Psychosocial and Treatment Plan Case Study
Psychosocial and Treatment Plan Case Study
Dr TJ Farnum
Diagnosis: Opioid Use Disorder, severe, F11.20 (ICD-10) (Active)
Narcissistic personality disorder and Insomnia
Narcissistic Personality Disorder DSM-5 301.81 (F60.81)
Dr. T.J. Farnum was a 48-year-old single Caucasian male, who presented for treatment with feelings of discontent due to his court-mandated obligation to attend six counseling sessions. The client was to follow the directives from the court from his arrest for DUI charges. Further, the client explained that the investigating officer charged him with DUI because he could not walk in a straight line. The client experiences a chief complaint of chronic back pain that extends into the neck. Besides, the client also reported injuries from a car accident seven years ago which caused severe back pain and problems sleeping. Substantially this has made him to functions on less than three hours sleep daily.
There is no other history of psychiatric disorders, psychiatric treatment or hospitalization, suicidal behaviors or substance abuse in closely related family members. The client reports no past psychiatric/psychological history. However, the client stated that he suffers from Orthostatic hypotension and severe back pain from a car accident. He reported balance issues which he attributed to back pain/sciatica. Additionally, he is also currently taking medication prescribed pain medications to manage the pain and has been hospitalized in the past to remove kidney stones.
The client has described a history of pain opioid and is currently prescribed oxycodone for pain management and Lotrel for hypertension. Similarly, he also reports pain management history with tramadol then stepped up to Flexeril. The client reports consuming caffeine regularly while denies alcohol abuse although there he admits taking two drinks per day in a social setting. In regards to drinking habits, the client indicated that he never drinks more than two drinks per day and only drink occasionally. Moreover, the client has also relied on pain medication, but in spite of this dependence, he experiences little pain relief. There are various types of substance which the client reports to use and it includes Oxycontin. Similarly, there is a pain medication used by the client beyond the prescription level in an attempt to obtain relief. Substantially this has been steady with an increase in the amount and frequency of the substance abuse as his tolerance level has increased. Notably, the client has consistently sought medical attention from several medical providers for prescription pain medication. Correspondently, this has caused the client to become dependent on the use of medication and maybe resulted in addiction.
The background of the client indicates that he is single and lives home alone with his dog. Besides, he had a traditional upbringing and is the oldest of three siblings. Born and was raised by both parents in Ozark, Al, the family is essential in his life especially the grandparents are important. This can be noticed with the fact that his grandparents lived nearby and played a role in his upbringing. The client said that his family is inferior as he started college at the age of 16. This was a normal childhood although his parents had a limited education which he explained that they hold master’s degrees. The client considered his grandfather to be “exceptional”. The client stated he looked up to his grandfather and held high regard for him. Client stated that there was no family history of abuse to include physical, sexual or substance. The client refused to answer questions about sexual orientation
The client can be described to be introvert given the fact that his social life is secluded with few friends who are always available for him whenever he needs assistance. For instance, he states that a friend recently bailed him out of jail. There was a past relationship although it was not significant enough to keep but due to his attitude of believing that people lack intelligence compared to him. There are no close family relationships in the life of the client and the hobbies he enjoys entail reading and writing. Find a reading and writing relaxing because he is sharing his knowledge with the world. the love for reading is attributed to the education level of the client.
Further, he has three doctoral degrees in psychology, clinical social work and applied statistics. As a result, his life has revolved around working in education most of his life. The client stated he has “always been academically superior”. He explained that having credentials is meaningful to him. He is currently employed with the University of Alabama. He stated he recently began a new position with the University of Alabama. Over the past five years, the client reported he has held positions with seven different places of employment. However, the main reason for quitting from past jobs is because he is not getting along with co-workers. The primary concern on this action is that he feels uncomfortable with the people around him. The believes that the co-worker often upset him and as a result it caused him to intentionally hit his car. More importantly, he also believes in working alone where he can be certain to enjoy working. The client’s socioeconomic status is upper middle class, and he states he is “satisfied with his lifestyle”. The criminal history addressed is mainly driving under the influence of alcohol. There is no affiliation to religion or even no significant cultural/ethnic practices. These conditions have forced the client to cope with stressful situations by reading and writing. The patient coping methods are adaptive/maladaptive since he believes to be excellent in all the activities.
Ruled out other diagnostic concerns and behavioral issues.
