2. CASE STUDY: DANIAL
Abstract
The case study follows a young man from age seven to 25. During the course of
his psychological evaluations different diagnoses are determined by his
presenting symptoms. As more information unfolds a clear picture is presented
which allows for a full diagnosis of his symptoms. Taking into consideration
cultural and ethical factors at each stage of development the patient is highly
influenced by the culture in which he was raised with. The cultural factor is a
large part of his disorder development as well as general personality and
behavior.
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3. CASE STUDY: DANIAL
Table of Contents
Title Page.............................................................................................................1
Abstract ...............................................................................................................2
Table of Contents ................................................................................................3
Introduction...........................................................................................................4
Section 1..............................................................................................................4
Diagnostic Hypotheses.....................................................................................5
Diagnostic Information...................................................................................6
Diathesis-Stress Perspective..................................................................7
Section 2..............................................................................................................8
Diagnostic Hypotheses.....................................................................................8
Diagnostic Information...................................................................................9
Diathesis-Stress Perspective................................................................10
Section 3............................................................................................................11
Diagnostic Hypotheses...................................................................................11
Diagnostic Information.................................................................................12
Diathesis-Stress Perspective................................................................13
Section 4............................................................................................................14
Background.....................................................................................................14
Danial: Age 7...............................................................................................15
Danial: Age 16......................................................................................16
Danial: Age 25.............................................................................17
1950’s Comparison........................................................................................18
DSM (1952) ................................................................................................18
DSM: II (1968)......................................................................................19
DSM: III (1980)............................................................................20
DSM: III-R (1980)....................................................................21
The DSM Today................................................................21
Conclusion .........................................................................................................22
References ........................................................................................................24
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4. CASE STUDY: DANIAL
Case Study: Danial
Introduction
The case study being addressed is that of a male patient named Danial.
Danial comes to therapy at three key developmental stages of his life.
When Danial is a young boy he has issues with anxiety. He fits the criteria
for anxiety disorder lined to attachment to his mother. His father complains that
his son plays with dolls. Danial shows irrational fears of death,
At age 16 Danial is socially withdrawn. He mistrusts his family and has
very few friends. Danial still identifies with girls over boys. He is nondescript
about his sexual preference but hints that he may be gay. Danial has a
fascination with death. However, he no longer associates it with fear but rather
curiosity.
At age 25 Danial still presents issues he had been dealing with throughout
his life. However, now at a fully developed adult his symptoms have fully
developed and taken hold of his life. He is in a homosexual relationship much to
his father’s lack of acceptance. He shows intense paranoid delusions and
suspicions of others.
Danial presents many diagnostic possibilities throughout his life. However,
only in adulthood does Danial’s symptomatic history and contributing factors
make for a probable diagnosis. Interpretation of each life stage presents a very
different diagnosis. However, Interpretation of each stage of development as a
whole allows for a new diagnosis based on medical history and developmental
factors.
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5. CASE STUDY: DANIAL
Section 1
Diagnostic Hypotheses
I hypothesize than Danial may fit the criteria for Gender Dysphoria
disorder. He meets only three out of the minimum of six criteria for the disorder.
However, upon probing it is possible to attain the information needed to make a
full diagnosis. Danial has a strong preference for toys that are stereotypically
used by another gender. His parents report he plays with dolls.
Danial shows a rejection of masculine toys, activities, and rough-and-
tumble play. His father reports he does not like to get dirty or play soccer like his
older brother. Danial also shows a preference of playing with girls. His father
reports he plays with girls. However, the strong desire to be of the other gender
or insistence that one is of the opposite gender is a criterion that must be present
for diagnosis. Danial nor his parents have not expressed this behavior occurring.
