Case Study of Danial.edited

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Case Study of Danial Tonya Adkins Capella University PSY 6210 Fall 2023 Unit 10

Part 1: Case Summary Danial, a 7-year-old child, was accompanied by his parents. As they sit, Danial clings to his Mother and sits near her. He has an older brother named Salim. Danial resides with his parents, Yelda and Nasir, who are the proprietors of three convenience stores that offer food and beverages. Originally from Pakistan, his family immigrated to the United States almost a decade ago, and practices the Islamic faith. His parents possess a high level of English proficiency and believe that their cultural background poses challenges in adapting to American society. Danial is diminutive for his age and is sometimes misidentified as a female due to his appearance. He is enrolled in the second grade and maintains an A average in his academic performance. His parents are worried due to his persistent abdominal discomfort that has been occurring since the start of the academic year. They clarify that he desires to remain at home with his Mother due to exhibiting the same conduct that occurred during the session. The absence from his Mother led to him working in his kindergarten class. The severity of his gastrointestinal ailments has increased compared to past years. In addition, he is experiencing insomnia and frequently experiences nocturnal awakenings. He wants companionship to facilitate his ability to regain sleep. The father has halted his son's crying. According to his parents, he sleeps outside their room due to his recurring nightmares of his Mother being abducted. Additionally, they explain that they can only entrust him to Yelda's parents, as he persists in crying when left unaccompanied by anyone else. Danial is clutching his Mother closely due to his anxiety and apprehension that harm may befall her. He exhibits a reluctance to engage in conversation and a desire to be alone, resulting in an

increased dependency on his Mother. Danial's father is observed expressing his disapproval of Danial's behavior by rolling his eyes. He lacks any personal or familial history of mental health issues. Another behavioral problem with Danial is his preference for engaging in play activities with girls and dolls. Diagnostic Clinical Impression 309.21 (F93.0) Separation Anxiety Disorder 302.6 (F64.2) Gender Dysphoria in Children OTHER FACTORS: V61.20 (Z62.820) Parent-Child Relational Problem V61.8 (Z63.8) High Expressed Emotion Level Within Family V62.89 (Z60.0) Phase of Life Problem V62.4 (Z60.3) Acculturation Difficulty Recommendations Ecklund (2012) emphasized the importance for psychologists to be aware of the intersecting identities of their varied child clients who have mental health difficulties. Factors such as culture, ethnicity, financial class, gender, sexual orientation, and spiritual practices are likely to have a significant impact on the child and their family. Emotional distress is caused by being separated from someone or something one is attached to. The Family Therapy program includes disorder-specific materials suitable for adolescents and children as young as five. It also provides parent training to address dysfunctional parental thinking, parenting behavior, and parent-child interaction. This training is based on the understanding that family dynamics influence separation anxiety (Schneider et al., 2013). The study suggested implementing child-centered interventions

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for anxiety as a means to mitigate or forestall the recurrence of anxiety problems during adolescence and adulthood. I highly endorse this therapeutic technique as it precisely targets separation anxiety problems in young children. Danial's primary challenge will be mitigating the intensity of his current separation anxiety. To accurately diagnose gender dysphoria, it is recommended to examine and analyze the individual's symptoms thoroughly. Danial satisfies specific criteria as determined by the interview conducted with his parents. Nevertheless, parents are frequently involved in all therapeutic modalities concerning the diagnosis and treatment of young children. In formulating a therapy plan, I would duly consider the cultural and religious views of Danial's family. Ecklund (2012) asserted that a child psychologist must engage with a heterogeneous clientele. I would also prefer to have a medical examination to eliminate the possibility of any underlying medical issues. A physician should evaluate the worsening of stomachaches to eliminate the possibility of any undiscovered stomach problems. Questions  What are your diagnostic hypotheses for Danial in this scenario? Justify your conclusions. His unwavering commitment to his Mother characterizes Danial's expression of separation anxiety disorder. In addition, he is encountering sleep disruptions and is frequently noticed lingering outside his parents' apartment. He has experienced bodily manifestations in the form of stomachaches and has reported discomfort related to the disease. He is worried about the possibility of his Mother being kidnapped. From the start of kindergarten and first grade, Danial has displayed indications of uneasiness and is currently experiencing stomachaches. His Mother stopped working as a school

