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Identify the DSM-5 diagnostic (or diagnoses) and associated code(s), explain the diagnosis in plain terms, and then outline how the juvenile's presenting symptoms in the case study fulfill each of the criterion related with the selected diagnosis.
According to the United States Department of Justice (2011), there are numerous hypotheses created by scholars to explain the link between interpersonal and intrapsychic experiences. These approaches describe how interpersonal relationships impact the internal world. The theories begin by explaining how these interpersonal abilities become internalized and become a part of an individual's personality. According to Freud, (1996), parent-child relationships are immensely crucial as without it; the child can quickly develop mental illness. Without proper parent-child relationship, the child might fail to negotiate psychosexual stages successfully. Sigmund Freud explained each stage of a child’s development and how this growth is directly related to the needs and demands of the body of an individual all developing from a sexual base. Through these relations, Freud offered in-depth explanations for human behavior conceptualized as psychosexual stages of development. According to Carley, (2015), every stage in an individual’s life has its requirements to prevent undesired outcomes at all levels of development. In his theory, Freud explains that abnormal mental situations can occur as a result of that individual trying to adapt to extremely challenging circumstances. Sigmund Freud developed the psychodynamic theory. He explained that the tendency of an individual being aggressive is the instinctive drive. This drive is related to the person and never the situation, and since it is intrinsic, it is unavoidable. The destructive energy manifests itself through the individual being aggressive to others or self through self-destructive behaviors like using drugs or committing suicide. The life and death instincts are in constant expression and satisfaction. The aggressive drive is part of id (psyche motivates behavior) while ego (rational self) and superego (the ideal image of an individual) normally oppose and repress aggressive impulses (Freud, 1996). Anna Freud inherits Freud’s psychoanalytic information and goes on to explain how parent-child relationship can cause pathogenic behavior. Anna Freud recommends parent-child emotional attachment as the ultimate solution to fuse and neutralize aggressive urges in later life of an individual. Therefore, from the above explanation, since aggression is intrinsic, it cannot be eliminated but can be controlled (Freud, 1996).
Corresponding codes in Sara’s case include violent behavior like strangling other children, committing the two murders, deceitful behavior like telling lies and stealing from surrounding shopping stores. Sara has poor social skills and normally bullies other children around her. In her early childhood years, Sara was exposed to maltreatment from her mother. For example, the number of times attempted suicide was reported, when she fell off from the window. Her mother normally neglected her, the distance between her mother and herself, loneliness and at some point at an early age, she was forced to indulge in sexual activities with men by her mother (Carpenter, 2011). All these are codes of abuse expressed by the victim and it is evidence that she is suffering from mental health problems.
Application of this theory to the case
Sara’s case can be classified as psychodynamic condition and the parent-child relationship. From the example presented, it is evident that Sara in her early years suffered fatal child abuse which according to U.S Department of justice, (2011), has caused some deaths around the world. According to Carpenter, (2011), the WHO educates that 57,000 deaths of children were recorded in the year 2000 as a result of fatal child abuse. The abuse Sara experienced was as a result of her mother having a low income, single motherhood, even though she was later married to Blard who is also not a good example to Sara because he is arrested most of the time and had a criminal history. Apart from physical abuse, Sara was almost killed through brutal ways by her mother and exposed to sexual abuses and neglect. In this case, is has been identified that the relationship between Betty, (Sara’s mother) and Sara was undesirable. Betty wanted to kill Sara when she was still you, could have been the one who threw her out of the window and did not take good care of her. Kevin, Miner, & Marquis, (2010) argue that the relationship between parent and child dictates what goes on in the mind of the child because they are vital to the development of self-concept, concept of others and the quality of relationships that child will have throughout their lives. Musanka, (2014) also notes and supports these views by noting that the early caregiver-child relationship is mostly internalized by children because they get to learn about themselves and others in the way they are being treated. Therefore, this framework suggests that the nature of this internalized relationship impacts on the sense of self and the sense of others and if this relationship was undesirable, there is the vulnerability of that child suffering from psychological problems. Since Sara sustained a violated childhood from her caregiver, the mental problems she is experiencing currently were bound to happen (Musanka, 2014).
Conduct a differential diagnosis (or diagnoses) by exploring an alternative diagnosis that they considered but chose not to assign. Similar to the diagnosis assigned, explain the diagnostic criteria for the differential/contemplated diagnosis and detail in what way the individual met and did not meet each criterion.
Another theory this paper would attach to this case could have been:
The attachment and security theory
According to Carley, (2015), the attachment and security theory is highly associated with the psychodynamics and parent-child relationship and was developed by Bowlby in 1969. It also emphasizes on the parent-child relationship and how they guide the development of an individual’s personality. The only difference is that unlike the parent-child relationship theory which focuses on people’s perception and their prior experiences, Bowlby is interested with the characteristics of their relationship. This theory has a stronger empirical foundation. If the parent’s behavior fails to make the child in question feel secure, safe and trust others, the child finds it very challenging to regulate their emotions. The child will need adaptively and can develop negative and insecure views of themselves and others. By doing so, these children will have already developed a psychological disorder (Kevin, Miner, & Marquis, 2010).