Danial also fits the criteria for Separation Anxiety Disorder. Danila meets
the three minimum criteria displaying seven of the eight symptoms. Danila’s
anxiety has created problems in the past. His anxiety worsens as he gets deeper
into school grades where this behavior is no longer tolerated. His worry stems
from his deep attachment to his mother, which may have an effect or is affected
by his possible gender dysphoria. His anxiety has lasted since he first went to
kindergarten passing the 4 week minimum. His mother reports this behavior
occurred in the first few weeks or so of each grade he entered.
It is very common that attachment anxiety is experience in periods of
exacerbation as well as remission (American Psychiatric Association, 2013).
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6. CASE STUDY: DANIAL
However, only now in second grade is he manifesting physical symptoms.
Further neglect for resolution of these anxieties could produce worse symptoms
in the future years. It is also a possibility that unresolved anxieties could manifest
into adulthood as maladaptive behavior.
Hereditary and life stress are the largest factors for separation anxiety
onset (American Psychiatric Association, 2013). These factors are heavily
applicable to Danial’s case. The family notes their family is free of any history of
mental disorders thus environmental influence is a strong factor to consider.
Girls are more likely to manifest reluctance in separation due to expression of
fears is more commonly expressed by boys in indirect behaviors (American
Psychiatric Association, 2013). Danial’s gender dysphoria may be a factor in his
experience with expressing his fears.
Diagnostic Information
I would need to ask Danial or his parents more questions about his
behavior in order to make a proper diagnosis of Gender Dysphoria. I would ask
what Danial thought his gender was and how he feels about being a boy.
Depending on what he says, I would ask if he is happy how he is or if he would
be happier being a girl. I would ask if he understands the difference between girls
and boys. I would ask Danial if he likes to wear girl’s clothes or if his parents
have ever found him wearing, admiring, or simulating female attire.
Depending on Danial’s answers or any indictors his parents may have
about Danial, it will be possible to make a clear diagnosis. Depending on the
responses from Danial, his behavior may be better understood as nonconformity
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7. CASE STUDY: DANIAL
to gender roles rather than an issue with his gender. However, lack of information
at this stage of life creates a difficulty in making any diagnosis for the stage or
application to future statges.
Diathesis-Stress Perspective
Considering the family history in the family of Danial, the primary sources
of stress derive from environmental influences and experiences. Although there
are not genetic dispositions to influence the likeliness of an anxiety or gender
disorder from developing, there is much stress which may have contributed. The
family is originally from Pakistan. Although Danial was born in America, his
brother, parents, and grandparents were born in another country. This in itself
could be a factor in stress related to the development of disorders. Assimilation
for the grandparents has been motes as difficult and could be also stressful for
the children.
Danial’s family keeps their Pakistan culture strong in the home. Danial’s
behavior related to his gender is typically interpreted with strong scrutiny as
common with many West Asian cultures (Woodruff, & De Sam Lazar, 2013).
Together with the stress of being a minority as well as adapting to a new culture
so different from their own presents a susceptibility to developing high anxieties.
Typically, children who have older brothers are more likely to develop
gender dysphoria, and thus sibling roles also play a factor in the development of
disorders (DSM). Yalda’s change to working with her husband rather than at
Danial’s school may also be a factor in the stress influencing development of
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8. CASE STUDY: DANIAL
disorders. Danial has many factors both within his family and outside his family
that could be contributing to his stress.
Section 2
Diagnostic Hypotheses
From the interview at age 16 Danial appears to be suffering from Major
Depressive Disorder. The prevalence of the disorder is higher in girls than boys
in adolescents (American Psychiatric Association, 2013). However, Danial still
assimilates to the female gender; he paints his finger nails with clear polish, does
not play sports, is sensitive, and associates with girls rather than boys.
Danial is not very social at home or at school. Danial has one male
acquaintance who he says is like him but does not explain to what context. He
says his female friends accept him and are like him in that they all don’t trust
people. He compares his friends to those of his star athlete brother stating they
think he is “a worthless piece of garbage “while he himself believes he is “not
worth the dirt on the bottom of [his] brother’s running shoes”. He believes he may
be and also hints that his father would agree.
The last few months Danial’s behavior has changed drastically. In the past
two months he has become more withdrawn often staying in his room a lot. He
also dropped out of band and theater club because he reportedly lost interest. He
has also been withdrawing from his small group of friends. In the past 6 weeks
he has lost 20 pounds and is now at 130. He reports that he has simply lost his
appetite. His mother says he eats like a bird.
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9. CASE STUDY: DANIAL
Danial shows strong irritability and is not as close to his m other as he was
when he was seven. He states that she tricked him into coming to see a
therapist. His mother states she has noted how “nasty” he treats everyone
referring to his irritability. She also says he cannot sit still but also stays to
himself a lot. His mother also notes how Danial has not been sleeping well at
night. This has been happening for several months. Danial’s mother alos
indicates he lacks concentration and does not listen to anything she says. She
says he is still sensitive as he was a child and tears up now and then.
When speaking to Danial alone he is irritated and nervous. He hints that
he has been buying bottles of vodka from a friend. When asked if he is feeling
depressed he responds with hostility. He denies suicidal thoughts. However, he
states he was playing with his father’s gun placing it to his head and pulling the
trigger just to see what it would feel like. He states he thinks about death a lot.
Diagnostic Information
Based on the new information gathered as well as his past history, Danial
is suffering from Major Depressive Disorder. His suicidal ideation as well as his
frequent thoughts of death put him at moderate severity. He has been withdrawn,
lost interests, decreased appetite, difficulty sleeping, and loss of weight. His
behavior goes past the typical teenage angst. The reason for his depression and
hostility may be his sexual identity, as he hints that his only male friend is “like
me”. He could also be struggling with the fact that his parent’s culture may not be
accepting of his chosen sexuality and thus he feels repressed, alone and
suicidal.
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10. CASE STUDY: DANIAL
The diagnosis for Major Depressive Disorder is based on Danial’s
symptoms as well as timeline. The behavioral changes Danial has been
experiencing have occurred within a few months. The diagnostic criterion
identifies five or more symptoms must occur within a two week period (American
Psychiatric Association, 2013). Danial meets 7 out of the 9 symptoms; depressed
mood most of the day, diminished interests, significant weight loss, insomnia,
feeling worthlessness, diminished ability to concentrate, redcurrant thoughts of
death with suicidal ideation.
Danial’s symptoms have created impairment in various areas of his life
including school, home, and social functioning. His behavior is not better
explained with another disorder. He does not appear to be using drugs or
medication and there is no history of this abuse in his family. He has not had any
manic episodes. He also meets the criteria for anxious distress with mild severity
as he displays tenseness sand unusual restlessness.
Diathesis-Stress Perspective
The diathesis-stress model applied to Danial’s case provides insight to his
development of a disorder. Biological factors do not apply to Dania’s case as he
has an impeccable medical history free of any mental or medical issues besides
his own. Unless he was exposed to an environmental hazard, is adopted, or
there is an unknown factor in the family history there is no biological factor or
trigger that could affect susceptibility to disorder development. ‘
The primary diathesis factors influencing are social and psychological.
Danial has strong pressures from his father to live up to his athletic brother’s
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11. CASE STUDY: DANIAL
image. Even in the first session at age 7 his father compared him to his elder
son. This creates a heavy social and psychological factor that can be attributed
to his disorder development.
Maladaptive upbringing and unconscious conflicts can affect the
development of any disorder. Danial has never had the kind of support from his
father in his interests that he needs to feel accepted. Danial he chooses to play
with dolls or avoid sports much to the disapproval of his father. This constant
negativity creates psychological stress.
Section 3
Diagnostic Hypotheses
At age 25, Danial’s untrusting attitude towards others has fully developed
in a paranoid personality disorder. At age 16 he indicated he did not trust people.
Now at 25 his trust has evolved into paranoid delusions about people’s
intentions. He works at a solitary job where he is very untrusting of his co-
workers and boss. He believes strongly that his boss is out to get him fired,
laughs at him behind his back, and pays him less than everyone else.
Danial states he does not want to hurt anyone unless they try to hurt him
first. He strongly believes his boss has paid off the three therapists he referred
Danial to in a scheme to spy on him. He fears the therapist will provide his boss
with information attained during the sessions. He also believes his family does
not understand him and are always snooping on him. He changes his phone
number often to avoid contact with them.
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12. CASE STUDY: DANIAL
Danial refers to the incident with the gun when he was 16 not as a suicidal
ideation but a curiosity concerning his distrust for people. The possibility that he
may be harm to others is present. He reacts angrily at the thought that his boss
may have indicated he was a harm to others. He has come to therapy under the
recommendation of his boss as well as his physician.
Danial reports that he has from three to five alcoholic drinks a day and
more on weekends. He also believes his boyfriend is having an affair. He has no
proof of this but expects to catch him in the act one day. His father strongly
disagrees with his homosexuality. He reports that his father believes there are no
homosexuals in Muslim religion. Danial points out that his family put cultural
pressures on him and does not embrace modern values as he has in America.
His family holds strongly their Pakistani cultures, traditions, and religious beliefs.
Diagnostic Information
Upon examination of Danial’s past history as well as his current
symptoms, he fits the criteria for Paranoid Personality Disorder. Danial meets six
out of seven symptoms with four being the minimum for diagnosis. Danials
symptoms under criteria A identify his intense distrust and suspiciousness of
people around him as well as misinterpretation of motives (American Psychiatric
Association, 2013).
Danial suspects without sufficient evidence that others are deceiving him,
is preoccupied with unjustified doubts of the trustworthiness of others, is reluctant
to confide in others of unwarranted fear that the information will be used
maliciously against him, reads threatening meanings into remarks, perceives
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13. CASE STUDY: DANIAL
attacks to his character which are not apparent to others and is quick to
counterattack, and has reoccurring suspicions without justification of infidelity
from his boyfriend (American Psychiatric Association, 2013). His behavior is not
better understood with another disorder such as delusional disorder as
functioning is impaired due to his symptoms.
Paranoid personality disorder first appears in early adolescents with
hypersensitivity, solitariness, poor peer relationships, peculiar thoughts and
idiosyncratic fantasies (American Psychiatric Association, 2013). Much of this
behavior was present when Danial was 16 and some of the behavior was also
present at age 7. Now at age 25, the symptoms are fully developed and are
creating unavoidable distress in his life.
Diathesis-Stress Perspective
Considering Danial’s prior history there is much room to use the diathesis-
stress model to explain his development of a disorder. Danial was always a
sensitive child. His father expressed early on his displeasure with Danial’s
chosen anti-masculine activities such as playing with dolls, befriending girls, and
dislike of rough-and-tumble play (American Psychiatric Association, 2013). This
stain between his father and himself creates a stressor that can be attributed to
the development of a disorder. A genetic disposition to developing disorders is
not applicable to Danial as he has a clean family history of any type of medical or
mental issue.
The primary stressor to Danial’s development to a disorder is cultural-
related. Members of minority groups and immigrants display guarded or
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14. CASE STUDY: DANIAL
defensive behaviors because of unfamiliarity in response to indifference of the
majority society (American Psychiatric Association, 2013). The result of this
cultural indifference, Danial growing up in modern America and his father and
mother holding onto Pakistani cultures and values create a vicious cycle of
mutual mistrust (American Psychiatric Association, 2013). Danial displays this
mistrust outside his family unit does not support the possibility that his mistrust is
due to culturally related behavior (American Psychiatric Association, 2013).
