nit 3 Case Studies  Laura Laura is a 55-year-old Latina who is a former nurse. She has been married for 35 years to Raymond, who is 63. Raymond, who is also Latino, is a practicing physician who is nearing retirement. Laura met Raymond at a hospital when both were in training for their medical careers. They dated for less than a year and married when Laura was 20 years old. She continued to work as a nurse after graduation until their first child, a daughter, was born and Laura and Raymond agreed she should stay home to care for their child. Their son was born two years later. Laura did not return to her career as a nurse, and remained a homemaker and stay-at-home mother. Throughout the years, Laura and Raymond frequently socialized with other couples, although Laura did not form individual friendships with other women, stating she “just isn’t comfortable” with most women. Laura was an avid reader and an artist, and tended to enjoy quiet, solitary pursuits rather than joining group activities, so she resisted Raymond’s suggestions that she join women’s philanthropic groups or participate in volunteer activities. Laura and Raymond spent weekends with their children when Raymond was not working, and they always took family summer vacations and spent time on family activities. Laura’s parents  live nearby and were very involved in the family activities as well. Laura is an only child. The family always considered themselves to be closely knit. Laura is in generally good health. Although she smoked cigarettes for 30 years, she quit seven years ago. She consumes alcohol daily and does not take any regular medications. She is sedentary and has gained 30 pounds over the past 15 years. Raymond does not smoke but he joins Laura in a nightly cocktail after work. He does not formally exercise but is on his feet most of the day at work. His weight is the same as it was when he was 25 years old. Raymond had prostate cancer five years ago; surgery and radiation treatments seem to have cured his cancer.  Laura’s children are now adults. Both completed college, found successful careers, and married. Laura’s daughter has recently given birth to her first child, a son.   In the past year, Laura has started to worry about her loved ones’ safety and well-being. She frequently becomes preoccupied with thoughts of injury or illness that could harm Raymond, her daughter or son, and now her infant grandson. Laura is unable to calm these fears or put them out of her mind. She often has trouble falling asleep because she “can’t shut down” her mind, and she wakes up in the middle of the night fearing something has happened to one of her loved ones. She is often fatigued during the day and is notably irritable. Lately, Laura has been calling her husband, daughter, and son several times a day, including when they are at work and cannot take her calls. She implores them to “be safe.” She has asked them not to drive or participate in social activities because they might ha ...

1. nit 3 Case Studies Laura Laura is a 55-year-old Latina who is a
former nurse. She has been married for 35 years to Raymond,
who is 63. Raymond, who is also Latino, is a practicing
physician who is nearing retirement. Laura met Raymond at a
hospital when both were in training for their medical careers.
They dated for less than a year and married when Laura was 20
years old. She continued to work as a nurse after graduation
until their first child, a daughter, was born and Laura and
Raymond agreed she should stay home to care for their child.
Their son was born two years later. Laura did not return to her
career as a nurse, and remained a homemaker and stay-at-home
mother. Throughout the years, Laura and Raymond frequently
socialized with other couples, although Laura did not form
individual friendships with other women, stating she “just isn’t
comfortable” with most women. Laura was an avid reader and
an artist, and tended to enjoy quiet, solitary pursuits rather than
joining group activities, so she resisted Raymond’s suggestions
that she join women’s philanthropic groups or participate in
volunteer activities. Laura and Raymond spent weekends with
their children when Raymond was not working, and they always
took family summer vacations and spent time on family
activities. Laura’s parents live nearby and were very involved
in the family activities as well. Laura is an only child. The
family always considered themselves to be closely knit. Laura is
in generally good health. Although she smoked cigarettes for 30
years, she quit seven years ago. She consumes alcohol daily and
does not take any regular medications. She is sedentary and has
gained 30 pounds over the past 15 years. Raymond does not
smoke but he joins Laura in a nightly cocktail after work. He
does not formally exercise but is on his feet most of the day at
work. His weight is the same as it was when he was 25 years
old. Raymond had prostate cancer five years ago; surgery and
radiation treatments seem to have cured his cancer. Laura’s
children are now adults. Both completed college, found
successful careers, and married. Laura’s daughter has recently

