Case Study
Patient Demographic: Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)
Mental Status Exam: Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia
Presenting Problem: You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.
Other Contexts:    tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her

Question: Which one of the following specifies the level of severity of depression for this client?
(A): Suicidal ideation
(B): Effects on functioning in multiple settings
(C): Number of criteria met over the minimum criteria for diagnosis
(D): Level of depressed mood reported

Correct Answer: Number of criteria met over the minimum criteria for diagnosis
Explanation: The number of criteria met that is over the minimum criteria for a diagnosis of depression is how a counselor specifies the severity of the depression as mild, moderate, or severe. This client is diagnosed with moderate depression, which is defined as being in between mild and severe depression (in which mild depression meets an amount of criteria just over the minimum requirements and severe depression meets an amount of criteria significantly over the minimum requirements). Suicidal ideation does denote the severity of the depression, but it does not affect the specifier other than being another criterion that is counted. The level of depressed mood is not measured when considering depression other than the state of being in a depressed mood more often than not. The effect of depression on functioning is an important criterion to consider and is also a criterion for the diagnosis of major depressive disorder. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis