Crystal is a 48-year-old woman from a large city.

Scenario 1
Crystal is a 48-year-old woman from a large city. She lives in a resource-constrained area with marked levels of continuous gang violence and inadequate social services, such as insufficient policing. At the time of treatment, she is married with two school-age children. Crystal was referred for treatment after witnessing a gang-related killing of a 23-year-old male in front of her house. Crystal reported that she knew the young man who was shot, as he lived in the same neighborhood as Crystal. Since the event, Crystal has been feeling scared and does not want to leave her house. She has also felt anger and shame for not having the courage to prevent the shooting. She avoided talking about the event and could not walk past or look at the location of the killing, which was near her front gate. She has had trouble concentrating and sleeping, so she took an over-the-counter sleep aid to help her fall asleep at night. In addition, Crystal described that she struggled to understand why people could be so cruel to each other and reported distress related to her marriage. On assessment, Crystal reported only verbal and emotional abuse, but it later became apparent that she had also experienced physical abuse in her marriage. Crystal is also going through an intake after being arrested for drug possession.
Primary Diagnosis:
Generalized Anxiety Disorder (GAD). DSM-5 300.02, ICD-10 (F41.1)
Posttraumatic Stress Disorder (PTSD). DSM-5 309.81, ICD-10 (F43.10)
Relationship Distress with Spouse or Intimate Partner. DSM-5 V61.10, ICD-10 (Z63.0)
Assume you are a human services professional working at a psychological treatment center in a local correctional facility.
Your team meets weekly to review the clients and share perspectives to ensure appropriate care is being given. Since this will be your first meeting, your supervisor has asked you to prepare a summary of the client in the selected case, including theoretical perspectives and research regarding the client’s disorder. You will share this summary with your teammates in the meeting.
Write a 700 word summary of the symptomology presented by the client in which you:
Explain the behavioral symptoms presented by the client.
Explain how the behavioral symptoms exhibited by the client are either typical or atypical with the provided diagnosis, based on your research.
Describe the client’s diagnosis through the lens of 2 theoretical perspectives. Include details to explain how the theoretical perspectives provide a deeper understanding of the behavioral symptoms and possible causes.
If necessary details are missing from the case study, fill in the gaps with information for your research.
Cite a minimum of 2 peer-reviewed journal articles.

ANSWER
**Summary of Client**

**Client:** Crystal, 48-year-old woman

**Diagnosis:** Generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), relationship distress with spouse or intimate partner

**Behavioral Symptoms:**

* Feeling scared and not wanting to leave the house
* Feeling anger and shame
* Avoiding talking about the event and the location of the killing
* Having trouble concentrating and sleeping
* Taking an over-the-counter sleep aid
* Struggling to understand why people could be so cruel to each other
* Reporting distress related to her marriage

**Typicality of Behavioral Symptoms:**

Crystal’s behavioral symptoms are typical of both GAD and PTSD.

**GAD:** People with GAD often experience excessive anxiety and worry about a variety of topics, including their health, safety, and finances. They may also have difficulty concentrating, sleeping, and controlling their worries. Crystal’s symptoms of feeling scared, not wanting to leave the house, and having trouble concentrating and sleeping are all consistent with GAD.

**PTSD:** PTSD is a mental health condition that can develop after someone experiences or witnesses a traumatic event. Symptoms of PTSD can include flashbacks, nightmares, avoidance of trauma-related reminders, and negative thoughts and emotions. Crystal’s symptoms of avoiding talking about the killing, avoiding the location of the killing, and struggling to understand why people could be so cruel to each other are all consistent with PTSD.

**Theoretical Perspectives**

**Cognitive-behavioral theory (CBT)**: CBT is a type of therapy that focuses on how thoughts, feelings, and behaviors are interconnected. CBT therapists believe that by changing unhelpful thoughts and behaviors, people can reduce their anxiety and other symptoms.

**Psychodynamic theory:** Psychodynamic theory is a type of therapy that focuses on the unconscious mind and how it influences our thoughts, feelings, and behaviors. Psychodynamic therapists believe that by understanding and resolving unconscious conflicts, people can reduce their symptoms and improve their mental health.

**Explanation of Behavioral Symptoms through Theoretical Perspectives**

**CBT:** From a CBT perspective, Crystal’s behavioral symptoms are due to her unhelpful thoughts about the traumatic event she witnessed. For example, she may have thoughts such as “I should have done something to stop the killing” or “I’m not safe in my own neighborhood.” These thoughts can lead to feelings of anxiety and fear, which can then lead to avoidance behaviors such as not wanting to leave the house.

**Psychodynamic theory:** From a psychodynamic perspective, Crystal’s behavioral symptoms are due to unresolved trauma from the killing she witnessed. The event may have triggered unconscious conflicts related to her sense of safety and security. These conflicts can lead to anxiety, nightmares, and other symptoms.

**Possible Causes**

Crystal’s behavioral symptoms are likely caused by a combination of factors, including her genetic predisposition, her life experiences, and the traumatic event she witnessed.

**Genetic predisposition:** GAD and PTSD are both thought to have a genetic component. This means that people who have family members with these disorders are more likely to develop them themselves.

**Life experiences:** Crystal’s life experiences, such as living in a resource-constrained area with marked levels of continuous gang violence and inadequate social services, may have made her more vulnerable to developing GAD and PTSD.

**Traumatic event:** The traumatic event of witnessing the gang-related killing of a young man in front of her house is the most likely cause of Crystal’s behavioral symptoms. This event was likely very stressful and upsetting for Crystal, and it may have triggered the development of GAD and PTSD.

**Conclusion**

Crystal is a 48-year-old woman who has been diagnosed with GAD, PTSD, and relationship distress with spouse or intimate partner. Her behavioral symptoms are typical of these disorders and are likely caused by a combination of factors, including her genetic predisposition, her life experiences, and the traumatic event she witnessed.

**References:**

* American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
* Barlow, D. H., & Beck, J. S. (2011). Anxiety disorders and phobias: A cognitive-behavioral approach (2nd ed.). Guilford Press.
* Herman, J. L. (1992). Trauma and recovery. Basic Books.