2. given birth to her first child, a son. In the past year, Laura has
started to worry about her loved ones’ safety and well-being.
She frequently becomes preoccupied with thoughts of injury or
illness that could harm Raymond, her daughter or son, and now
her infant grandson. Laura is unable to calm these fears or put
them out of her mind. She often has trouble falling asleep
because she “can’t shut down” her mind, and she wakes up in
the middle of the night fearing something has happened to one
of her loved ones. She is often fatigued during the day and is
notably irritable. Lately, Laura has been calling her husband,
daughter, and son several times a day, including when they are
at work and cannot take her calls. She implores them to “be
safe.” She has asked them not to drive or participate in social
activities because they might have an accident or be infected
with a disease by someone with whom they socialize. She is
especially concerned that her infant grandson might contract a
disease and die. She insists that her daughter not take the baby
out or allow visitors. She has been known to drive to her
daughter’s house at night to check whether the family is home,
and if they have guests. Laura’s family members are beginning
to be annoyed with her “meddling” behaviors and no amount of
logical discussion seems to convince her that her fears are
ungrounded. For this reason, her family is becoming upset with
her and starting to avoid her.
• Conceptualization and Diagnosis of Laura.
You reviewed the cases of Laura in the study activities for this
unit. You will respond to each of the questions below. Your
initial post must be at least 250 words in length and include at
least two references to a current article in the professional
literature to support your ideas. Start by considering the broad
category of the client's presenting issues. What words would
you use to describe the client's presenting concerns and the

3. types of thoughts, feelings, and behaviors the client is
experiencing? What broad categories in the DSM-5 do these
words relate to (i.e., depression, anxiety, trauma, et cetera).
Next, look at the case study and review the specific symptoms
the client is reporting. Compare these symptoms to those listed
in the broad categories you have considered. In what area of the
DSM do the client's symptoms seem to fit best? Select the
DSM-5 diagnosis that you believe is the best match for the
symptoms that the client is presenting and be sure to include the
numeric ICD 10 code along with the name of the disorder.
Support your choice of diagnosis by listing the diagnostic
criteria in the DSM-5 and noting for each one how the client has
expressed this. Does the client meet all criteria for this
diagnosis or are there some areas that you are not fully sure
about? If you do not have enough information about some
symptoms that are required criteria for the diagnosis you have
selected, what additional questions would you need to ask the
client, or what other information would you need to obtain from
other sources so that you could support an accurate diagnosis?
Response Guidelines Read the posts of your peers and respond
to at least two. Try to choose those that have had the fewest
responses thus far. For each response, discuss the DSM-5
diagnosis your peer applied to the case and the symptom criteria
she or he noted as either present or absent. Were there
additional criteria needed in order to make an accurate
diagnosis?
Peer 1 Post
James is a 43 year old Caucasian male that has reported that he

4. feels awful and has no energy. He also reports that he's married
and his relationship is satisfactory but their sexual relationship
has declined over the past two years. James is satisfied with his
job but has a feeling that he is not able to move up in his
profession at this time. James reports that he is in good health
and takes no medications but has recently stopped going to the
gym due to a strong loss of interest in it. James reports that his
appetite has significantly increased and this explains his weight
gain. James also admits that he has an issue with drinking and
increased number of alcohol as often as four after work or
before dinner. James is not suicidal at this time although he
says that it would be nice not to wake up tomorrow but does not
have a plan at this time to take his life. The client's overall
sense of discontentment can be categorized as depression if we
were to consider the broad sense of the DSM-5. The client is
reporting symptoms of feeling awful and having no energy. The
client also is stating that there is a decline in his sexual
relationship with his wife. The client also reports that he's lost
interest in exercising and taking care of his self physically. The
client enjoys drinking alcoholic beverages several times a day.
The client admits that the alcohol helps him to fall asleep. The
client symptoms continue to fall in the Realms of depression
although there is not enough information to make this
conclusion due to his issue with drinking alcohol which is a
depressant.. The client is exhibiting several symptoms that
need further investigation. Measures for symptom severity,
diagnosis, and problem behaviors may provide insight into
client limitations, but typically neglect client strengths.
(WILKINSON, 2015) Although the diagnosis could very well be
duel with that of alcoholism and depression more investigation
needs to be done because we do not know how long each was
present. I would defer diagnosis until further evaluation. A
physical examination would be beneficial in this case being that
he has several physical issues that have not been examined by a
physical doctor. The client continues to say that he is healthy
while he has had a loss of interest in several activities including

