Case Study

Overview

A student on the dean's list every semester, Carrie came into treatment because she felt she was simply not herself anymore. She used to remember times when she was happy. Recently, her boyfriend had just broken up with her. She was dating him for approximately ten months. The breakup came out of no where and she was not expecting it. At one point they had talked about taking a break, but it was brief and they both decided against it. However, she did mention that he was the reason she was here. He felt it was time for her to take control of her life again and be the person she was when she started seeing him. She admitted she knew she wasn't the same either and when he said that she promised him to seek treatment.

Further on in the session, Carrie explained she had been raped that summer. She knew her attacker and had dated him. She was with her last boyfriend at the time, and she felt that he had helped her through it completely. However, she would no longer engage in large social groups in fear another attack would happen. She could not associate herself with anyone that was a mutual friend of his. Not only was this a hindrance, but also every time

that her boyfriend would try to kiss her, she simply did not feel the love and affection she used to feel before the rape, it was almost as if her body was "numb to the feeling of love." She was scared this pattern would continue throughout her other relationships. She believed this was the case because it brought back memories of her trauma. The last thing she mentioned about this trauma was the fact that at least once a night she would wake up in panic that she was once again being raped. She figured this led to the eventual break up even though he denied that it had a part in it. The main reason she felt this was due to the fact that she felt that if she had not been at that house at the time of the rape, the rape would have never happened. She said if she had not been drinking it never would have happened. Lastly she contributed the rape to the fact she was not as strong as she could be. In all actuality, she blamed herself for the rape.

As a new student at her school, Carrie had not felt she had any close friends to talk to about her break up. She felt she was just another number in all of her classes. As an avid track athlete in high school, Carrie was running track at a Division I school before her transfer to her present school. She had school records there, the coach helped her improve her times, and she absolutely loved running. However, due to recent heart problems ventricular arrhythmia and recent, recurrent asthma attacks, she was forced to quit running and not do physical activity or put herself in any situation that would over exert her heart. She felt that since she could not run, she was not doing the thing that she loved to do more than anything in the world.

She felt she did not have anything to look forward to during the day. Because she was forced to quit running due to her ventricular arrhythmia, she felt something was missing in her life. Carrie said she had a strong support system in her family, and knew things would turn out okay with her heart. However she felt it brought extra stress to her life. When asked about depression in her family, she said she had an uncle with depression but neither her parents nor brother had been diagnosed with depression.

Assessment

I told Carrie that as a college student, it was extremely hard to cope with all these recent occurrences in her life without talking to someone. She agreed with me, yet she once again emphasized that fact that she did not have a close group of friends at school that she felt comfortable talking about these things too. Carrie cooperated throughout the visitation. It was obvious she felt she needed help and was willing to seek help.

Because Carrie was struggling with so much in her life, I felt it was necessary to see how depressed she was about the recent events in her life. I had Carrie take the MMPI-2 profile to determine her amplitude of her depression. Her results indicated she was experiencing a moderate depression. However, when she took the Beck Depression Inventory-II, her results indicated she had severe depression. From these two tests, I came to the realization she may have a moderate depression with relapses into severe depression. I also wanted to know Carrie's extent of her trauma, and how she was dealing with it at that point. To determine the severity of her trauma, I decided to ask her questions that would give me a better insight to her anxiety from the trauma. From the interview I concluded that she was attempting to cope with the trauma, but did not know where to start and simply needed guidance with coping strategies.

Diagnosis

The results of Carrie's tests along with her interview made me come to the conclusion that Carrie was not only suffering from depression, but also with Post Traumatic Stress Disorder, seeing how she had the symptoms for over one month. Though her depression may be severe at times, there is no indication that would lead me to believe she is a threat to herself or others. The signs that point to Major Depressive Disorder are her depressed mood, her appetite change, her change in sleep patterns, along with the feeling that her rape led to her boyfriend breaking up with her. As for Post Traumatic Stress Disorder, she endured the following symptoms - she was involved in an event that was a threat to herself, she felt helpless during the event, she had loss of sleep due to the fact she cold not get the trauma out of her head, she avoided kissing her boyfriend, and she could not stay asleep.

Axis I: Major Depressive Disorder, Post Traumatic Stress Disorder

Axis II: No evidence of a personality disorder

Axis III: Ventricular Arrhythmia, Asthma

Axis IV: Problems keeping close friends.

Axis V: Current Global Assessment