Section 4
Background
There are very strong cultural as well as ethical factors that affect
diagnosis at different stages of Denial’s life. Considering Danial’a background,
primarily his father’s attitude toward his behavior and the strongly implemented
cultural beliefs growing up in America, Danial’s behaviors are highly influenced
by his culture in a negative aspect. His father’s strong cultural and religious
beliefs have also attributed to ethical factors contributed to Danial’s development
of his disorder. Furthermore, Danial’s resistance to these beliefs and traditions
have created a strong conflict within his famiy.
The family emigrated from Pakistan when Danial was very young. Danial
and his family were born and raised with the culture so much different from that
of America. Danial’s family holds tightly the traditions and culture of their native
land much to Danial’s resistance. The Pakistani culture puts heavy emphasis on
religious beliefs and traditions (Malik, 2006). Much like many cultures there are
also certain behaviors that are strongly ideal and undesirable.
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15. CASE STUDY: DANIAL
Danial: Age 7
At age 7 Danial first came to therapy due to symptoms of anxiety.
Identifying possibilities for his symptoms, his culture as well as ethical principles
was put into question. The most perceived factor at the time was his father’s
strong displeasure with Danial’s problems. His father is both unsupportive
emotionally and physically; he sits far from his son and wife in therapy as well as
rolling his eyes in annoyance to his son’s behavior. His father is very vocal about
comparing Danial to his soccer star older brother. He also shows considerable
annoyance from Danial playing with dolls.
It is common in many Asian cultures such as Pakistain’s neighboring
country India, that baby boys are highly favored over girls (Woodruff, & De Sam
Lazar, 2013). Thus, his father’s rejection of stereotypical girl behavior and
attributes possibly stems from this strong application of their culture beliefs and
traditions. This can also be applied to his father’s continual comparison of Danial
to his typically masculine son Salim. His father repeatedly compares him to his
son which has had a significant effect on Danial’s self-esteem.
There is strong cultural influence as well as ethical issues to consider with
this case. The ethical principles of this issue is weather is it correct to voice this
preference over masculinity as well as discourage behavior favored by the son. It
is possible that Danial’s rejection from his father caused him to repress his
desires consequently resulting in further distance from his family as a whole. His
unsupportive family thus plays a large part in his attitudes and behaviors towards
others.
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16. CASE STUDY: DANIAL
Danial: Age 16
At age 16 Danial seeks therapy again because of his recent decline in
mood and behavior. He is noticeably distant and distrusting of his family. He also
hints to a friend “like [him]”indicating he may have realized he was a homosexual.
His distance from his family is interpreted as a negative behavior. In many
cultures such as American teenage angst is understood by parents, however it is
theorized to not be universal but influenced by culture (Press, 2011). His distance
is typical of teenage behavior especially during a time when he may be releasing
he is gay.
The strict ideals of his culture make it difficult for Danial to relate to or be
close to his family thus he isolates himself. Danial’s lifelong feeling of being
outlasted by his family due in part by his unshared beliefs in culture and values
has severely changed his development. His resistance to these cultural beliefs is
possibly influenced by the modern American cultural ideal of individuality. Danial
is torn between becoming who he wants to be and who his family wants him to
be. Danial feels he cannot be himself with his family because of their cultural
disapproval and resents them for not allowing him to be himself free of judgment.
The ethical issue within this stage of development for Danial focuses
around his development of individuality. Although the shared cultural beliefs are
not present within the family, a supportive unit is ethically ideal. Danial is at a
stage of his life where he is trying to find his individuality. His lack of support of
his development to become an individual is a large stress on his life. The ethical
concern is his parent’s lack of support during a vulnerable stage of his life.
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17. CASE STUDY: DANIAL
Danial: Age 25
At age 25 Danial is now fully developed and has strong hold in his own
cultural and ethical beliefs. His family’s lack of support of individualism which is
embraced by American culture is not shared by his family’s culture. The conflict
has escalated to the point where Danial now avoids contact with them. This
negative impact and lack of support may prove to be a factor in his further lack of
trust of individuals in his life. In an ethical aspect, his parent’s resistance to
understand their son resulted in his decline in mental health. The lack of support
also weakens the chances of conflict resolution with Danial and his family,
primarily his father.
