Jacob is a 32-year old African-American male who just returned from his 2nd tour of duty overseas. Before he is able to begin a 3rd tour of duty, his commanding officer is mandating that he seek counseling due to what Jacob describes as “odd behaviors”. Jacob admits that over the past few weeks, he does not feel safe, but he cannot tell you why. He cannot leave the house without checking that all the doors are locked 3 times. Once he feels the house is safe, he is hypervigilant about walking the property to make sure that the outside is secure and that no one is lurking in dark corners. He does not believe that this impairs his life nor interferes with his judgment and ability to meet his daily responsibilities. He is only seeing you because he shared this with his commanding officer who is now requiring that he seek counseling.
During your intake session, Jacob discloses that he grew up in a rough neighborhood where it was not uncommon to hear gun shots and people screaming. When he was 6-years old, he witnessed his uncle being shot to death, but cannot tell you details. He describes his parents as very loving, trying to shield both he and his brother from life on the streets. His uncle’s death was never talked about. He does admit that he used to have flashbacks and nightmares of his uncle’s death, but that they went away.
Jacob also has experienced violence during his last tour overseas. While he denies actually seeing or participating in direct combat, he does admit to hearing gun fire and the cries of other soldiers. During this time, he admits to recurring thoughts of his uncle’s death. He is able to correlate his military experience with his childhood experience of trauma and violence. He describes his ability to compartmentalize those experiences as ‘the past’ and wants to move forward. Jacob sees the military as his family and wants to dedicate his life to his country. He is adamant about not wanting a wife or family of his own, for fear that “what if something would happen to them and that I would not be able to protect them”.
Formulate a Differential Diagnosis for Jacob. Consider what comorbid disorders may exist and what additional information you may need to confirm your diagnostic impression. Choose one provisional diagnosis for Jacob. Support your diagnostic impressions by walking thru the DSM-5 diagnostic criteria (letter by letter) for the proposed diagnosis and match each DSM-5 criterion with vignette content. (See Sample Vignette Analysis located under Resources for guidance)
Choose two (2) theoretical models and explain how each may conceptualize Jacob’s clinical presentation. From the perspective of each theoretical model, discuss how you would provide clinical treatment. Integrate vignette content to illuminate your treatment approach.
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