Case Study
Patient Demographic: Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.
Presenting Problem: Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.

Question: Molly's symptoms are indicative of?
(A): Persistent Complex Bereavement Disorder
(B): Adjustment Disorder
(C): Major Depressive Disorder
(D): Post-Traumatic Stress Disorder

Correct Answer: Persistent Complex Bereavement Disorder
Explanation: Persistent Complex Bereavement Disorder is a diagnosis used for those who have experienced the death of someone close to them, with other specific criteria. These include longing for the deceased, preoccupation with the deceased of circumstances of the death, marked difficulty in acceptance, emotional numbness, a desire to join the deceased, and a distrust of other individuals. Molly is showing symptoms consistent with this diagnosis and symptoms have persisted for more than 6 months. Although Molly is exhibiting distress and impairment in functioning after an indefinable stressor (her father's death), it has lasted longer than 6 months. Additionally, Molly's symptoms are more severe than the diagnostic criteria for Adjustment Disorder with Depressed Mood which includes, low mood, tearfulness and feelings of hopelessness. Post-Traumatic Stress Disorder can be diagnosed after someone experiences the sudden death of a close family member. Although Molly is experiencing some symptoms of PTSD such as intrusive thoughts, Molly does not meet the criteria of persistent avoidance of stimuli that remind her of the event. In fact, she is preoccupied with the event and perseverates on details of the accident and similar events. Finally, although Molly is showing many symptoms of Major Depressive Disorder, she is focused on the loss of her father. Her symptoms are more consistent with Persistent Complex Bereavement Disorder. Due to the precipitating factor of her symptoms, Major Depressive Disorder is not the best diagnosis at this time. Therefore, the correct answer is (B)
Competency: professional practice and ethics