AnnaTruttier_u03a1_DepressiveDisorderandAssessments

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1 Diagnostic Approaches Anna Truttier Clinical Mental Health, Capella Univerisity Principles of Psychopathology COUN5107 Dr. Thomas January 29 th 2023

2 Unit 3 Diagnostic Approaches Working with clients from different backgrounds, cultures, and walks of life will require specific care. Since each client is one-off, their presenting symptoms will be unique to their life. In the following paper, a client named Annie will be introduced, and her symptoms will be presented. When trying to assess Annie’s presenting issues and center on a diagnosis, a clinician must use vital theoretical models to help identify psychological disorders, focus on the client's culture to help navigate and establish appropriate care, and use systems perspectives of assessments. Part 1: Examining Models of Psychopathology Annie is a 13-year-old Asian American, the youngest of four siblings. Her parents came from India for college and decided to plant roots and start their family in the United States. They travel and stay for weeks to stay connected to her parents' family in India. Annie understands minimal native language and mostly speaks English to her parents. When Annie was young, she spent three weeks in the hospital due to a severe illness. At thirteen, she is pretty healthy but still has fears and anxiety from her hospital stay. Annie is painfully shy and avoids big social situations where there are new and large groups of people. Annie is a good student but puts much pressure on herself to do well, which causes her to have test anxiety. She becomes so anxious and nervous that her heart starts racing, and she begins to tremble, making breathing difficult. Along with these anxieties, she also fears the dark, which causes her nighttime routine to be intertwined with her parents staying in her room until she is asleep. Annie’s older siblings have left the nest, and Annie’s parents find her constant need for reassurance burdensome. To understand Annie and why she may be experiencing these symptoms looking at the three theoretical models of psychopathology will be of great importance. The three models used

3 are the sociocultural, biological, and psychological approaches—the sociocultural approach views disorders resulting from environmental conditions and cultural norms (Nolen-Hoeksema, 2019). Unlike sociocultural approaches, biological approaches observe disruptions as the outcome of abnormal genes. The psychological approach views disorders as affecting one’s thinking process, personality, and conditioning (Nolen-Hoeksema, 2019). As mentioned above, Annie is experiencing sufficient symptoms that are causing distress in her daily life, making it quite difficult for her and her family. Applying the Sociocultural approach means observing these dysfunctional behaviors as an explanation for the stressors that Annie is experiencing in her daily life. Theorists who lean towards a sociocultural approach views abnormality as falling along a continuum because they do not view disorders as different from normal functioning (Nolen-Hoeksema, 2019). This approach gives meaning and understanding to Annie’s presenting issues and honors the culture that she lives in. According to Eshun et al. (2009), culture is a configuration of learned behaviors and results of behavior whose component elements are shared and transmitted by the members of a particular society. Since the Sociocultural approach views these symptoms as a result of the environment, it is essential to observe Annie’s environment. Annie feels much pressure to do well in school, causing her many anxieties. This pressure could be coming from her parents wanting her to live up to high expectations and fearing that she will fail. Annie travels to and from India a lot, which could also explain why she is incredibly shy or afraid of being alone at night. She constantly goes back and forth between two separate cultures, so assimilation is difficult. It might not be realized, but cultural traits and social norms play a pivotal role in how we experience the world around us. Cultural characteristics and models influence how we think, respond to distress, and feel comfortable expressing emotions (Eshun et al., 2009).

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4 Furthermore, the biological approach views disorders as abnormal genes, so when identifying Annie’s symptoms, it is essential to consider her genetic makeup. Using the biological approach to understand Annie’s presenting symptoms means that her behavior is a consequence of her genetics and physiology. That said, although we do not have enough information about Annie’s family with the knowledge of genetics, it is safe to say that Annie’s presenting symptoms directly correlates to her family. In recent years, proponents of biological approaches have embraced a continuum perspective of abnormally seeing disorders as collections of deficits in fundamental neurobiological processes (Nolen-Hoeksema, 2019). According to Narmandakh et al. (2020), the familial nature of anxiety disorders is assumed to be partly genetic and partly due to social factors. Moreover, Annie’s anxious tendencies could have been inherited from her family. Parents with anxiety and depression disorders may have limited social resources and, as a result, a reduced capacity to help their offspring cope with stressful social situations (Narmandakh et al., 2020). This could also be why Annie’s parents do not understand her anxieties and see them as a burden. Finally, taking a closer look at the psychological approach, as mentioned above, results from a person's cognition, personality, and conditioning. Annie’s maladaptive cognitions regarding her test-taking are a prime example of how a psychological approach could be a critical factor in a person’s presenting conditions. Along with Annie’s shyness and inability to feel comfortable in large groups or with new people, these are all forms of cognitions that are debilitating in Annie’s day to day. According to Narmandakh et al. (2020), current research shows that a child’s temperament has consistently found that behavioral inhibitions such as shyness predicts later anxiety disorders. These anxieties present in many ways, and several factors like Annie’s thinking, personality, and conditioning increase the risk for multiple anxiety disorders and shyness mostly related to these developments (Narmandakh et al., 2020).

