What kind of questions you might ask to evaluate each diagnostic possibility?
Review the Case Study of Ben, Part 1. Use the Case Study Response Guide to guide your analysis of how you might apply the DSM-5 to diagnose Ben’s condition.
For your initial post in this discussion, though, rather than providing a diagnosis, submit your responses to these questions:
What diagnostic possibilities does Ben’s case present?
What have you read in the case history so far that presents these possibilities for you?
What kind of questions you might ask to evaluate each diagnostic possibility? You must consider at least two, but no more than three, diagnostic possibilities, and develop a series of questions to interview for each possibility.
What possible answers would lead you toward or away from each of your possibilities?
What further information and referrals would you want to clarify Ben’s diagnosis?
Case Study of Ben (Part One)
Ben is a 46-year-old computer scientist at a large university. In recent weeks, his wife has noticed that he has been “different.” He is being seen on your service at the local hospital, where you are asked to evaluate him.
Ben is a hostile interviewee. He does not want to talk to you, and has made it clear that he is here against his will. In recent weeks, according to his wife, Cindy, he has been moody, irritable, and increasingly inappropriate in his actions and comments. For instance, Cindy tells you that last Friday night at a neighborhood party, he went up to an attractive young neighbor and, after asking if she was having as good a time as he was, put his hand on her breast. She reacted furiously, and Ben seemed surprised at her reaction. The young woman’s husband pushed Ben away, and Ben became furious and struck the man. Cindy is embarrassed and says Ben has never been like this before now. In the past, she says, he has always been kind and respectful, “even a little shy.”
Yesterday morning, Ben began to eat his breakfast cereal with his fingers. Cindy says he left for work much later than usual and seemed to be having a hard time organizing his briefcase, his keys, and so on. “Lately, he has been making all kinds of plans and then just not following through on them, which is so unlike him. He has always been real careful, real well-organized, and when Ben makes plans, he always keeps them.” But yesterday, after Ben left the car running in the driveway and took the bus to work, Cindy became alarmed. She called their family doctor, who sent Ben to the hospital for this evaluation.
Cindy says nothing has happened to Ben that might explain his change. Ben admits he has had lots of work stress lately, “because of my goddamn boss’s stupidity.” He is surly. He snaps at his wife, “What do you mean, nothing has happened? You idiot, what about that asshole boss of mine?” His wife is embarrassed at his crude language. When you ask Ben if anything else has gone wrong lately that might explain his irritability, he snaps, “Isn’t that enough?” but then considers the question. He starts to speak, then seems distracted by something on your bookshelf and shrugs his answer off.
Cindy mentions that about six months ago, Ben was in an auto accident in which his car rear-ended the vehicle in front of him. Ben, who was a passenger, hit his head on the rear-view mirror. Ben was taken to the emergency room for an X-ray, which had negative findings. Cindy was instructed to monitor him for 24 to 48 hours for any signs of brain injury, but nothing appeared. Other than a slight headache, Ben was his normal self the next day. The irritability and erratic behavior did not start until about five days ago, nearly six and a half months after the accident. No other traumas were noted.
Ben works 50 hours a week for a software company, earning about $130,000 per year. He has always had excellent reviews and never missed a promotion. He is close friends with many coworkers and always had a lot of friends. He is still close with a number of his high school and college friends, and frequently calls old neighbors on the telephone. “Everybody likes Ben,” says Cindy. “That is why I was so shocked by what he did last Friday and by how he’s started swearing and acting so . . . gross.”
Cindy and Ben met and married about 23 years ago. It is the first marriage for both of them, and Cindy says it has always been a good marriage. “We had some fights a few years ago, a kind of rough spot. Everybody goes through that. I think Ben got a bit over involved with one of the women at work, but we got through that okay. That was maybe 10, 11 years ago.” Ben laughs and says, “Over involved? I wish I’d a stuck it to her, goddamn it! She was something!” His tone is lecherous.
Cindy says there has never been any separations or talk of divorce. “Nothing was ever that troubling; just a few arguments,” she says. Their sex life has always been fine, and they have “lots of fun” when they go out together, which they have done weekly, until last Friday.
Ben did very well in high school and college, earning nearly straight As and a spot on the Dean’s list nine times in college. He graduated with honors and landed the best job out of anyone in his class. His parents are still alive, living in Arizona. Neither is in great health, but there is nothing seriously wrong. Ben and Cindy travel to Phoenix to see them twice a year and everyone gets along well. Cindy says she has heard no particularly bad stories about Ben’s childhood, and he agrees. He is still close with his only brother, who is three years older. At this point, Ben stands up and asks you who you are and why you are here. You explain, and he seems relieved. He had seemed slightly anxious. You inquire, but he waves you off.
Cindy says Ben had had a couple of glasses of wine at the party, but he has not had a drink since Friday night. Usually, he drinks two or three glasses of wine on a weekend, and perhaps one glass each evening with dinner. He has never had a drinking problem, according to Cindy. Ben refuses to answer, but a check of his medical records later confirms Cindy’s information.
Ben also has had a remarkably healthy life. Except for a tonsillectomy when he was nine and the surgical removal of an impacted wisdom tooth, Ben has had no injuries, no illnesses, and no accidents resulting in any health problems. He takes no medication, not even aspirin. He does not get headaches. He is not overweight; in fact, he jogs four miles each day and feels in good health, he says. He smirks briefly at you and says, “You could use a few miles a day, Doc.” When Cindy reacts, he snaps at her, “Oh, get with it, baby!”