Essay on Josie Bellings
Based on the information that you have, what diagnosis would you give Josie? Please include differential diagnoses. Please match her symptoms with the corresponding DSM-5 criteria.
Josie Bellings, a 34-year-old nurse, presents to your office. Her boyfriend, Robs, is with her.
“Hi,” Josie sighs deeply. “Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.”
Robs breaks in. “She’s told me she sometimes washes her hands six times in a row. Maybe even seven or eight to be sure. She does this at home, too.”
Josie nods. “Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night.”
“Even if I’ve already locked up and she saw me do it,” puts in Robs.
“Well, I feel like I have to have some control over my world. And, um, Robs doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”
Robs adds, “Actually, I did know about that, Josie. I’m also concerned because Josie will get focused on something and then not be able to shut her mind down. She perseverates and I cannot distract her for anything.”
Josie reports that she has always had these symptoms but that they are worse recently. She reports feeling depressed, mainly because of the OCD symptoms that are causing her trouble. She denies any SI, HI, or A/V hallucinations.
with this as one of the resources***
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Josie Bellings Case Study
From the case scenario presented, I would diagnose Josie with paranoid schizophrenia. Schizophrenia refers to a mental illness that affects a person’s behavior and thinking, and the affected individual does not agree with the reality. Obsessive Compulsive Disorder (OCD) is diagnosed by assessing individual’s behavior, thoughts, and moods. As posited by Taylor (2001) the DSM-5 criteria for diagnosing paranoid schizophrenia encompass hallucinations, delusions, disorganized behavior or catatonic behavior, as well as, unusual speech and negative symptoms including hallucinations, delusions, as well as, disorganized speech.
Josie depicts constantly repeating impulses, thoughts or mental images. Essentially, these impulses, thoughts or mental images are undesirable and cause stress or anxiety. As a fact, she tries to ignore these thoughts, mental images or impulses or try to make them disappear. Moreover, she depicts behaviors such as putting things in a particular place, constantly washing hands so that her obsession can disappear. Principally, she feels that the purpose of these thoughts or behaviors is to prevent or minimize distress, or to avoid feared event or situation. Evidently, it is clear that Josie suffers from obsessive compulsive disorder (OCD) since her boyfriend reports that he realized a change in her behaviors recently. She started experiencing behavioral changes during her first years as a nurse and her anti-social behavior continues to worsen. She does not have a good relationship with her colleagues and she overdoes activities. Reports have indicated that patients suffering from paranoid schizophrenia are usually suspicious, tense, reserved, guarded and at times aggressive (Townsend, & Morgan, 2017). However, such patients can sometimes carry themselves appropriately in social situations. Josie’ mental condition assessment indicates a continuous eye contact movement. She moves her eyes furtively and suspiciously. Moreover, she experiences difficulties repeats the task severally. Josie’s boyfriend also reports that she has suspicious behavior, as well as, delusions of reference, persecution including washing her hands several times after having attended to the patients.
I would recommend psychotherapy diagnosis for Josie. Besides psychotherapy diagnosis, I would recommend Dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT). Cognitive behavioral therapy as contended by Townsend and Morgan (2017) teaches various ways of behaving, thinking, and responding to compulsions and obsessions. A specific form of cognitive behavioral therapy that is appropriate for Josie is known as exposure therapy with response and prevention that entails gradually exposing the patient to her fears or obsessions, as well as, learning positive and healthy ways of managing her anxiety. Principally, cognitive behavioral therapy will assist the patient to gain more understanding to the mental disorder she suffers from and ways of minimizing the severity of symptoms and reducing the chances of the disease worsening. Similarly, dialectical behavior therapy is appropriate to Josie since it teaches her on how to formulate healthy ways to adapt to the stress, control her emotions and improve on the way she relates with others (Townsend, & Morgan, 2017). Essentially, DBT combines both behavioral and cognitive theories and patients suffering from mental illness such as schizophrenia might benefit from this diagnosis to enhance their interpersonal skills. This diagnosis would assist Josie since she needs to learn ways of developing positive attitudes towards her work and the patients she treats. Presently, she is afraid of the patients she treats and thinks that she might develop similar illness they suffer from. As a fact, she prefers washing her hands several times after attending to clients. Moreover, she hardly engages in group activities and lacks good rapport and relationship. Precisely, she has non-specific symptoms including irritability, loss of interest and insomnia among others.
In conclusion, from the case scenario provided, it is evident that Josie suffers from obsessive compulsory disorder. Therefore, as healthcare practitioner, I would use DSM-5 to recommend cognitive behavioral therapy and dialectal behavioral therapy.
Taylor, B. (2001). Obsessive compulsive disorder. Obsessive-Compulsive Disorder: Theory, Research, and Treatment, 229.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.