During the interview, the client was well dressed and neatly groomed. The client presented as resistant and angry to most of the questions during the interview. The client exhibited defensiveness and anger during the interview and was minimally cooperative and argumentative throughout the interview as well as often questioned the clinician level of competency. Besides, there are times when the client was uncooperative and seemed uninterested in participating in the interview. Despite these inconveniences, his rate of speech and tone seemed natural and also the thought processes were logical although he demonstrated poor insight into his situation. There was no exhibition of psychotic symptoms in his thought content. More importantly, the client denied having any obsessions, compulsions, or phobias. His memory seemed unimpaired as he also seemed to be fully oriented. The client’s intelligence was estimated to be above average but his judgment and impulse control are inadequate. Substantially this is evident from DUI and his abuse of prescription medications. He denied any suicide or homicide ideation.
The Client has chronic pain, stress relationships, legal issues, and abuses opioids. These also seem to present the client to live in a state of chronic anger and displeasure with others. There is also evidence of grandiose ideas regarding his abilities, education, and accomplishments. The client described a pattern of attaining far less sleep than would normally be needed. In spite of attempts to try to get the client to be more realistic, his grandiosity continued. Moreover, he indicates that he did not like past jobs because he doesn’t like dealing with students or faculty at work. The client described feelings of anger directed at those who discount his grandiosity. Moreover, he believes that some of the jobs were boring and did not match his level of education and also tends to be quite judgmental of others
The client frequently has eruptions of intense and inappropriate anger triggered by seemingly insignificant stressors. The client described a history of engaging in impulsive behaviors that have the potential for producing harmful consequences for himself. It is also noted that the client has very poor impulse control and coping skills. In most cases has denial regarding the negative consequences of his substance although he acknowledged drug abuse. This began after surgery and continued abuse in spite of the negative impact he felt during the time he was taking drugs. The client has continued to abuse prescription drugs despite recurring physical, legal, problems that were directly caused by substance abuse. The denial for substance abuse even though he is using them has caused many problems in his life leading to the addition of drug abuse. The incidence of addition can be determined by the confirmation on the pattern of chronic drug abuse. Similarly, the client made frequent pessimistic verbalizations about his inability to control the pain or live a normal life or be understood by others. There are minimal recognition and understanding of substance abuse and mental health issues. Therefore, understanding the displays vulnerability for further substance use or mental health problems. The client reported that he had no previous treatment for alcohol or drugs.
Dr. Farnum met full DSM-IV criteria for Narcissistic Personality Disorder. In the interview, the client was prone to express and assert his superiority to others. He also verbalized throughout the interview how he was more successful than most people as he possessed a superior intellect and unique skills. Overall, the client negative or oppositional attitude toward the environment, likely impeding the formation of healthy relationships with others. The client responses suggested an excessive concern with issues of personal space and, perhaps, a lack of interest in interacting with others. Unfortunately, his ideational style suggested relative inflexibility. As a result, of the client behaviors, others may get the impression that he has little concern regarding their opinions or values. For example, when discussing his thoughts about himself in relation to others
The client has some difficulty tolerating and coping with physical problems. Problems may interfere with recovery and mental health treatment. This patient may cause neglect care of serious problems affecting the client. Moreover, it was also noted that the client is functionally impaired during acute illness or from chronic symptoms, and illness interferes with treatment. The main severe symptoms of emotional, behavioral, or cognitive problems, very poor impulse control and coping skills. Additionally, the client displays inconsistent compliance, minimal awareness of either the client’s addiction or mental disorder, and is minimally cooperative.
Defense Mechanisms: The client minimizes the impact or severity of his illness by applying the essence of denial cases from his actions such as drinking alcohol.
The motivation for Change: The client appears poorly motivated for change.
Addictive Behaviors: The client describes problems with prescription opioids, as is elsewhere described.
The client has no awareness of the negative impact of mental health problems or substance abuse. No coping skills to arrest mental health or addiction illnesses.
The understanding of narcissistic personality disorder is characterized by a long-standing pattern of grandiosity which is either in fantasy or actual behavior. Similarly, it is an overwhelming need for admiration and can usually be a complete lack of empathy towards others as experienced by the patient in this context. Therefore, it is essential to understand the primary goals and objectives which can be achieved in the short and long term as part of diagnostic measures. The personality disorders such as narcissistic are mainly diagnosed by a trained mental health professional such as psychologist (Caligor, Levy & Yeomans, 2015). The families, physicians, and general practitioners are generally not trained or well equipped to ensure this type of psychological diagnosis is managed. The goal is to get treatment as soon as possible for childhood mental health problems to be put into consideration. The aim of this is to assist in evaluating the relevant aspects which might be the cause. Similarly, the other goal is to participate in family therapy to learn healthy ways of communicating or coping with conflicts and emotional distress (Caligor, Levy & Yeomans, 2015). Lastly, the other goal is to attend parenting classes to seek guidance from therapists with assistance from a mental health professional.
Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415-422.