group
of acquaintances as well as family, and lost interest in almost everything, including band and
the theater group, both of which he has dropped out of in the last two months. You get the
impression that Danial has started buying half-pint bottles of vodka from an acquaintance in
Case Study of Danial
the past month, but he will tell you no more about this once it comes out. You ask if he feels
depressed and he snaps at you irritably that he is not. He denies any reason for not wanting to
see people or for his loss of interest in almost everything he used to do. Ã¢â‚¬Å“NothingÃ¢â‚¬â„¢s happened
to me, I just donÃ¢â‚¬â„¢t want to be around people, any people, including you.Ã¢â‚¬Â He denies feeling
suicidal but mentions playing with his fatherÃ¢â‚¬â„¢s revolver the previous week, holding the muzzle
to his head and clicking the trigger to imagine what it would feel like if it was loaded. He thinks
about death a lot, he says, Ã¢â‚¬Å“But itÃ¢â‚¬â„¢s only an existential dream. WeÃ¢â‚¬â„¢re all going to die. ItÃ¢â‚¬â„¢s just a
matter of when.Ã¢â‚¬Â At this, he smiles again, as if to himself.
Danial, 25, works as a draftsman for a large architectural design firm. It is a fairly solitary job.
HeÃ¢â‚¬â„¢s come to see you because, Ã¢â‚¬Å“My boss told me to get help, or else. Bottom line: He wants
to fire me, but his boss, my uncle, wonÃ¢â‚¬â„¢t let him.Ã¢â‚¬Â He smiles and says, Ã¢â‚¬Å“ItÃ¢â‚¬â„¢s good to know
people in high places.Ã¢â‚¬Â
DanialÃ¢â‚¬â„¢s physician also referred him, and has sent you DanialÃ¢â‚¬â„¢s previous treatment records
(Parts 1 and 2), which indicate no significant medical concerns. You ask why he thinks his
boss wants to fire him and are told, Ã¢â‚¬Å“HeÃ¢â‚¬â„¢s always making jokes about me behind my back. I
hear Ã¢â‚¬Ëœem all laughing. IÃ¢â‚¬â„¢m his star draftsman, but he doesnÃ¢â‚¬â„¢t pay me what IÃ¢â‚¬â„¢m worth. IÃ¢â‚¬â„¢m sure
he pays the others more than he pays me, not that theyÃ¢â‚¬â„¢ll say boo about that. They have kind
of a pact, I think, to keep stuff like that from me. And my boss only gives me compliments to
get me to work harder. HeÃ¢â‚¬â„¢s not fooling me. Neither are the others. TheyÃ¢â‚¬â„¢re jealous because of
my uncle and . . . other things. You know the kind of stuff I mean.Ã¢â‚¬Â
You ask him to tell you more. He frowns at you, stares, then shakes his head. Ã¢â‚¬Å“YouÃ¢â‚¬â„¢re in on
this, arenÃ¢â‚¬â„¢t you!?Ã¢â‚¬Â He laughs. Ã¢â‚¬Å“Sure. I see it now. He gives me the names of three therapists
and tells me to see one. Smart. IÃ¢â‚¬â„¢ll bet he paid the three of you to do what he wants. You all
knew I was coming to one of you! To think I was dumb enough to believe that with three
names to choose from this had to be on the up-and-up.Ã¢â‚¬Â He shakes his head. Ã¢â‚¬Å“Jeez!Ã¢â‚¬Â
You explain that you donÃ¢â‚¬â„¢t know his boss. Ã¢â‚¬Å“Yeah,Ã¢â‚¬Â Danial says, Ã¢â‚¬Å“I believe you. Now, I suppose
youÃ¢â‚¬â„¢ve got a bridge to sell me.Ã¢â‚¬Â You explain that he is welcome to choose any therapist he
wants, and that if he prefers to end the session he is free to choose another therapist. Ã¢â‚¬Å“Sure,Ã¢â‚¬Â
he says, Ã¢â‚¬Å“so you can tell my boss I walked out, and he still gets me to work with someone in
his pocket. IÃ¢â‚¬â„¢m not falling for that. IÃ¢â‚¬â„¢m here. IÃ¢â‚¬â„¢ll work with you. He said I needed therapy and my
uncle went along with it. So, IÃ¢â‚¬â„¢m getting therapy. IÃ¢â‚¬â„¢m not playing my bossÃ¢â‚¬â„¢s game. But I donÃ¢â‚¬â„¢t
want you sending him any little messages about what we talk about.Ã¢â‚¬Â You agree that
everything you talk about will be confidential unless (in the spirit of informed consent) thereÃ¢â‚¬â„¢s a
potential Danial could harm himself or someone else. Ã¢â‚¬Å“Did he tell you I was a danger to him?Ã¢â‚¬Â
he asks. Ã¢â‚¬Å“Is that what this is about? You canÃ¢â‚¬â„¢t trust the man. HeÃ¢â‚¬â„¢ll say anything to get his way.Ã¢â‚¬Â
You reiterate that you have never spoken with his boss.