5 Part 2: Assessment Instruments to Aid in Diagnosis For counselors to provide culturally responsive assessments and diagnostics to diverse populations, counselors need to be well-versed and culturally competent. Cultural competency is imperative. If the wrong review is chosen, this could lead to more harm than good being done and increases the risk of early termination of the therapeutic relationship. Fifty percent of racially and ethnically diverse clients end treatment or counseling after just one visit with a mental health practitioner (Department Of Health and Humans, & Services, D.O.H.A.H, 2016). Annie is a young Asian American girl with many abnormalities that interfere with her daily life. To appropriately care for Annie, an appropriate assessment must be acquired to understand further her presenting symptoms. The two assessments that will be used for Annie are the Parent-Guardian Level I Cross-Cutting Symptom measure and the Cultural Formulation Interview. Each of these can be administered to Annie appropriately and culturally competently. Using the Parent-Guardian Level 1 Cross-Cutting Symptom measure is essential for the clinician to understand a client's presenting issues better. Since Annie is only thirteen years of age, her mother will be there to fill out the questions included in the Parent-Guardian Level 1 Cross-Cutting Symptom. It is essential that Annie also completes the assessment so we can get a better understanding of Annie herself. Using this measurement, we must consider that the psychiatric domains listed in the evaluation differ from culture to culture. A person’s presentation of symptoms, interpretations of the illness, and help- seeking expectations are all influenced by an individual’s cultural background and sociocultural context (American Psychiatric Association, 2017). When administering this assessment, the clinician should be mindful and culturally responsive to questions or any misunderstandings that Annie and her parents may have. Furthermore, with the reliability this measurement has yielded in DSM-5 field trials, this

6 measurement gives clinicians the opportunity for additional areas of information that significantly impact the child’s treatment planning, treatment, and prognosis (American Psychiatric Association, 2017). The following assessment administered to Annie would be the Cultural Formulation Interview(CFI). This assessment is critical as it is more tailored to culturally diverse clients. The CFI is an interview protocol used by clinicians in any setting to gather essential data to produce a cultural formulation (Jarvis et al., 2020). Using this interview protocol for Annie can help establish more of a culturally competent relationship with her and her family. This shows her family that the clinician takes her culture seriously and is there to help bridge those gaps of honoring their culture and the therapeutic process. According to Jarvis et al. (2020), using CFI can improve clinical communication by enhancing clinician rapport, allowing the clinician to obtain new, cultural data in a relatively short period, and eliciting patients’ perspectives on what caused their symptoms. The CFI has been evaluated internationally in the United States, Canada, Kenya, Peru, the Netherlands, India, and Mexico and, generally, is clinically acceptable and helpful in these varied settings (Jarvis et al., 2020). Although the CFI shows positive feedback amongst diverse cultures, it is essential to take a closer look at Annie’s culture. As mentioned, Annie travels back and forth between India and the United States. This can be difficult for a young girl to try and assimilate between cultures. Studies have shown that Asian Americans, in addition to cultural factors such as stigma and acculturation, do not feel comfortable speaking to mental health professionals who do not share the same ethnic background, primarily due to cultural and language differences (Han & Pong, 2015).

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7 Amongst Asian cultures, mental health issues are often looked over and seen as a weakness which causes a barrier to those who need mental health services. Despite high rates of mental health problems, mental health is commonly overlooked in Asian communities, and cultural barriers are a significant determinant of mental health services (Han & Pong, 2015). For a clinician to adequately help Annie, it is essential to know how cultural beliefs can impact the diagnostics. For example, in many Asian American cultures, views are held that individuals who have mental illness may be possessed by supernatural entities such as demons or spirits (Han & Pong, 2015). With this information, it is essential to respect these beliefs and understand that this could be a leading cause of why Annie’s family has difficulty understanding her. Another barrier that should be addressed within Annie’s culture is the belief that mental illnesses are a sign of weakness. Many Asian Americans believe that emotional disturbances result from evil thoughts, lack of willpower, self-control, and personality weaknesses (Hans & Pong, 2015). Using the CFI will help understand if the presenting symptoms that Annie is experiencing could result from pressure from her parents not to exhibit any deficits, such as the anxiety that she shares and her shyness. Moreover, Annie’s culture has been discussed regarding barriers and stigmas regarding mental health. It is worth exploring and understanding how Annie, her parents, and their culture cohabit with each other. Annie is at a prime age of establishing her identity and wants more autonomy. Within the Asian Indian culture, children must respect their parents and have little freedom over themselves. Indian culture emphasizes hierarchy based on age, and respect for parents and elders is understood (Jensen & Dost, 2015). Since Annie is experiencing life in the western world, it is understandable that Annie might want more autonomy. This could be an explanation as to why there is little understanding between Annie and her parents. Asian Indian immigrant adolescents and parents have reported

