Cassandra accounts to have such personality disorder as she is a victim of post traumatic stress disorder (PTSD) that affects her in a difficult condition mostly on the physical side as not easy for her as she tries to hurt herself due to past and painful experiences she went through with her father and basically also with her ex-boyfriend. The critical encounter of post traumatic stress disorder (PTSD) from within the case study base from mental health proponents as well as journals within the disciplines of trauma, personality care, assessment and intervention from the year 2004 and beyond. Given the fact that personality disorders have high prevalence in the general population, prediction and prevention of PTSD in individuals is problem concern of health.
Post traumatic Stress Disorder (PTSD), Criteria and DSM-IV Cluster
The presence of DSM-IV cluster will have to be ideally noted and analyzed from within issues of personality problems Cass is facing as of the moment, the issue of her denial attitude and anxiety possibilities the precise nature of her admission upon indulging herself to alcohol use, substance abuse domain and her eating disorder history which led her to become schizophrenic and have unpredictable mood swings, mood fluctuations and being mentally ill may result to fleeting ideas of self-harm as seen in Cassandra’s behavior over others and if she feel secured, she does not want the person to leave her side, nursing care is substantial in the case of Cass. The DSM-IV is of post traumatic stress indications within three criteria of certain symptom clusters of posttraumatic stress disorder (PTSD) as noted by the Diagnostic and Statistical Manual (DSM-IV) (APA, 2004)
DSMIV Cluster Criteria Cassandra’s Case (total of three, A,B,C) as cited from, (Spitzer et al., 2007 p. 235)
Prevalence
Ideally, McNally (2007) have attempted to explain the incredibly high prevalence rates of PTSD in the NVVRS study, suggested that it may have in part resulted from making the diagnosis in many individuals who were not functionally impaired but were merely exhibiting normal human reactions to adversity. Thus, Bryant (2007) discusses some findings on dissociation and concludes that the assumptions leading to the diagnosis of Acute Stress Disorder as flawed. How the diagnosis can be abused in real life settings, both forensic and clinical, is discussed in the study done by Rosen and Taylor (2007). Jones and Wessely (2007) have noted how PTSD has obscured the role of secondary gain in explaining failure to recover from trauma aside, McHugh and Treisman (2007) have argued that the diagnosis has moved the mental health field from, rather than towards, an understanding of natural psychological responses to trauma.
Causes of PTSD
There maybe difficulty towards characterizing the prevalence of PTSD or to accurately assess PTSD of Cass case such as in response to apparent increasing rates of traumatic events worldwide. Although the wide range of symptoms displayed can make diagnosis more difficult, accurate diagnosis of PTSD remains essential. Although ample measures compare symptoms against DSM-IV criteria, not all use the most recent PTSD criteria or any criteria. Similarly, time frame of symptom assessment varies considerably from 1 week to 1 month, although certain DSM-IV diagnosis (Hawkins and Radcliffe, 2006 p. 427) requires symptoms to be present for at least 1 month, methods for outcomes assessment and longitudinal follow up need to be developed. Thus, some journals covering trauma and assessment are not included and additional measures for specific types of trauma were not reviewed as an outcome. Accurate assessment of PTSD for the case situation is critical because of the detrimental effects trauma can have on the aspects of functioning. Correct symptom description, diagnosis, and response to interventions can be made only to the extent that measures allow. Although current measures are promising and innovative measures are emerging, further work remains to address measurement issues in PTSD in relation to mental issues found in Cass case (Hawkins and Radcliffe, 2006 p. 427). Post traumatic experiences of Cassandra have made her weak having low self esteem to cope with situations that surround her, she is in denial of the truth as she fears of being left out and neglected and does not want to dig up on salient issues of such physical injuries she had and amiably can’t accept realities of life as Cass was crying, pleading, physically fighting with them and using foul language. She was also sexually abused by her father at an early age which caused her to have traumatic openings that brought her to assume personality disorder in such PTSD adaptability as being recognized through her eating manners that have led to the prevalence of anorexia nervosa (eating disorder) and presence of substance/alcohol abuse as her experiences with the male archetype are of bad connotations first with her father and second to her ex-boyfriend, the past history of being hurt and abuse physically, emotionally and mentally have repeated in the presence of her ex-boyfriend that triggered her personality problems and issues to come out, placing certain separation anxiety with her recent broke up as she wishes and hope for love and affection that she never felt during her early years when she was 12 years old.
