Mary is a 45-year-old African American female who came to see the social worker for help with her "nervousness" because she is having difficulty controlling it. She first presented with feelings of nervousness mainly around work. She is afraid she will not be able to perform well at her job, even though she is capable of doing the work. She sits at her desk thinking about when someone will next give her a task to do. Once she is given a task it is difficult for her to concentrate because she is so afraid she will not be able to do it. She is also afraid to answer the phone at work because she is afraid of saying something wrong. Mary reports always feeling fatigued during the day and having difficulty staying asleep at night. She avoids interactions with her coworkers due to a fear of being criticized for her work. Her mind is always racing with thoughts of what could go wrong. 

        When discussing her history, Mary reports feeling nervous and worried for as long as she can remember. In school, Mary was afraid the teacher would call on her and she would not know the answer to the question. Mary also does not like driving to new places because she is afraid she will not be able to find it. Mary also states she is afraid someone will get into her house, so she checks to make sure the door is locked several times before she can leave. She sometimes has doubts that she did not lock the door, but she can usually alleviate those doubts by remembering she checked the door before she left. She currently lives with her mom who Mary says also worries about everything. Mary has little social interaction outside of her mom. Mary would like to have more friends and interact with others besides her mom, but it is difficult for her to put herself out there because she is afraid of not being liked and being rejected. She talks about wanting to do more social activities but does not follow through and reports that it is very difficult for her to engage in new social activities. Mary states she is tired of worrying about everything and wishes she could enjoy life more and perform daily activities without being afraid something bad will happen.

Marsha is an 8-year-old White female in the second grade in a public school. She currently lives with her mom Carol, her adoptive father Mike, and her younger sister Jan, in a small 2 bedroom apartment in a working class community. When she was born, her mother Carol was married to Marsha's biological father.  Carol reports that the pregnancy with Marsha was normal and she did not experience any problems besides morning sickness in the first trimester. Carol reports that Marsha's biological father was physically abusive to Carol (even during her pregnancy) but she never witnessed him abusing Marsha. When Marsha was 2, Carol left her husband and Marsha never saw her father again. When Marsha was 3 years old, Carol met Mike and after a short courtship they were married and Mike legally adopted Marsha.

Carol says that during infancy, Marsha was a difficult to soothe baby and Carol got easily frustrated with her because she did not have any help to care for her. Carol wished that Marsha was an easier baby to care for, because she felt like Marsha always needed something from her. Carol reports that during toddlerhood and the preschool years, Marsha hit most milestones as expected (talking, crawling, and walking). She did report some difficulty in making friends in preschool, as Marsha was more active than most of the other kids. Carol also reports that Marsha was difficult to toilet train and did not achieve this task until she was almost 4. At age 5, Marsha's younger sister, Jan, was born. Marsha had a hard time adjusting to the birth of her sister and would say that she hates her and sometimes tries to hurt her (this is still currently a concern).

Currently, Marsha has poor hygiene. Other kids at school have said that Marsha smells, but Marsha does not see the problem. Marsha gets angry easily and often screams at Mike and her sister. If she does not get what she wants, she will throw a tantrum that sometimes lasts for hours. Carol reports that these tantrums have been going on for years and they occur so often (usually several times per week) that the whole family feels like they are "walking on eggshells" around Marsha because they do not know when she will explode. She is particularly sensitive to times when she feels like Jan is getting more attention than her, and so Carol and Jan are unable to play anything together without Marsha intruding upon them.  At home, Marsha is also very loud and active when she plays and has difficulty following through on an activity. She typically moves quickly from one activity to the next, leaving a mess behind her, which is very frustrating for Carol. Her overall mood would also be described as irritable.    

Academically, Marsha is doing average in all of her courses. The teacher reports that her biggest concerns are around Marsha's social and emotional functioning. Marsha has difficulty making and keeping friends and easily gets angry with other kids and her teacher. Many kids do not want to play with her at recess because she will shove them out of her way to get a turn on the swings. She also speaks out of turn in class, frequently gets out of her seat, and has difficulty remembering to turn in her homework, even though she will complete it.  

Carol reports that when she was growing up she did not do well in school and thinks she had an undiagnosed learning disability. She states that her parents were not supportive of her in school and made her feel bad for not doing well. Carol currently has a strained relationship with her parents. Mike is close with his parents and the family sees them often.

Rubric

This assignment is intended to improve students' capacity to apply a strengths-based bio-psycho-socio-spiritual assessment of client concerns in the context of the DSM-5 diagnostic model. Read the two cases below and provide a diagnostic assessment for each case, including:

• The resources, strengths and or competencies that are evident in the client situation (3 points).
• The other sociological or biological variables such as class, culture, socioeconomic status, and/or physical limitations play an important role in contributing to or shaping the focal problems (2 points).
• A DSM-5 diagnostic assessment, with a listing of the diagnostic criteria for the diagnosis selected and an explanation for how the client meets each criterion (10 points).
• A description of which other disorders were considered in the differential diagnosis, and why those ultimately were not selected. Discuss at least two diagnoses (5 points).
• A list of additional questions the assessor would like to ask the client in order to develop a more comprehensive understanding of the client's difficulties. State at least five questions (5 points).
• An annotated bibliography of two current (last 5 years) research-based articles or chapters that could be used to assess this case, and to select possible treatment interventions. The DSM or course textbook do NOT count (2 points).
• A list of treatment goals consistent with the client assessment. Discuss at least three goals (3 points).