assistant when he started kindergarten, which is when his problems initially manifested. Danial adamantly declines to participate in solo interviews, and apart from occasionally allowing his elders, he strictly prohibits any other individuals from observing him. Currently, Danial meets all the criteria outlined in the DSM-5 for separation anxiety disorder. Therefore, it would be appropriate to diagnose Danial with separation anxiety disorder. Danial's tendency to cling tightly to his Mother is indicative of separation anxiety disorder. Furthermore, he often places himself near his parents' door as a result of his insomnia. The person has reported experiencing stomach discomfort, a clinical symptom of the illness. Regarding the kidnapping of his Mother, he harbors fears. From kindergarten to first grade, Danial has displayed signs of concern, such as experiencing stomachaches. His Mother stopped working as a school assistant at the same time as his symptoms began to appear when he started kindergarten. Danial refuses to participate in interviews unless his elders, whom he occasionally allows to observe, are present. According to the DSM-5, Danial currently meets all the criteria for separation anxiety disorder. Hence, it is imperative to diagnose Danial with separation anxiety disorder accurately. Danial meets all eight diagnostic criteria for separation anxiety disorder as outlined in the DSM-5. During his initial interview, he had symptoms that were in line with a separation anxiety problem. Female children are more commonly affected by separation anxiety. Alternatively, given Danial's evident manifestations of gender dysphoria, it is plausible that he defines himself as female for diagnostic reasons. However, a more thorough discussion on gender dysphoria would be required to establish a definitive diagnosis. Individuals experiencing gender dysphoria during

prepubescence may express their wish to identify as a female. According to the American Psychological Association (APA), individuals prefer wearing attire typically associated with females, engaging in traditional activities related to females, playing with toys typically associated with females, and displaying a preference for socializing with females. Men experiencing gender dysphoria tend to abstain from vigorous physical activities and competitive sports and exhibit minimal enthusiasm toward objects typically associated with males (APA, 2022).  Describe what further diagnostic information you need (what further diagnostic evaluation is warranted) at the end of this scenario. Danial fulfills the criteria for separation anxiety disorder. Hence, the primary emphasis would be on gender dysphoria. To obtain a comprehensive diagnosis, conducting another interview with Danial would be necessary. During the interview, he would be asked about his gender identity. Then, he elaborates on whether he is inclined to identify as a female. Ensuring his comfort and safety during discussing this sensitive topic is crucial. During the interview, I would secure the presence of his Mother while requesting his father to exit the room. It is essential to assess whether Danial is genuinely inclined to identify as a female or if his diminutive physical height merely influences his preference for interacting with ladies and explore whether he faces harassment from males due to his physical appearance, which could explain his preference for socializing with girls. If, following this interview, Danial expresses a self- identification as female, it would be reasonable to consider a diagnosis of gender dysphoria. Conducting a medical examination to assess testosterone levels, sex development, and genital anomalies might be beneficial in achieving a precise diagnosis.

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The DSM-5 addresses the issue of individuals experiencing gender dysphoria being subjected to bullying and social isolation by their peers, resulting in significant psychological suffering (APA, 2022). If this occurs to Danial, it could be an alternative reason for his reluctance to attend school. Hence, conducting a comprehensive inquiry into gender dysphoria is warranted. Applying intersectionality theory in clinical practice to patients with various cultural group identities can lead to case conceptualization and therapy considering all pertinent cultures that shape the individual.  From a diathesis-stress perspective, what impact do the cultural, ethnic, and psychosexual issues have on Danial and his family in this scenario, and what other problems may play a role? Danial's family originates from Pakistan, although he is the sole one born in the United States. His family struggles to integrate into American society due to cultural and religious differences. An examination of the ideas of gender, sex, and sexuality in psychiatric discussions can question widely held cultural beliefs about mental health and mental disease by showing how these beliefs are influenced by culture and history ( Lambert, 2023). Danial grapples with additional identity challenges due to his family's lack of comprehension regarding his status as a native-born U.S. citizen and the associated responsibilities imposed upon him. This, combined with his Mother's abrupt return to work, has resulted in a combination of separation, anxiety, and identity problems. Danial underwent a series of swift changes: his Mother resumed employment, he resumed schooling without his Mother's presence in the classroom, and he was no longer permitted to sleep in his parents' bed. However, Danial's family has reported no familial history of any mental disease. The study proposes examining

the temperament of a young child as a prognostic indicator for anxiety disorders. I posit that the efforts made by Danial's parents to uphold their cultural and religious convictions may generate a certain level of stress that, in turn, triggers anxiety in Danial. His endeavor to conform has pushed him beyond the limit, resulting in the development of separation anxiety disorder ( Ecklund, 2012). Applying the biological predisposition component of the diathesis-stress concept becomes challenging. Emphasizing the way Danial's culture deals with separation at different stages of a person's life is of more significance. Adolescents suffering from anxiety disorders experience significant limitations in their daily functioning and face potential negative consequences if they do not receive appropriate treatment ( Kendall et al., 2016). Part 2: Case Summary Danial resurfaces at sixteen years of age. His Mother reported that the treatment was successful when he was seven years old. During the second interview, Danial exhibited indications consistent with major depressive disorder. He is irritable and sensitive, has experienced substantial weight loss, has no appetite, exhibits signs of agitation, suffers from insomnia, is tearful, and is unable to remain still. Danial has conveyed thoughts of self-harm by claiming to have placed an unloaded firearm to his temple and deactivated its trigger. Additionally, Danial has painted fingernails, which is consistent with his gender dysphoria. Although he claims to have one male friend, he prefers to spend time with the women he associates with rather than "the guys." Additionally, Danial is acquiring half-pint quantities of vodka.

Diagnostic Clinical Impression 296.23 (F32.2). Severe Major Depression Disorder with Melancholic features 303.23 (F64.10). Social Anxiety Disorder 302.85 (F64.1). Adolescent Gender Dysphoria OTHER FACTORS: V61.20 (Z62.820) Parent-Child Relational Problem V62.4 (Z60.4) Social Exclusion or Rejection 305.00 (F10.10). Alcohol Use Disorder, Mild Recommendations The presence of melancholic elements has been recognized as one of the defining characteristics of major depression since DSM-III. As per the DSM-5, individuals exhibiting melancholic features experience either anhedonia or a lack of mood reactivity. They also display three or more symptoms, including a distinct quality of depressed mood, worsened mood in the morning, early-morning awakening, psychomotor agitation or retardation, anorexia or weight loss, and excessive guilt (Imai et al.,2021). It is imperative to promptly enroll Danial in treatment to address his emotional instability and the challenges he has in his personal life and family dynamics. He should undergo a screening to assess the potential risk of suicide. Following the evaluation of the severity of the risk, the doctor should decide whether hospitalization is necessary to mitigate the risk of self-harm. The family should also advise the therapist that he has a history of engaging in gunplay. This information is crucial since it will provide further data on the danger. When should we exercise prudence and take preventive measures to mitigate potential self-inflicted harm? The family members need

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to be informed to mitigate potential future conflicts. Well, ask; he needs an assessment for substance and alcohol abuse. The treatment should encompass the acquisition of novel coping mechanisms to assist him in managing his addiction. If he persists in his current behavior, it could exacerbate his depression. Immediate action must be taken to address this conduct. He is seen as emotionally volatile throughout his therapy sessions with his therapist. He can effectively assist and comprehend him because of his prior experience working with other Muslim families. He is capable of helping him address and resolve relationship issues with his family members. Additionally, he possesses the ability to provide him with tactics that can be utilized to mend his interpersonal relationships. Danial should be promptly referred to a hospital in light of his suicidal ideation and discourse. I suggest that they do a thorough evaluation of them. Following the intervention for his suicidal ideation, I would consult with the facility to develop a treatment strategy and examine any interview records as well as medical or psychological diagnoses. The source of his interpersonal difficulties is his interactions with his father and brother. They must possess the ability to repair and establish mutual comprehension. The psychological assessment should be evaluated and analyzed by his behavioral patterns and level of depression. Understanding the origins of this disorder can be facilitated by considering the supplementary details concerning his gender dysphoria and how he manages to cope with this disease. A comprehensive medical assessment should be conducted to exclude any potential medical conditions and further substance abuse concerns. Questions

 What are your diagnostic hypotheses for Danial in this scenario? Justify your conclusions. The diagnosis of major depressive disorder is made when an individual exhibits five or more symptoms that persist for two weeks. During the interview process, it is discovered that Danial fulfills the requirements. Danial's Mother has reported that he is displaying signs of tearfulness. In addition, he has seen a decrease in his desire to eat and has shed a total of twenty pounds over six weeks. His irritability is frequently indicative of severe depressive disorder in adolescents (APA, 2022). In addition, his Mother notes a decline in his engagement in activities. He has been experiencing chronic insomnia. He exhibits psychomotor activity, characterized by his Mother like a cat on a hot tin roof. He is exhibiting suicidal thoughts, as evidenced by his action of pointing a gun at his head. Danial's present ailments are adversely affecting all aspects of his life. Danial is currently free from any symptoms associated with separation anxiety. At the age of seven, he exhibited all the symptoms of separation anxiety as per the established criteria. In a recent interview, his Mother confirmed that past treatment had been effective. Danial presently meets the diagnostic criteria for major depressive illness and alcohol use disorder and exhibits symptoms of gender dysphoria. Danial fulfills criteria A-C as specified in the DSM-5 for major depressive disorder. In addition, the DSM specifies that the symptoms must be present nearly daily. The interview with Danial's Mother indicates that he has been experiencing symptoms for a minimum of six weeks. Furthermore, suicidal ideation, images of death, and suicide attempts are frequently observed in individuals with major depressive disorder, according to the DSM (APA, 2022). Danial tested the sensation by holding an unloaded revolver to his cranium and

pulling the trigger. He stated that he frequently contemplates mortality. He then expresses grave concerns regarding mortality.  Describe what further diagnostic information you need (what further diagnostic evaluation is warranted) at the end of this scenario. In the past, Danial showed signs of gender dysphoria, which prompted me to conduct a more in-depth interview since he arrived wearing clear nail polish. It is crucial to examine this to avoid gender bias when administering treatment. In addition, a physician must ensure that all circumstances that could impede treatment or diagnosis are considered. At the age of seven, Danial preferred feminine attire. He enjoyed engaging in activities typically with girls, and his father acknowledged his inclination towards playing with toys traditionally associated with ladies. If Danial experiences gender dysphoria, it would be suitable for the clinician to refer to him using the proper gender. Hence, conducting a more comprehensive assessment of Danial through an interview is imperative. Another aspect to consider is Danial's admission of acquiring half-pints of vodka from an acquaintance. It is crucial to assess whether alcohol use disorder played a role in his diagnosis of major depressive disorder, either as a contributing component or as the cause. Additionally, it is crucial to verify that his present state is not a result of alcohol consumption. Hence, interviewing Danial regarding his present alcohol usage by the DSM-5 criteria is not only crucial but will yield the most effective treatment strategy for Danial.  From a diathesis-stress perspective, what impact do the cultural, ethnic, and psychosexual issues have on Danial and his family in this scenario, and what other problems may play a role?

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According to the Migration Policy Institute (2019), immigrants reside in a country other than their country of birth, with the condition that they are only considered first- generation immigrants. Practically, academics employ the terms "second-generation immigrants" or "children of immigrants" (Kiang et al., 2022). They recognize the significance of an immigrant environment for individuals who do not fall within this categorization. These discrepancies lead to techniques that focus on differences, comparing the identity and mental health of immigrants with non-immigrants. Alternatively, studies may control for generation, although this approach less clarifies the relationships between these factors. Immigration involves adapting to unfamiliar social norms and structures. Research in the United States is ongoing in conventional settlement locations, new settlement communities, and other regions that are not usually focused on (Kiang et al., 2022). According to the diathesis-stress paradigm, Danial's previous separation anxiety condition can be attributed to a biological component. During the conversation, Danial's family affirmed the absence of any ancestral record of psychological illnesses. However, it should be noted that the absence of familial history does not necessarily imply its nonexistence. Specific symptoms or indicators of psychiatric problems are frequently perceived as cultural standards, resulting in undetected conditions and an erroneous representation of familial medical history. However, the biological aspect must be disregarded based on the available facts. Following the principles of the diathesis-stress model, Danial's sources of stress appear to be from his father and cultural influences. In an interview, Danial's father compared him and his brother, highlighting their differences. The combination of that

stressor and the fact that Danial is the sole member of his family born in the United States presents a distinct situation for him. Danial is experiencing difficulties adapting to and integrating a new culture and other circumstances that may have contributed to his current state, which aligns with the diathesis-stress paradigm. Furthermore, he had a preexisting susceptibility to psychological illnesses as a result of his prior experience with separation anxiety. Part 3: Case Summary Danial is 25 at this point in the case study. He works with his uncle at an architecture firm. After talking to his boss, he applied for an interview. Before meeting with Danial, the therapist reviewed his seven- and sixteen-year-old records. Danial had anxiety and gender dysphoria as a child, according to a study. His father dislikes him due to his penchant for feminine qualities, which has affected him. Reports said sixteen-year-old Danial had a gun to his head. His gloomy father's treatment of him, which was different from that of his brothers, deeply affected him. He claims his boss, who plans to fire him, ordered him to resume treatment. The employer warned him that he could lose his job without help. He also suggested consulting his doctor for medicines. Danial cites his boss and coworkers mocking and conspiring against him when asked why his manager wants to fire him. He feels underpaid as a skilled draftsman. The therapist explained that he was unfamiliar with his boss and advised the patient to see another therapist. He stays with the psychotherapist, believing she will notify his supervisor of his session termination. Danial was told during the verbal agreement that

all discussions are confidential unless he endangers himself or others. He mentioned wanting to hurt his boss, causing the therapist to confirm that he did not know him. He signed a confidentiality agreement to ease his anxieties about his emotional issues and using his father's gun. He denies sadness and distrusts strangers. His contentment allows him to sleep. He is not losing weight. He is only there to placate his boss and uncle and dodge their insistence on help. He also wants to know if his lover is cheating. Danial avoids questions about his personal life and struggles. He reports drinking three to five drinks during the weekend. His relatives' insistence on Islamic rituals creates a tense family dynamic. His phone number has been changed to ensure limited contact with his parents. His employer and doctor endorsed Danial. He says his supervisor wants to dismiss him and makes insulting comments about him when he is away. He thinks his pay is low for a top draftsman. He gossips about himself, believes his peers get better pay, and thinks his boss's comments are a way to get him to work harder. He thinks his coworkers envy him. He thinks I am working with his boss. Danial requires me to sign a confidentiality agreement to keep our sessions private. Often skeptical, he wants clarity before answering queries. Danial drinks three to five highballs every night. Danial investigates his family's struggles to adapt to a new culture and its effects on him. He also admits his male lover and refutes his father's argument that Muslims are not gay. Diagnostic Clinical Impression 301.0 (F60.0) Paranoid Personality Disorder 305.00 (F10.10) Alcohol Use Disorder, Mild Other factors

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V61.29 (Z62.898) Child Affected by Parental Relationship Distress V62.29 (Z56.8) Other Problems Related to Employment V61.10 (Z64.0) Relationship Distress with Intimate Partner V62.89 (Z65.8). Other Problems Related to Psychosocial Circumstances. Recommendations It is recommended that Danial seek treatment for his paranoid personality disorder. Furthermore, I would integrate therapeutic interventions for alcohol use disorder. I propose undertaking a comprehensive assessment in order to investigate the possibility of a gender dysphoria diagnosis. Regularly performing a thorough evaluation of both mental and physical health is crucial for excluding the potential occurrence of alternative issues. Based on the insights gleaned from the present interview and the prior mental health documentation, the therapist recommends that Danial initiate therapeutic intervention. Through active engagement in these sessions, he will gain significant abilities to proficiently control his cognitive processes concerning self- perception, social interactions, and paranoid ideation. Additionally, he will gain insight into how paranoid thoughts may influence his perception of others during the therapy session. Additionally, it will bring attention to the fact that his actions might have incited his supervisor to threaten termination had he not proactively sought counseling. An additional course of action would be to consult a psychiatrist regarding the administration of medication to Danial to manage his emotions and behavioral reactions. It would benefit him to acquire additional information from his superior or significant other. It would facilitate comprehension and portray his genuine conduct in his professional and social surroundings. In conclusion, I propose

that an evaluation be undertaken to ascertain the presence of substance addiction concerns on his part. This will assist in the eradication of any potential contributors to his capricious and paranoid behavior. Questions  What are your diagnostic hypotheses for Danial in this scenario? Justify your conclusions. He is currently asymptomatic for major depressive illness and separation anxiety. The prior diagnoses will be considered when examining the cause of the current diagnosis of paranoid personality disorder. Danial fulfills the established criteria for paranoid personality disorder. The individual exhibits indications of alcohol use disorder as a result of consuming three to five high balls per night. During Danial's interview at the age of sixteen, he expressed his skepticism towards others. Paranoid personality disorder typically manifests in adolescence with symptoms such as isolation, social anxiety, difficulties in forming relationships with peers, and peculiar or eccentric behavior (APA, 2022). In a prior interview, he expressed the belief that his Mother deceived him into visiting a psychiatrist. Based on the progression outlined in the DSM- 5, Danial started exhibiting symptoms of paranoid personality disorder at the age of sixteen. The prevalence of this disease is higher among males, as stated by the American Psychological Association (APA, 2022). Furthermore, it is crucial to acknowledge that during his interview, at the age of seven, he had symptoms of separation anxiety disorder, which should be regarded as a component of the progression and trajectory of paranoid personality disorder. Danial exhibits suspicion and distrust towards his boss, colleagues, therapist, and partner. He is reluctant to share his thoughts with me because he believes I am

colluding with his boss to fulfill his desires. This is also included in the DSM diagnostic criteria. The primary determinant of paranoid personality disorder is the perception of suspicion and distrust, which is interpreted as malevolent (APA, 2022). Danial exhibits a characteristic of perceiving others as conspiring against him with malicious motives. Danial believes that any information disclosed during the session will be utilized to his detriment, which aligns with the criteria outlined in the DSM. During his interview, he refutes his previous diagnosis of depression and asserts that he is neither emotional nor depressed. Nevertheless, he proceeds to express his skepticism about individuals. He subsequently asserts his belief that his spouse is engaged in an extramarital relationship, which he has been unable to substantiate. As per the DSM-5, an individual diagnosed with paranoid personality disorder exhibits excessive and irrational jealousy (APA, 2022). Currently, Danial does not exhibit signs of schizophrenia, bipolar disorder, depressive disorder with psychotic aspects, or any other psychotic disorder. Additionally, his symptoms cannot be attributed to the physiological effects of a neurological or other medical problem (APA, 2022). It is noteworthy that Danial exhibits independent behavior, which aligns with the trait of self-sufficiency associated with paranoid personality disorder. People often face difficulties cooperating with others and do best when working alone. He is imbibing at least three to five high balls, occasionally exceeding this quantity. Regarding alcohol consumption disorder, he fulfills the minimum requirements for a diagnosis of mild usage. Given the few facts available, it is impossible to classify it beyond the mild categorization, as he has not met any other

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criteria. Conducting more interviews is crucial in order to delve deeper into the extent to which his alcohol consumption is affecting his life.  Describe what further diagnostic information you need (what further diagnostic evaluation is warranted) at the end of this scenario. Danial now fulfills a minimum of four diagnostic criteria outlined in the DSM. Nevertheless, going deeper into his excessive distrust or suspicion is crucial. A clinician must evaluate whether the individual's paranoia may be attributed to an alternative disorder. Currently, he is exhibiting symptoms consistent with paranoid personality disorder. Nevertheless, several psychotic diseases imitate the characteristics of paranoid personality disorder. Hence, a clinician must ascertain that the present symptoms are not attributable to any alternative condition. To gather more information, I would do a comprehensive interview with Danial to assess for potential signs of schizophrenia, bipolar disorder, depressive disorder with psychotic aspects, delusional disorder, medical disorders, substance-induced disorders, or any other relevant psychiatric conditions. It is crucial to elaborate on alcohol use disorder. Considering the limited information provided by Danial regarding his alcohol use, it is necessary to conduct a more thorough assessment. To assess Danial's alcohol usage, he should be questioned based on the specific criteria outlined in the DSM for alcohol consumption disorder. This will help identify whether his use falls within mild, moderate, or severe categories. This would enable a healthcare professional to administer suitable therapy. A precise diagnosis would enable a clinician to exclude the likelihood of any psychological disorder caused by alcohol consumption.