In a few minutes, he calms down and asks, Ã¢â‚¬Å“So what do we do in this so-called Ã¢â‚¬ËœtherapyÃ¢â‚¬â„¢?Ã¢â‚¬Â
You suggest that he tell you about himself, maybe what his boss is concerned about, or what
he (Danial) might want help with. After another discussion about confidentiality, he insists that
you to sign a note stating that you will not reveal anything to anyone about what he says
unless itÃ¢â‚¬â„¢s about hurting himself or someone else, Ã¢â‚¬Å“Because IÃ¢â‚¬â„¢m not going to hurt anyone
unless they try to get me first.Ã¢â‚¬Â You sign the agreement. Only then does he begin to talk about
himself, after insisting, Ã¢â‚¬Å“I donÃ¢â‚¬â„¢t want you writing all this down. And if you break our agreement,
IÃ¢â‚¬â„¢ll sue you. I will. Believe me.Ã¢â‚¬Â
Case Study of Danial
You ask about his earlier emotional issues and the event with his fatherÃ¢â‚¬â„¢s revolver, which you
read in the records. Ã¢â‚¬Å“IÃ¢â‚¬â„¢m not depressed, if thatÃ¢â‚¬â„¢s what youÃ¢â‚¬â„¢re thinking. I like everyone and
everything, I just donÃ¢â‚¬â„¢t trust Ã¢â‚¬Ëœem,Ã¢â‚¬Â he says. Ã¢â‚¬Å“IÃ¢â‚¬â„¢m happy. I sleep fine. IÃ¢â‚¬â„¢m not losing weight. IÃ¢â‚¬â„¢m
not here for happy pills. IÃ¢â‚¬â„¢m just here to find out how to get my boss off my back.Ã¢â‚¬Â He smirks.
Ã¢â‚¬Å“And, maybe, how to know if my partner is having an affair. IÃ¢â‚¬â„¢ve never been able to prove
anything, but . . . I know he is, and he gives me signs all the time. I just havenÃ¢â‚¬â„¢t caught him at
Danial is reluctant to talk about himself, but eventually answers some questions after making
you explain why you are asking each one. You learn that he drinks three to five highballs a
day on weekends, Ã¢â‚¬Å“sometimes more, lots more once in awhile,Ã¢â‚¬Â and that he has ongoing
trouble with his family of origin, whom, he says, Ã¢â‚¬Å“tried to hold him hostageÃ¢â‚¬Â to old country
ways. He tells you his parents donÃ¢â‚¬â„¢t understand him and are always Ã¢â‚¬Å“snoopingÃ¢â‚¬Â into his life,
which is why he changes his cell phone every couple of months.