Another theory that would have explained case study is the developmental psychology. This theory explains abnormal behavior from lifespan development perspective. The theory considers a negotiation and attainment of earlier developmental tasks and how they can affect an individual. The journey of life an individual takes which includes their failure and success may leave a person unprepared to meet future challenges which could lead them into psychopathology. As a result of such an environment, an individual may suffer from low self-esteem, depression, difficulty in making friends and keeping relationships, loneliness, violence, and anxiety (McLeod, 2017).
Provide treatment recommendations and the rationale for why each was provided
Functional family therapy is one of the recommended therapies for Sara. This is a brief family-centered approach where services are given to the youth and their parents. It is recommended to families with teenagers who have developed a violent behavior; there are substance use, conduct disorder, and disruptive behavior.
The second recommendation is the Cognitive-Behavioral Interventions can also be used in Sara’s case. Cognitive behavioral interventions are ways that psychologists can use to deter future crime among young juveniles. In this response, Sara may be taught to be aware of social cues which help her solve her problems, develop nonaggressive responding techniques, anger management, development of social skills and group treatment models. CBI will restructure Sara’s thinking and teach her pro-social cognitive skills through the use of different types of cognitive approaches.
Multisystem therapy is also another treatment recommended for Sara with mental health problems. It fits situations with identified casual factors and correlating factors like substance abuse and delinquency. It also takes care of juveniles who have emotional issues.
The wraparound approach can also be recommended for Sara. This is a type of care that has proper planning which rotates around the child and the family and has a set of community activities. It also supports the child and the family so that they can achieve a positive outcome. This treatment plan was developed by the child and adolescent service system program, and they use a coordinated network of mental health. It also incorporates various types of systems of care. Even though it is challenging, it is instrumental in restoring the mental health of a patient.
Multidimensional treatment foster care can also be used in Sara’s case because her condition is severe. She also suffers from chronic emotional and behavioral disorders. Consideration is given by trained, local and supervised families for six to nine months. During this period, family therapy is also provided to the affected family.
Also discuss diversity factors and identified risk and protective factors related to delinquency taken into consideration with the presenting problem, diagnosis (or diagnoses), and treatment recommendations.
Diversity factors, identified and protective factors related to delinquency
Currently, there is no single path to delinquency, and many chances and risk factors increase the opportunity for the youth to get involved in an offending behavior. Misconduct results typically as a result of the interaction, manipulation, and protective factors can trigger a child to get involved in mischievous behavior. For example, a child may be triggered by restlessness, substance use, poor financial backgrounds, hyperactivity, child abuse, exposure to domestic violence, antisocial behavior, aggression, Dishonesty, Antisocial parents, poor parent-child relationships, separation of parents, abusive parents, child being neglected and low parental involvement in the child’s life. The child can also turn to be a delinquent when she comes from weak social ties, antisocial peers and low-income family relationships.
When diagnosing Sara’s problems, a psychologist will look at symptoms which are categorized into four classes. The classes include aggressive behavior like fighting, bullying, and cruelty to animals, if the patient is disruptive and destructive like vandalizing, deceitful behaviors like stealing and shoplifting, and if the juvenile consistently violates rules at school and home.
According to Musanka, (2014), since juvenile crime is serious and signifies a proportion of total crime activity in the neighborhood, it is supposed to be handled with a lot of care as these juveniles deserve and require special handling. This is because these juveniles are in a formative state and criminal behavior identified should not continue into adulthood. This then requires that Sara should be rehabilitated. Rehabilitation means that Sara will be put under a correctional program for juveniles. Because Sara’s issues result from interrelated factors, the juvenile justice system will not be entirely appropriate for her. A dynamic correctional system that extends beyond mere treatment within the justice system will be most suitable. Her treatment will require an ultimate care system which is interwoven with intervention models. The juvenile justice system, on the other hand, will provide mental health for this patient. Some of the treatment models to be considered in this case may include professional clinical care, psychopharmacology and the environment that she lives in should be protective and stress-free (U.S department of justice, 2011).
Abnormal Psychology . (n.d). Retrieved October 8, 2017, from http://www.blackwellpublishing.com/intropsych/pdf/chapter15.pdf.
Carley, S. (2015). Psychodynamic Theories: Freud, Klein, & Adler. NewYork: CreateSpace Independent Publishing Platform.
Carpenter, M. (2011). Juvenile Delinquents, Their Condition And Treatment. London: Nabu Press.
Child abuse and neglect by parents and other caregivers. (2014). Retrieved October 8, 2017, from http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap3.pdf.
Freud, S. (1996). Psychoanalytics. Washington DC: Sage Publications.
Kevin, F., Miner, J., & Marquis, A. (2010). Theoretical Models of Counseling and psychotherapy. NewYork: Routldge.
McLeod, S. (2017). Simply Psychology. Retrieved October 8, 2017, from https://www.simplypsychology.org/psychodynamic.html.
Musanka, T. (2014). Sigmund Freud's psychodynamic theory. The origins of aggression. London: GRIN Publishing.
Psychodynamic Theory. (n.d.). Retrieved October 8, 2017, from http://ncsss.cua.edu/res/docs/field/PsychodynamicHBSE.pdf.
U.S department of justice. (2011). Office of justice and deliquency prevention , 5-11.
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