The case study of Miranda Cooper, a 52-year-old divorced Caucasian woman, is complex. Miranda presents with suicidal ideation, self-harm, and a history of substance abuse. Her personal history of physical and sexual abuse and family history of mental disorders has contributed significantly to her d...
3/27/2023 Diagnosis of Miranda Cooper
PSYC3009: Abnormal Psychology
Words: 2651
Talia Liebovitz
UNIVERSITY OF THE WITWATERSRAND
,The case study of Miranda Cooper, a 52-year-old divorced Caucasian woman, is
complex. Miranda presents with suicidal ideation, self-harm, and a history of
substance abuse. Her personal history of physical and sexual abuse and family history
of mental disorders has contributed significantly to her diagnosis. Her most recent
suicidal ideation was triggered by the loss of her son, who committed suicide three
months before her admission. Miranda has a history of alcohol abuse and, until four
weeks prior to her admission, was two years sober. In this essay, the difference
between abnormality and normality, along with the reasons Miranda’s behaviour
constitutes abnormality, will be discussed. A further critical and diagnostic analysis of
Miranda Cooper using the Diagnostic and Statistical Manual of Mental Disorders 5th
edition (DSM-5) will be provided presenting the primary diagnosis of posttraumatic
stress disorder (PTSD) and differential diagnoses of Major Depressive Disorder (MDD)
that will be discussed and elaborated on. The causes and aetiology, prognosis, and
the best cause of treatment of PTSD will also be provided.
It is difficult to correctly define ‘normal’ and ‘abnormal’ behaviour as it is a complex and
contested issue due to the subjectivity of individual perceptions of what is considered
normal. One could say that abnormality is anything outside of what is accepted by
society, or even dangerous behaviour towards oneself and others, but this opens many
questions and debates. To combat these continuous debates, the DSM-5 provides a
widely accepted definition that abnormal behaviour consists of behavioural,
psychological, or biological dysfunctions within an individual that are unexpected in
their cultural context and associated with present distress and impairment in
functioning, or increased risk of impairment (American Psychiatric Association, 2013).
Ultimately the behaviour must be deviant, atypical and maladaptive, symptoms must
impair functioning and behaviour must cause personal distress (Barlow et al., 2017).
In determining whether a mental disorder is to be considered abnormal, it is important
to understand that mental illness is not all-round different behaviour, it is just an
intensification of societally considered normal behaviour (Sweet & Decoteau, 2017).
Miranda’s suicidal ideation, substance abuse, previous self-harm and initial refusal to
voluntarily be admitted, as well as her uncooperativeness to be treated are examples
, of deviant behaviour as they are actions that depart from socially acceptable actions
and ways of living (Sweet & Decoteau, 2017). Initially, she exhibited anger, agitation,
and irritability and was verbally abusive to clinic staff. Her atypical, and maladaptive
requests to be “knocked out” could indicate abnormal sleep patterns and an overall
desperate desire to have a full night’s sleep without intrusive thoughts. This however
may hinder her from adapting to or coping with situations or stressors in healthy ways.
Miranda’s symptoms can be seen to impair functioning and cause personal distress in
that she feels extreme guilt and hopelessness, she is detached from reality
(delusions), and while she has no auditory, visual or tactile hallucinations, she feels
her son’s presence. She is also emotional labile which has resulted in self-isolation
and outbursts, which hinder her daily functions and social interactions.
In considering if Miranda’s behaviour constitutes abnormal behaviour, it is best to
consider how her behaviour and these exhibited emotions are symptoms present in a
particular mental disorder. Miranda primarily meets the criteria for post-traumatic
stress disorder (PTSD), a persistent, distressing disorder that follows exposure to a
traumatic event, as described in the DSM-5 (see Appendix A, Criteria A). In Miranda’s
case, there are several instances where she could have directly (A1) and indirectly
(A2) experienced trauma, the most recent being the traumatic event of losing her son
through suicide, and her own previous suicide attempts (Atwoli et al., 2015; Levin et
al., 2014). Miranda also speaks about her childhood history of sexual and physical
abuse which are extremely traumatic for a young child and can have adverse effects
in adulthood (Levin et al., 2014; Stanley et al., 2019).
It is not possible to diagnose PTSD until at least one month after a stressful event has
occurred, since many people experience strong reactions to stress that typically
subside within a month (Criteria F of Appendix A) (American Psychiatric Association,
2013). Individuals experiencing a qualifying stressor must demonstrate symptoms
from four different clusters that sort into four categories: reexperiencing, avoidance,
numbing, and hyperarousal (Criteria B-E in Appendix A).
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