8 more frequent and intense conflicts than European Americans (Jensen & Dost, 2015). These conflicts could also stem from the compliance to respect and hold the father in the highest regard. Features of the Indian culture is the cultural beliefs is the idea that parents, especially fathers, are to be regarded by children as a god (Jensen & Dost, 2015). These insights into Annie’s culture will help center on a more precise diagnosis. Part 3: Systemic Perspectives for Diagnosis Although a precise diagnosis has yet to be made for Annie, clinicians must use reliable resources like the Diagnostic Statistical Manual (DSM-5), the International Classification of Diseases (ICD), and The Decision Tree Tool to administer diagnostics for Annie properly. The clinician must determine which disorders are possible candidates for consideration and choose among the disorders that best account for the presenting symptoms (American Psychiatric Association, 2017). Decision trees and the DSM-5 are reliable resources for correctly diagnosing individuals. However, other conditions may be of clinical focus and attention when analyzing Annie. These additional issues help clinicians make appropriate and well-educated diagnoses for clients. According to the DSM-5, these other issues are labeled as “codes” to help understand and classify these symptoms. Code Z60.3 and V71.02 refer to acculturation difficulty. It states that this code may be used when adjusting to a new culture is difficult. This is important to remember when trying to diagnose and develop a treatment plan with Annie since she travels between India and the United States. Code Z72.810 can be used in addition to help understand Annie’s anxieties regarding social settings. This code states that this category may be used when the focus of clinical attention is antisocial behavior in a child or adolescent. By using these Z and V codes listed in the DSM-5 and the ICD, clinicians and their clients must understand that they are not diagnoses. These codes merely note stressors in a

9 client’s life that may not be diagnosable but play a factor in a client's mental health. These codes are there to help support the diagnosis and the treatments. Although these codes are not diagnoses, they are helpful when clinicians are looking at a client’s information and helping understand the environment they are emersed in daily. Conclusion After examining Annie’s case and analyzing her present issues, research was done on the three psychopathology approaches; sociocultural, biological, and psychological. Assessments were also used to help determine what therapy methods would be best for Annie and her family to maintain the importance of their culture. Finally, focusing on the client’s culture and using systems perspectives to help navigate and properly diagnose Annie.

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10 References American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: Dsm-5 . Department Of Health And Human Services, & Services, D. O. H. A. H. (2016). A Treatment Improvement Protocol - Improving Cultural Competence - TIP 59 . Lulu.com. Eshun, S., Gurung, R. A. R., & Gurung (Eds.). (2009). Culture and mental health: Sociocultural influences, theory, and practice . John Wiley & Sons, Incorporated. Jensen, L. A., & Dost, G. A. (2015). Adolescent-Parent Relations in Asian Indian and Salvadoran Immigrant Families: A Cultural-Developmental Analysis of Autonomy, Authority, Conflict, and Cohesion. Journal of Research on Adolescence (Wiley-Blackwell) , 25 (2), 340–351. https://doi.org/10.1111/jora.12116 Han, M., & Pong, H. (2015). Mental Health Help-Seeking Behaviors Among Asian American Community College Students: The Effect of Stigma, Cultural Barriers, and Acculturation. Journal of College Student Development, 56 (1), 1-14. http://library.capella.edu/login?qurl=https%3A%2F%2Fwww.proquest.com %2Fscholarly-journals%2Fmental-health-help-seeking-behaviors-among-asian %2Fdocview%2F1650952447%2Fse-2%3Faccountid%3D27965 Jarvis, G. E., Kirmayer, L. J., Gómez-Carrillo, A., Aggarwal, N. K., & Lewis-Fernández, R. (2020). Update on the Cultural Formulation Interview. FOCUS , 18 (1), 40– 46. https://doi.org/10.1176/appi.focus.20190037 Narmandakh, A., Roest, A. M., de Jonge, P., & Oldehinkel, A. J. (2020). Psychosocial and biological risk factors of anxiety disorders in adolescents: a TRAILS report. European

11 Child &Amp; Adolescent Psychiatry , 30 (12), 1969– 1982. https://doi.org/10.1007/s00787-020-01669-3 Nolen-Hoeksema, S. (2019). Abnormal Psychology (8th ed.). McGraw-Hill Higher Education (US). https://capella.vitalsource.com/books/9781260426151 Thomas, J. G., & Sharp, P. B. (2019). Mechanistic Science: A New Approach to Comprehensive Psychopathology Research That Relates Psychological and Biological Phenomena. Clinical Psychological Science , 7 (2), 196– 215. https://doi.org/10.1177/2167702618810223

AnnaTruttier_u03a1_DepressiveDisorderandAssessments

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