Considering all the presented ethical and cultural factors, Danial’s
diagnosis was difficult to make until all the pieces were together. Although at
each stage a diagnosis was present, only when all the presenting information
was used did a clear image appear. The ethical aspect of interpreting behavior
was deeply affected by cultural beliefs. Thus, an understanding of the culture
Danial’s parents enforced and the culture Danial choose to embrace is a large
necessity for diagnosis of his disorder.
As Danial ages and becomes more of an individual his hold onto his family
and cultural roots diminishes. Danial has now fully embraced the modern norms
of American culture. Danial’s choice to withdraw from his family come at the price
of independence. Danial’s choices are focused on self-fulfillment rather than
obligation to traditions. Danial chooses to embrace a culture where individuality is
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18. CASE STUDY: DANIAL
idolized rather than a culture that has high expectations of fitting a socially
acceptable mold of desirable attributes.
1950’s Comparison
Psychosexual diagnosis has changed considerably since its first
appearance in the Diagnostic Statistical Manual. In 1973 homosexuality was
removed from the DSM II as a mental disorder (American Psychiatric
Association, "LGBT-Sexual Orientation", 2015). Prior to the revision,
homosexuality as a clinical diagnosed mental disorder had a long history in
psychology. The misunderstanding and lack of research on homosexuality began
a public outcry for change to the DSM.
DSM (1952)
At the time of the first publication of the DSM in 1952, homosexuality was
viewed as an illness by cultural standards (Group for the Advancement of
Psychiatry, "LGBT-Sexual Orientation", 2012). The DSM identified homosexuality
as a sociopathic personality disorder (Group for the Advancement of Psychiatry,
"LGBT-Sexual Orientation", 2012). At the time homosexuality was not a yet a
topic that brought much thought or debate. It was accepted as a negative mental
condition and treated as such. In 1953 a federal law was created that deemed
anyone who was a homosexual to be fired from his or her government job
(AA/EO institution, "Allies & Advocates", 2015). Between 1940 and 1970 electric
shock aversion therapy was the most common treatment method for
homosexuality (Smith, Bartlett, & King, 2004).
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19. CASE STUDY: DANIAL
The DSM’s personality disorders identify homosexuality as a category of
sexual deviation (American Psychiatric Association, 1952). The deviation is a
disturbance defined as an illness in terms of conformity with cultural norms,
discomfort, and relationships with other individuals (American Psychiatric
Association, 1952).
Homosexuality is defined as a pathologic behavior of a deviant sexuality
which is not in relation to extensive disorders such as schizophrenia (American
Psychiatric Association, 1952).The initial DSM’s diagnosis of homosexuality
interprets same sex attraction as a disturbance in socially acceptable behavior.
DSM II (1968)
In 1968 the DSM-II was published. This revised edition of the original DSM
from 1952 altered the diagnostics of homosexuality. Homosexuality was re-
categorized in the DSM-II under non-psychotic personality disorders however still
within the same category structure as personality disorders (American
Psychiatric Association, 1968). The DSM-II clearly identifies the difference
between the classification of homosexuality in comparison to the DSM-I.
Homosexuality is noted as a detailed subdivision not contained in the DSM-I
under sexual deviations (American Psychiatric Association, 1986).
The DSM-II also provides more clarity to the category of sexual deviations.
The category classifies the individuals as those who are unable to substitute
normal sexual behavior for their distasteful practices (American Psychiatric
Association, 1968). The DSM-II also excludes deviant behavior that is that is
believed to be the direct result of normal sexual acts is not readily being made
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20. CASE STUDY: DANIAL
available (American Psychiatric Association, 1968). This means that
homosexuality is not diagnosable to those who resort to the behavior due to
circumstances; such as prison or other low male to female ratio.