Additionally, it would enable the physician to comprehend the influence that his alcohol consumption has on his present disorder. The primary concern is differentiating between Danial's paranoid personality disorder and any alcohol-induced condition he may have. Elaborating on this would enable a clinician to ascertain Danial's most appropriate therapy method.  From a diathesis-stress perspective, what impact do the cultural, ethnic, and psychosexual issues have on Danial and his family in this scenario, and what other problems may play a role? Individuals who have paranoid personality disorder exhibit an extreme level of mistrust towards others, which significantly hinders their ability to establish interpersonal connections and effectively navigate their daily activities. The illness is believed to be influenced mainly by genetics, although challenging childhood circumstances and trauma can also contribute. Treatment can be problematic due to the symptoms of the illness (MSEd, 2023). As previously mentioned, interviews have revealed the absence of any familial history of mental illness. Considering Danial's prior diagnosis of separation anxiety disorder, major depressive disorder, alcohol use disorder, and possible gender dysphoria, these conditions will serve as the biological factors in the diathesis-stress model. To address Danial's stressors, examining his surroundings and their impact on his capacity to manage his conflicting identities is crucial. It is crucial to consider how his formative interactions with family and friends contribute to the development of paranoid personality disorder and alcohol use disorder. Islam grants a dominant and controlling position to heterosexuality. This can be comprehended considering that the primary ideological means of transmission, such as Islamic sacred scripture (the Koran), Islamic law (Shari’ah), and the vocal teachings of

the Prophet Mohammed (Ahadith), expressly prohibit homosexuality (Jaspal & Cinnirella, 2012). As previously mentioned, interviews have revealed the absence of any hereditary background of mental disease. However, as Danial has previously been diagnosed with separation anxiety disorder, severe depressive disorder, alcohol use disorder, and possible gender dysphoria, these disorders will serve as the biological factors in the diathesis-stress model. To address Danial's stressors, examining his surroundings and their impact on his capacity to manage his conflicting identities is crucial. It is crucial to consider how his formative interactions with family and friends contribute to the development of paranoid personality disorder and alcohol use disorder. According to the diathesis-stress model of diseases, Danial's difficulties in establishing his identity can be traced back to his upbringing in a Pakistani Muslim household that resisted assimilation into American culture. As the sole member of his family born in the United States, Danial faced the ongoing challenge of assimilating into his family. These difficulties persisted at ages seven, sixteen, and twenty-five and were the subject of discussion. Danial's failure to integrate his several personas is the primary factor that led to the onset of paranoid personality disorder. Alcohol consumption disorder commonly coexists with personality issues. Part 4  Given Danial's family background and his open homosexuality, what cultural and ethnic factors do you need to be aware of at the different stages of his life, and how would you deal with them in arriving at your diagnosis? Give your reasoning with supporting documentation. There has been a growing scholarly focus on the intersection of sexual and religious identities in recent years. Gay and lesbian individuals who have religious faith typically have more significant social and psychological difficulties due to their sexual orientation.

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Researchers in the field of social sciences have examined the convergence of these identities among homosexual individuals who identify as Christians, Jews, and, more recently, Muslims (Jaspal & Cinnirella, 2012). Regarding Danial, he draws attention to the fact that his father has asserted that no one is both gay and Muslim. For this reason, it is essential to determine whether or not he shares the same sentiments as his father. If Danial does, it will be essential to assist him in comprehending the fact that his homosexuality and faith do not have to conflict with one another. In order to help him handle any religious concerns that he is currently dealing with, it would be helpful to find a method for him to comprehend how both may coexist. The likelihood of Danial receiving effective treatment would be significantly increased if he were to resolve the concerns he has with his identification.  Compare and contrast the changing roles of psychosexual diagnoses in the DSM text since the 1950s. During the 1950s, the psychoanalytic community widely embraced the notion of "character disorders," and psychoanalytic practitioners began differentiating them from more severe mental illnesses that result in a loss of contact with reality, known as psychosis (Lautieri, 2019). The publication of DSM II in 1968 aimed to align the American psychiatric categorization system with the International categorization of Diseases developed by the World Health Organization (APA, 1968). The use of neutral language in this context aimed to avoid endorsing any particular theoretical ideas that may be controversial (Lautieri, 2019). During the 1950s, homosexuality was considered a morally wrong act. The reason it was classified as a condition was due to its controllable and treatable nature, as well as

