Case Study
Patient Demographic:  Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual
Mental Status Exam: Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.

Presenting Problem: Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.

Question: Symptoms indicate the possibility of?
(A): Post-Traumatic Stress Disorder and Major Depressive Disorder
(B): Post-traumatic Stress Disorder and Dissociative Amnesia
(C): Adjustment Disorder and Dissociative Amnesia
(D): Post-Traumatic Stress Disorder and Traumatic Brain Injury

Correct Answer: Post-Traumatic Stress Disorder and Traumatic Brain Injury
Explanation: Carl's symptoms -- avoidance, guilt, distressing dreams, reckless and self-destructive behaviors -- have caused significant distress and impairment, indicate Post Traumatic Stress Disorder. He lost consciousness for half a day after the blast and could not remember who he was for two days. According to his medical records, he suffered from disorientation and confusion for about 11 days. Since he has been home, Carl has suffered from light sensitivity and seizures. Other symptoms included irritability, aggression, and apathy. In adjustment disorder, the severity of the stressor does not meet Criteria A of PTSD. Dissociative amnesia may or may not include exposure to a traumatic event and does not include light sensitivity, physical injury to the brain. Major Depressive Disorder also does not have to include a traumatic event and may not include any PTSD Criterion B or C symptoms (intrusion symptoms and avoidance of stimuli). Therefore, the correct answer is (D)
Competency: counseling skills and interventions