Case Study
Patient Demographic: Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)
Mental Status Exam: Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner
Presenting Problem: You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.
Other Contexts:    vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week

Question: Which of the following would be considered a differential diagnosis for adjustment disorder?
(A): Disinhibited social engagement disorder
(B): Normal stress response
(C): Bereavement
(D): Generalized anxiety disorder

Correct Answer: Normal stress response
Explanation: When bad things happen, it is normal that it affects the individual. A normal stress response is expected for situations that are difficult, but what distinguishes it as an adjustment disorder is when the stress affects functioning. Generalized anxiety disorder would involve anxiety surrounding general situations that affect functioning, but this would not be appropriate because the anxiety is surrounding his relationship with his wife and children. Although the client is experiencing the loss of a relationship, bereavement is not a consideration because the client is experiencing anxiety and depression surrounding the adjustment to a different way of life as opposed to just about the loss of a relationship. Disinhibited social engagement disorder is when children approach and engage with individuals with whom they are not familiar, but this does not define this individual’s situation. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis