Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.

Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
Vee is a 26-year-old African-American woman who presents with a history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.”
When she is stressed, Vee says that she often “zones out,” even in the middle of conversations or while at work. She states, “I don’t know who Vee really is,” and describes a longstanding pattern of changing her hobbies, style of clothing, and sometimes even her job based on who is in her social group. At times, she thinks that her partner is “the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at the thought of him leaving her. Vee reports that, before she began dating her current partner, she sometimes engaged in sexual activity with multiple people per week, often with partners whom she did not know.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
Describe the presenting problems.
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
Discuss which cluster the primary diagnosis belongs to.
Formulate and prioritize a treatment plan.
ANSWER
Presenting Problems:
Vee presents with a complex set of mental health issues and self-destructive behaviors. The primary presenting problems include:
1. Non-Suicidal Self-Injury (NSSI): Vee has a history of cutting her arms and legs since adolescence. NSSI is a concerning behavior that indicates significant emotional distress and coping difficulties.
2. Suicidal Ideation and Attempts: Vee has made two suicide attempts by overdosing on prescribed medications. She also reports chronic suicidal ideation, using it as a way to cope with her emotions.
3. Identity Disturbance: Vee experiences a sense of identity confusion and often “zones out.” She struggles to maintain a stable sense of self, leading to frequent changes in her hobbies, clothing style, and even her job based on her social group.
4. Impulsivity and Relationship Instability: Vee exhibits impulsive behavior, particularly in her romantic relationship. She alternates between idealizing her partner and feeling intense anger or frustration. Her impulsivity extends to sexual behavior with multiple partners.
Primary Diagnosis and Differential Diagnosis:
Primary Diagnosis: Borderline Personality Disorder (BPD) – DSM-5 Code: 301.83
Differential Diagnosis:
1. Bipolar Disorder (BD) – DSM-5 Code: 296.xx
– Vee’s mood swings and impulsivity might be mistaken for bipolar disorder, but her symptoms seem more consistent with BPD due to the chronic nature of her emotional instability and identity issues.
2. Major Depressive Disorder (MDD) – DSM-5 Code: 296.2x or 296.3x
– Although Vee has a history of suicide attempts and chronic suicidal ideation, her mood disturbances appear to be more related to her borderline personality traits than a primary mood disorder like MDD.
Cluster:
The primary diagnosis, Borderline Personality Disorder (BPD), belongs to Cluster B of personality disorders. Cluster B disorders are characterized by emotional dysregulation, impulsivity, and dramatic or erratic behavior. BPD specifically involves instability in self-image, relationships, and emotions.
Treatment Plan:
1. Safety Assessment: The immediate concern is Vee’s safety due to her history of self-injury and suicide attempts. A thorough safety assessment is necessary.
2. Dialectical Behavior Therapy (DBT): DBT is an evidence-based treatment for BPD. It focuses on emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Vee can benefit from learning these skills to manage her emotional volatility.
3. Individual Psychotherapy: Long-term individual therapy should address identity issues, self-esteem, and the core features of BPD. Cognitive-behavioral therapy (CBT) and schema therapy are also effective options.
4. Medication Evaluation: Consultation with a psychiatrist is essential to evaluate the need for medication, especially if Vee’s mood instability is causing significant distress or impairment.
5. Psychoeducation: Education about BPD and its management should involve Vee’s partner to enhance understanding and support within the relationship.
6. Crisis Plan: Develop a crisis plan that includes coping strategies for dealing with suicidal ideation and self-injurious behaviors. Vee should have access to crisis hotlines and emergency contacts.
7. Support Groups: Encourage participation in support groups for individuals with BPD. Peer support can be invaluable in recovery.
8. Regular Follow-Up: Maintain ongoing assessments and follow-up appointments to monitor progress and adjust the treatment plan as needed.
In conclusion, Vee’s presentation is indicative of Borderline Personality Disorder, characterized by emotional instability, identity disturbance, impulsivity, and self-destructive behaviors. A comprehensive treatment plan, including DBT and individual therapy, can provide Vee with the necessary tools to manage her symptoms and improve her overall well-being.