The DSM-I nor the DSM-II does not specifically point out the nature of
homosexuality. Page (1975) states "the term sexual deviation is criticized in that
the behavior may be different from the norm without being undesirable or
harmful” (p. 373). As the culture of the 1970’s changed as did it’s misconceptions
about homosexuality.
DSM III (1980)
The homosexual community was in an uproar about the continued
classification of their sexual presence as a mental illness. The issue quickly
escalated into a controversial topic that was impossible to ignore. In 1973 the
Board of Trustees for the American Psychiatric Association met and decided on a
revision of homosexuality for the upcoming DSM-III (Page, 1975). The group
came to a decision to eliminate homosexuality as a mental disorder (Page,
1975). The solution was based on the shared idea of limiting the term sexual
deviations to undesirable behaviors that create great personal distress or
interfere with the personal welfare rights, and safety of others (Page, 1975).
In 1974 the DSM-III began their revision to homosexuality (American
Psychiatric Association, "DSM: History of the Manual", 2015). This revision
identified a new specific homosexual disorder with criteria for diagnosis. The
disorder took on the name Ego-Dystonic Homosexuality which is defined as a
state of which a person has unwanted and distressful homosexual arousal and
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21. CASE STUDY: DANIAL
wishes to acquire or increase said arousal (Kaplan & Sadock, 1991). The manual
identifies two criteria that must be met for diagnosis. Criteria A states that the
individual must complain that his or her heterosexual arousal is absent or weak
as well as interfering with maintaining or creating a relationship with a member of
the opposite sex (Decker, 2013).
DSM III-R (1987)
In 1980 the DSM-III was published with its new revision on homosexuality.
Numerous inconsistencies as well as unclear criteria required a new revision of
the DSM-III. With new revisions the 1987 DSM-III-R was published with no
further use of Ego-Dystonic Homosexuality. As the culture became more aware
of the nature of homosexuality it also became more accepting. The behavior of
homosexuality was eventually understood to not harm nor affect anyone thus it
could not be found as a sexual deviation by the APA’s criteria.
The DSM Today
After many revisions to the DSM there was no longer mention to
homosexuality. Fast research and cultural understanding of homosexuality’s
nature changed the outcome of diagnosis. Homosexuality is now an accepted
variant of normal sexual behavior rather than a deviation (Comer, 1996). The
history of the changes to homosexuality’s diagnosis was at the cost of great
struggle.
Social change was slow moving in the days of heavy religious influence. In
modern society, religions still have a firm grasp on the culture’s perspective of
illnesses. However, fights of individuality for women, religious groups, races, and
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22. CASE STUDY: DANIAL
sexual orientations have paved the way for change among modern society. The
DSM’s history since the 1950’s has greatly impacted as well as been impacted
by the changing culture.
Conclusion
The case study of Danial presented serious dysfunctions at each key
stage of his life. At age 7 Danial experiences symptoms of anxiety. At age 16 he
is withdrawn and begins to mistrust others. At age 25 he experiences paranoid
delusions. The case study presents three stages of life development. Each stage
adds more information to develop a full diagnosis. At each stage, a diagnostic
possibility is present. However, it is only at the adult stage that the entire case fits
together.
Danial’s case study provides the perfect example of the importance
of diagnostics. Each stage presents a specific set of symptoms. The symptoms
are applicable to many disorders. Given the limited information however, the
diagnosis could not be made until all presenting information has been
considered. Only when the full case is examined in its entirety does the diagnosis
have validity.
Danial’s case also presented two primary factors in understanding
diagnostic possibilities. Danial’s culture and sexual preference were of much
influence on his disorder development. It is theorized that Danial’s heavily culture
influenced family affected by his sexual preference could be a presenting factor
in disorder development. The Diagnostic and Statistical Manual of Mental
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23. CASE STUDY: DANIAL
Disorders considers these factors and more a condition that may be a focus of
clinical attention (American Psychaiatric Association, 2013).
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24. CASE STUDY: DANIAL
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