Ã¢â‚¬Å“Besides,Ã¢â‚¬Â he adds sarcastically, Ã¢â‚¬Å“There are no gay Muslims, you know. My dad tells me that
all the time.Ã¢â‚¬Â He wags his head. Ã¢â‚¬Å“Hell, almost everyone at the firm is gay, and we come from
all over the world. WhatÃ¢â‚¬â„¢s he thinkÃ¢â‚¬â€that Allah only makes Christians and atheists gay?Ã¢â‚¬Â
Mental Status Evaluation (MSE) Checklist
a. Physical Appearance. Client appears
stated age, appears older, or appears
younger, hairstyle, fingernails, and so
b. Dress. Appropriate, clean, pressed,
wrinkled, disheveled, and so on.
c. Hygiene. Clean, well groomed,
presence of body odor, and so on.
2. Behavior and Mannerisms
Gait limping, slow, hurried, and so on.
Posture. Slumped or rigid.
Mannerisms. Foot tapping, eye blinking,
hand rolling, head nodding, and so on.
a. Toward Interviewer.
b. Toward Treatment.
c. Toward Others.
4. Mood and Affect
a. Mood. Sad, elated, happy, bored, and
b. Affect. Outward expression of mood
such as smiling, frowning, crying, or
Appropriateness. Does the affect
match the mood and the situation?
a. Quantity. Talkative, poverty of speech,
and so on.
b. Quality. Circumlocution, monotonous,
loquacious, loud, and so on.
Rate of Production. Mumbles, slow
production, pressured speech, and so
6. Perceptual Disturbances
a. Hallucinations. False perceptions.
b. Illusions. Misperceptions of reality.
a. Thought Content. Delusions,
obsessions, phobias, suicidal ideation,
homicidal ideation, and so on.
b. Thought Processes. Flight of ideas,
poverty of thought, relevancy, and so
8. Sensorium and Cognition
a. Alertness. Awareness of
surroundings, goal-directed thinking,
responding to the environment, and
b. Orientation. Person, place, time, and
c. Memory and Concentration.
Remote, recent past, recent, and
d. Abstract Thinking. Conceptual
thinking, ability to understand abstract
ideas, ability to use inductive and
e. Intellect and Fund of Knowledge
basic knowledge and intelligence.
9. Impulse Control
a. Sexual. Ability or lack of ability to
control sexual impulses.
b. Physical. Ability or lack of ability to
control physical impulses such as
hitting, biting, or yelling.
c. Social. Ability or lack of ability to
control social impulses.
10. Judgment and Insight
a. Social Judgment. Awareness of
others, empathy, social decision
making, and so on.
b. Insight. Awareness and
understanding of oneÃ¢â‚¬â„¢s mental illness,
insight into cause, effect, and course
c. Reliability. Is the client a good source
of information, is he or she honest,
aware, and able to report to the
therapist his or her daily happenings?
PSY6210 Case Study Response Guide
Use this outline to structure your case assignments.
1. Case Summary
Provide a brief summary of what you have learned about the individual reviewed in the
case. Include information about the individual in terms of demographics and general
history, and the sources of that information, and the reason that the individual was
referred, and by whom.
Summarize any information you may have about evaluations that have been conducted,
including the results.
2. Clinical Impression (Diagnosis)
Write the clinical impression in the DSM-5 format:
XXX.xx (Yyy.yy) Primary Diagnoses (list in order of salience).
(DSM-5 Code is first, as in XXX.xx, and ICD-10 codes next, in parentheses.)
Use the V and Z codes, or simply appropriate descriptors to psychosocial and contextual factors
of importance to the diagnostic case. These replace the DSM-IV-TR Axis IV & V used to
address these concerns.
Explain any recommendations for interventions, treatment, and/or disposition.
Address the specific questions that were asked in the instructions for this assignment.
Here is a sample assignment question and an appropriate brief response:
Question: Describe what further information you would need to accurately diagnose this
Response: To diagnose this case accurately, I would also need to review any pertinent
medical records. I would want to interview this clientÃ¢â‚¬â„¢s mother, with whom he lives, to
corroborate the clinical interview data supplied by the client, and to learn more about his
developmental history. I would also want toÃ¢â‚¬Â¦
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