5. work and exercising and even in sexual activities with his wife.
This could be several different physical diagnosis including
thyroid ,diabetes, erectile dysfunction and so on. There are
studies that indicate high false-positive rates of depression,
with significant levels of diabetes-specific distress due to living
with diabetes. This refers to the emotional distress associated
with managing a long-term condition over time and is an area of
greater concern, which requires more targeted interventions
directed at the emotional side of diabetes. (Fosbury & Shaban,
2016) It would be best for the counselor to hold off on making a
diagnosis by eliminating these external factors first.
WILKINSON, B. D. (2015).
The Orientation Model: A Dual-Process Approach to Case
Conceptualization. Journal Of Humanistic Counseling, 54(1),
23-40. doi:10.1002/j.2161-1939.2015.00062.x
Fosbury, J., & Shaban, C. (2016). Are we over-diagnosing
depression in people with type 1 diabetes?. Journal Of Diabetes
Nursing, 20(3), 108-109.
Peer 2 Post
The Case of Laura Presenting Issues: Preoccupied with negative
thoughts; Ungrounded fears; Inability to remove thoughts from
her mind; Anxiety; Trouble falling asleep; Fatigue; Irritability;
Persistent behaviors aimed at preventing the ungrounded fears.
Symptoms lasting for a year.
Broad DSM-5 Categories: Generalized Anxiety Disorder:
Excessive anxiety and worry occurring more days then not for at

6. least 6 months; Difficult to control the worry; Anxiety and
worry are associated with fatigue, irritability, and sleep
disturbance; Worry causes clinically significant distress or
impairment in normal life functioning; The intensity of the
anxiety and worry is out of proportion to the actual likelihood
of the event; Difficult to control the worry, often worrying
about the health of family members or misfortune of children
(DSM-5). Obsessive Compulsive Disorder (OCD): Recurrent
and persistent intrusive and unwanted thoughts that cause
anxiety or distress; The individual attempts to neutralize
intrusive and unwanted thoughts with some other thought or
action; Repetitive behaviors or mental acts that the individual
feels driven to perform in response to an obsession; Behaviors
or mental acts are aimed at preventing some dreaded event or
situation, however, these behaviors are not connected in a
realistic way with what they are designed to prevent and are
clearly excessive; The obsessions or compulsions cause
impairment in social functioning (DSM-5).
Diagnosis: Obsessive Compulsive Disorder 300.3 (F42) with
absent insight/delusional beliefs. At first look a Generalized
Anxiety Disorder diagnosis appeared to be the accurate
diagnosis for Laura. However, as I begun to read the differential
diagnosis in the DSM-5, OCD was listed. Ellis, Hutman, and
Diehl (2013) emphasize the importance of integrative case
conceptualization and a key aspect of this is differentiating a
diagnosis, or discriminating the most significant issues. The
difference between Generalized Anxiety and OCD is that in
Generalized Anxiety “the focus of the worry is about
forthcoming problems, and it’s the excessiveness of the worry
about the future event that is abnormal” (DSM-5). Whereas with
OCD, “the obsessions are inappropriate ideas that take the form
of intrusive and unwanted thoughts” (DSM-5). Laura’s
symptoms are better matched with OCD criteria. Laura has
become preoccupied with thoughts that her loved ones are going

7. to become injured or ill; So much so that she has been calling
her family members several times a day even when they cannot
take calls, begging them to be safe and asking them not to drive
or participate in social events because they could be in an
accident or contract a deadly disease. She also drives to her
daughter’s house at night to check whether the family is home
safe or if they have guests that could pass on a disease. These
actions fall within the OCD criteria of “excessive behaviors
aimed at preventing some dreaded event or situation” that stem
from” inappropriate ideas that take the form of intrusive
thoughts”. The added diagnosis of absent insight/delusional
beliefs is supported by the fact that logical discussions have not
convinced Laura that her fears are ungrounded. Additional
Information: More information is needed to pinpoint the
underlying cause of Laura’s fear of loss. Information on her
childhood and any traumatic situations in her life will help.
Focusing on her developmental life stage is also important. In
addition, Scott and Cervone (2016) emphasize the importance of
one’s personality and self-schemata when conceptualizing a
case; An assessment of self-schemata can highlight where Laura
fits with valance, competence, rejection sensitivity, self-beliefs,
competence, and self-efficacy (Scott & Cervone, 2016).
American Psychiatric Association (2013). Diagnostic and
Statistical Manual of Mental Disorders (5th ed.). Ellis, M. V.,
Hutman, H., & Deihl, L. M. (2013).
Chalkboard case conceptualization: A method for integrating
clinical data. Training and Education in Professional
Psychology, 7(4) 246–256.
Scott, W. D., & Cervone, D. (2016). Social cognitive

8. personality assessment: A case conceptualization procedure and
illustration. Cognitive and Behavioral Practice, 23(1), 79–98.