Major issues/problem/risks
- PTSD
Persons with documented childhood abuse and or neglect were more than 4 times as likely as those who were not abused or neglected to be diagnosed with personality disorders during adulthood as childhood physical abuse, sexual abuse, and neglect were each associated with elevated personality disorder symptom levels during early adulthood after other childhood maltreatment. Recently, changes have been proposed to DSM-IV diagnostic criteria for post-traumatic stress disorder (PTSD) to refine the diagnosis because of concerns about its construct validity. Specifically, Spitzer et al. (2007) suggested narrowing the PTSD definition of trauma, specifying a symptom onset time frame after the trauma, and removing symptoms that overlap with other anxiety and mood disorders and examine whether removing these overlapping anxiety/mood disorder symptoms resulted in differences in PTSD prevalence rates, diagnostic caseness, comorbidity and mental health-related disability, structural validity, and internal consistency. Little difference was found between the criteria sets in diagnostic comorbidity and disability, structural validity, and internal consistency (Elhai, Grubaugh, Kashdan and Frueh, 2008 p. 597). Assessing whether impulsive and aggressive traits can be placed on continuum with DSM-IV Cluster B Personality Disorder and to determine if different aspects of these personality traits are specifically associated with individual Cluster for personality disorders and why frequently differ in clinical pictures and courses.
- Eating disorder
The need to recognize and execute certain ‘Eating Attitudes Test’ in diagnosing presence of Cass’ anorexia nervosa as it might likely due to changes in the diagnostic criteria as not been validated with Diagnostic and Statistical Manual of Mental Disorders criteria with and without an undifferentiated DSM-IV eating disorder diagnosis. Further, eating disorders are among the most common psychiatric problems that affect women (Kreipe and Birndorf, 2004) and conditions impose high burden of morbidity and mortality. Unfortunately, the diagnosis of eating disorders can be elusive, and more than one half of all cases go undetected (Becker, Grinspoon, Klibanski and Herzog, 2004). Cass eating disorder condition has occurred most commonly as ten times common than in males. Several adolescents and adults who do not meet the strict diagnostic criteria for eating disorders have disordered eating patterns, which can have a significant adverse impact on health.
- Alcohol/substance abuse
Substance abuse is a substantial problem among women, who representup to 30 percent of the patients in substance abuse treatment (Chatham, Hiller, Rowan-Szal, Joe and Simpson 1999; Griffin, Weiss, Mirin and Lange, 1989; Wilsnack, 1984 as quoted from, Hien, Cohen, Miele, Litt and Capstick, 2004 p. 1426). Thus, up to 80 percent of women seeking substance abuse treatment report lifetime historiesof sexual and/or physical assault, many of these women havesymptoms of posttraumatic stress disorder (PTSD) (Dansky, Sladin, Brady, Kilpatrick and Resnick, 1995; Fullilove, Fullilove, Smith, Winkler, Michael Panzer and Wallace, 1993; Hien and Scheier, 1996; Zweben, Clark and Smith, 1994 quoted from, Hien, Cohen, Miele, Litt and Capstick, 2004 p. 1426). Women with co morbid PTSD and substance use disorders have poortreatment retention rates and outcomes (Zweben, Clark and Smith, 1994 quoted from, Hien, Cohen, Miele, Litt and Capstick, 2004 p. 1426). Such alternative, integratedmodel that addresses PTSD and addictions may be more likelyto succeed, more cost-effective, and more sensitive to the uniqueneeds of these patients (Brown, Stout and Mueller, 1999; Brady, Killeen, Saladen, Dansky and Becker, 1994; Sullivan and Evans, 1995 quoted from, Hien, Cohen, Miele, Litt and Capstick, 2004 p. 1426) Currently and up to date, little integrated approaches have been empirically tested and demonstratedas efficacious.