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its non-genetic origin. That critique appeared to be broadly accepted. Nevertheless, it has been excluded from the DSM language (Ross, 2015). Ross (2015) contends that gender dysphoria, like homosexuality, will ultimately be excluded from the DSM due to antiquated data and evolving perspectives on the matter. The findings of this recent study led to the improvement of the criterion sets used for diagnosing personality disorders in DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), and DSM-5 (APA, 2013). The DSM-5 (2013), the latest edition of the diagnostic handbook, presents a novel framework for studying personality disorders in upcoming research. Based on the results of that research, it is possible that in the future, we may evaluate personality disorders using a dimensional framework that incorporates different personality features: the present dominant diagnostic approach and the suggested dimensional system (Lautieri, 2019).

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References American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th edition, text rev). American Psychiatric Association. Ecklund, K. (2012). Intersectionality of identity in children: A case study. Professional Psychology, Research and Practice, 43(3), 256- 264. https://doi.org/10.1037/a0028654 Imai, H., Noma, H., & Furukawa, T. A. (2021). Melancholic features (DSM-IV) predict But do not moderate response to antidepressants in major depression: An individual participant data meta-analysis of 1219 patients. European Archives of Psychiatry and Clinical Neuroscience, 271(3), 521- 526. https://doi.org/10.1007/s00406-020-01173-4 Jaspal, R., & Cinnirella, M. (2012). Identity processes, threats, and interpersonal Relations: Accounts from British Muslim gay men. Journal of Homosexuality, 59(2), 215-240. https://doi.org/10.1080/00918369.2012.638551 Kendall, P. C., Cummings, C. M., Villabø, M. A., Narayanan, M. K., Treadwell, K., Birmaher, B., Compton, S., Piacentini, J., Sherrill, J., Walkup, J., Gosch, E., Keeton, C., Ginsburg, G., Suveg, C., & Albano, A. M. (2016). Mediators of change in the Child/Adolescent anxiety multimodal treatment study. Journal of Consulting and Clinical Psychology, 84(1), 1– 14. https://doi.org/10.1037/a0039773 Kiang, L., Stein, G. L., & Juang, L. P. (2022). Ethnic and racial identity of immigrants And effects on mental health. Current Opinion in Psychology, 47, 101424. https://doi.org/10.1016/j.copsyc.2022.101424

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Kossowsky, J., Pfaltz, M. C., Schneider, S., Taeymans, J., Locher, C., & Gaab, J. (2013). The separation anxiety hypothesis of panic disorder revisited: A meta- analysis. American Journal of Psychiatry, 170(7), 768- 781. https://doi.org/10.1176/appi.ajp.2012.12070893 Lambert, V. (2023). Gender dysphoria and the medicalization of distress. New Zealand Sociology, 38(1), 56-67. Lautieri, A. (2019, March 27). The history of the psychiatric diagnostic system continued . MentalHelp.net. https://www.mentalhelp.net/personality-disorders/history-of-the-psychiatric- diagnostic-system-continued/ MSEd, K. C. (2023, October 26). Paranoid Personality Disorder . Verywell Mind. https://www.verywellmind.com/paranoid-personality-disorder-2795448 Ross, C. (2015). Commentary: Problems with the Sexual Disorders Sections of DSM-5. Journal of Child Sexual Abuse, 24(2), 195–201. http://dx.doi.org/10.1080/10538712.2015.997411 Schneider, S.m Blatter-Meunier, J.m Herren, C., In-Albon, T., Adornetto, C., Meyer, A., & Lavallee, K.L. (2013). The efficacy of a family-based cognitive-behavioral Treatment for separation anxiety disorder in children aged 8-13: A randomized Comparison with a general anxiety program. Journal Of Consulting And Clinical Psychology, 81(5), 932-940. doi:10.1037/a0032678

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