156 Case Studies

Case 1

Joan is a 22 year old call center agent working for Teletech. She recently sought the help of a physician because of
recent physical distresses she has been experiencing. According to her she feels like she is having heart attacks.
She has been experiencing chest pains and feels at times that she is choking. She recounts experiencing numbness
all over her body during the attacks as well as heat sensations which seem to rise up from her body to her head.
These attacks, according to her, seem to happen out of the blue, without warning, and reach its peak within
minutes. She says the last attack was over a month ago already but she has constantly been worrying about a next
possible episode. Because of her intense fear she is usually unable to report for work and has been having heated
discussions with her boss at work regarding her absences. Results of her physical exam turned out negative and
the doctor advised her to consult with a psychologist. During her session with the psychologist, she recounted that
she has been having problems with her boyfriend and they recently broke up before Valentine’s Day. She says it is
difficult to lose someone she loves and trusts considering that she was often physically abused by her parents
when she was still in elementary. Based on the symptoms presented and her narratives, Joan might be
experiencing what type of disorder?

Panic Disorder
300.01 (F41.0)
Risk factors: Childhood physical abuse, recent break-up

Case 2

Gideon is an 18 year old student from UP referred to a psychologist because of weird behaviors observed by his
classmates and teachers. According to his classmates, Gideon believes that there is a conspiracy among some of
the students and a teacher to kick him out of school. They said that Gideon has been very vocal about this for
about a month already. He also recounts hearing voices telling him that he does not deserve to be in UP because
he is not good enough. He interprets random conversations of his teacher and his classmates to be coded
conversations directed to humiliate him. Even the random gestures of his classmates like hand movements are
considered signals also. The psychologist, after a lengthy conversation with Gideon, also found out that he has
been experiencing other problems also together with the ones observed by his classmates. Gideon recounts to not
having interest in seemingly all activities he does. He says he feels that he is not happy almost every day and he
usually feels sleepy most of the time. He feels like he is fatigued and his abilities to think and concentrate are
impaired most of the time. He says his experience has been worse the past two weeks because the symptoms
observed by his classmates coincided with the difficulties he disclosed with the psychologist. He says he has been
experiencing this before for over a year but this recent episode proves to be the worst. Based on his estimate, this
is the third time that this has happened already. He also acknowledged that the symptoms observed by his
classmates tend to occur also in the absence of the symptoms he disclosed with the clinician. Usually this happens
for two or more weeks. Based on the presenting symptoms, Gideon would be diagnosed with what disorder?

Schizoaffective Disorder
295.70 (F25.1) Depressive type
Multiple episodes, currently in acute episode

He says he has been experiencing this before for over a year

Based on his estimate, this is the third time that this has happened already

Case 3

Margie reports constant feelings of emptiness. She has also been constantly apprehended in her school for picking
up fights. She says she has difficulty controlling her anger which in turn make her relationships with people, and
even with her close friends suffer. Her friends report that they cannot figure out how to relate properly with her.
They say she is unpredictable. There are times she is too good to be true to the point of constantly affirming them
as her true friends. However, there are times she is like a different person altogether, cursing and dismissing them
as her friends. Margie also engages in suicidal and self mutilating behaviors whenever her mood is down.
Whenever she feels good she is very impulsive and engages in shopping sprees and binge eating. Despite her
troubled relationship with her friends, it is obvious that she cannot stand being abandoned by her friends; hence
her efforts to constantly win them back. Her behaviors severely affected her grades also as well as her relationship
with her parents. If you are a clinical psychologist, what diagnosis would you give Margie?

Borderline Personality Disorder

301.83 (F60.3)

Case 4

Robert, a seven year old student in Xavier School, has often been complained by his classmates for his unusual
behavior. He is always having temper tantrums and swears a lot when he is angry. He is always engaged in verbal
and physical fights. Physical altercations however are not that damaging and do not result in physical injury. His
classmates say that he has been like this since they have known him two years ago. What his classmates do not
understand is his outbursts are unreasonable. They attest that they haven’t done anything to provoke him. His
outbursts are not in any way associated with behaviors to intimidate someone and to get or achieve something.
His classmates say his behaviors are by no means signs of bullying, which is often pre-meditated. For most of them,
they can’t figure out what are Robert’s motivations for such behaviors. His behaviors just seem to appear out of
the blue and without much provocation. Because of these, Robert has always been referred to the school
counselor and his parents are stressed about being always asked what is wrong with their son. During counseling,
Robert recalled that, as a child, he was often verbally abused by his father whenever he commits mistakes and this
resulted in emotional trauma growing up. Robert may be diagnosed with what type of disorder?