Nursing interventions
Cassandra needs right amount of care and attention along with proper care assessments and interventions of nurses handling her situation. The presence for health care support is substantial and that nurses will have to provide ample care to intervene Cass health issues mostly in her trauma. The need to present conceptual basis and empirical evidence for considering avoidance and numbing as distinct posttraumatic stress disorder (PTSD) symptom clusters. PTSD symptom cluster distinction has implications for revising current diagnostic criteria. The recognition may lead to advances in understanding and treating of Cass as she encounters health issues relative to her PTSD. Ideally, several recent research is amiably needed to establish dimensional nature of PTSD symptoms and to assess whether identified dimensions differ as function of the trauma experience as implications for nursing care assessment, diagnosis, and intervention to be discussed in accordance to literature studies and organization base. General criteria for the diagnosis of Cassandra’s personality disorder have to be provided based on rating items describing features of personality disorder that Cass manifests such as low self-directedness, cooperativeness, affective stability and self-transcendence as it responds closely with concept of personality disorder in DSM-IV. Several criteria are to be provided for rating severity of personality disorganization as well as for sub typing based on profile of three additional dimensions corresponding to features of DSM-IV clusters A, B, and C. Further, the latter approach should facilitate efficient screening in clinical practice, encourage an understanding of development of co morbidity as one self-organizing process thus, provide some sort of theory driven basis for therapeutic planning with eating issues, alcohol/drugs intake and psychotherapy.
The salient unifying theme across these contributions is the questionable validity of the DSM-IV PTSD diagnostic criteria as they now stand, especially in relation to apparent false positives. While making many legitimate points, there refrain from attempting to solve problems they raise, and they do not propose new set of criteria for DSM-V’s PTSD and related categories. Many people have been exposed to overwhelming trauma, including abuse and assault. Posttraumatic stress can persist and become chronic disorder, with behavioral and physiologic alterations affecting health across the lifespan. Often the etiologic role of trauma in health problem remains undiscerned and unacknowledged. Acknowledging the effects of trauma is caring intervention in itself, and it can lead to more effective healthcare and better relationships with patients as there process of acknowledging the effects of trauma in clinical reasoning, in dialogue with the patient and in planning care and interventions.
References
American Psychiatric Association (2004). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC
Becker AE, Grinspoon SK, Klibanski A, Herzog DB (2004). Eating disorders. N Engl J Med 340:1092-8.
Bryant, R. A. (2007). Does dissociation further our understanding of PTSD. Journal of Anxiety Disorder, 21, 183–191.
Elhai, J. Grubaugh, A. Kashdan, T. and Frueh, B. (2008). Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. J Clin Psychiatry. 2008 Apr;69(4):597-602 Erratum in:
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Hawkins, S. and Radcliffe, J. (2006). Current Measures of PTSD for Children and Adolescents. Journal of Pediatric Psychology 31(4) pp. 420–430, Advance Access publication June 9, 2005 Journal of Pediatric Psychology vol. 31 no. 4 © The Author 2005. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
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Hien, G. Cohen, L. Miele, G. Litt, C. and Capstick, C. (2004). Promising Treatments for Women With Comorbid PTSD and Substance Use Disorders. American Journal of Psychiatry Vol. 161 No. 8 Aug. 2004 pp. 1426-1432
Jones, E., & Wessely, S. (2007). A paradigm shift in the conceptualization of psychological trauma in the Twentieth Century. Journal of Anxiety Disorders, 21, 164–175.
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