Basic Case Summary
- Date of initial assessment – 02/12/2021
- School status – Public High School
- Client’s name – Gretel
- Age – 16
- Employment status – Unemployed
- Gender – Female
Gretel is caught by the assistant principal having stolen her colleagues’ lunch boxes severally as a mere prank but refuses to redeem her actions at the command of her superior. She faces extreme detachment cases from the loss of her biological mother and the hatred set by her ‘witch’ mother-in-law. She portrays aspects of seeking attention due to feeling unwanted and worthless. This spikes a rampage of an aggressive personality with a manipulative and menacing unruly character (Caselli et al., 2017). She expresses a short temper and fuses as she refuses any form of correction or negative feedback. She faces cognitive distortion to the point of considering suicide as payback.
Background, Family Information, and Relevant History
Gretel is a 10-year-old girl with a twin brother born in Vienna, Australia, to a middle-class family breadwinner, the father, who was a skilled carpenter. When Gretel was two years old, her mother was overwhelmed by her pregnancy, leaving her bedridden. The loss of her mother a day before her third birthday may have precipitated he descent into emotional instability. Moreover, her father remarried a woman with paedophobia, making Gretel feel uncared for. Their father’s decision for the family to move to the United States may have worsened her impending brain dilemma. She moved away from everything she had grown accustomed to, and with their father’s retreat to work, emotions of loneliness and sadness. Gretel and the ‘evil witch’ for a stepmother treat each other as arch-nemeses since there is no mutual affection nor respect. This failed relationship extended towards Gretel’srelationship with her peers and teachers, where she emitted a negative attitude toward everyone around her.
Consequently, her academic prowess was adversely affected by this developing character. Her performance substantially deteriorated since she had no regard for pleasing her teachers. She forcefully took her peer’s lunch boxes as a joke, and when requested to take them back, she would lash at her teachers. Her attendance in class dropped as she was elsewhere, breaking the rules, ready to blame her brother with no remorse. Gretel is not sexually active from a young age, and therefore, no hormonal effects on her health care.
Problem and Counseling History
Gretel has no history of counseling, as she has a hard time opening up to what is mentally bothering her. Through keen observation and application of CBT series of corrective steps, the focus lies on changing the maladaptive core thoughts of feeling unloved and undeserving. Gretel showed no symptoms of any clinical syndrome under DSM-Axis 1 analysis, thus no hereditary dysfunctions (Caselli et al., 2017). Gretel scored more than 2 on the depression scale through a DSM-Level 1 compilation scale, prompting the character to detach from her peers. Through a DSM-Level 2 (PROMIS Emotional Distress and Depression), she scored a rough 25 out of a maximum 35 on the scale. It implies that her anxiety levels were more than depression, and this conceptualization was spiked with “Maybe I’ll just kill myself… That’ll teach her”. From her physical examination and interview, Gretel was diagnosed with an antisocial and avoidant personality disorder. This conclusion arose from her relationship with her ‘evil witch’ stepmother. She had developed a taste for chaos and was resistant to criticism as she was left to fend for herself and her siblings through theft.
The patient did not report any physical challenges or general medical issues under the DSM-Axis 3. Through an in-depth MSE, Gretel proved to be aware of her surroundings and actions. Still, she suffers from psychosocial problems since her social events of family troubles affect her emotional paradigm. Gretel expressed undue confidence in the consultant as she was determined to fill the hole left by her absent father and cruel stepmother.
DSM-5 Diagnostic Impression
- Z03.2 Observation for possible mental instability through behavioral check
- Z62.898 Parental distress affecting child’s normal development
- Z71.9 The need for more counseling and close monitoring
Discussion of Diagnostic Impression
Gretel suffers from an impending mental breakdown arising from the DSM-Level 1 check and Axis 2 compilation. Through her social behavior of manipulation, theft, and stealing, she expresses a possible self-destruction sequence that arises from her bohemian relationship with her stepmother (Caselli et al., 2017). She does not desire any feedback, even when committing a crime, since she has not been brought up with positive feedback. Her nature of blaming everything on her innocent brother shows a primitive relapse in survivor instincts which imposes a drawback on mental development. The extent she goes to introducing suicide to the table raises red flags since she proves a sense of nothing to live for as long as her stepmother is taught a lesson “Maybe I’ll just kill myself…That’ll teach her”. This additionally drives the need for Z71.9, where Gretel needs further analysis on her personal life with constant mentoring under DSM-5 Cultural Formulation Interview (CFI), which recommended this as a mitigating factor.
Z62.898, parental distress affecting normal child development is noted all over Gretel. After the death of her biological mother at a very young age, she shows a lack of motherly love. Her father’s new spouse brings random men to their home when he is at work and when Gretel threatens to report this, she withdraws privileges as a form of punishment. The DSM-Axis 4 imposes that Gretel acts rationally due to her parents’ lack of affection and love.
Caselli, I., Poloni, N., Ielmini, M., Diurni, M., & Callegari, C. (2017). Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5. Psychology Research and Behavior Management, 10, 387.