Michelle Adams is a 51-year-old former hairdresser. She arrived at your clinic at the urging of her primary care doctor. A note revealed she had been tearful and frustrated at her last medical appointment, and her doctor, who had been struggling to control her persistent back pain, felt an evaluation by a mental health provider might be helpful. Greeting Ms. Adams in the waiting room, you are struck by both her appearance and her manner: here was a woman with shaggy silver hair and dark sunglasses, seated in a wheelchair, who offered a limp handshake and a plaintive sigh before asking if you would mind pushing her wheelchair into her office. She was tired from a long commute and explained, "Nobody on the street offered to help me. Can you believe that?"

Ms. Adams stated she had suffered unbearable back pain for the last 13 months. She had seen "a dozen" doctors in various specialties and tried multiple treatments, but the pain was unrelenting. On the night "that changed everything," she had locked herself out of her apartment and, while trying to climb in through a fire escape, had fallen and fractured her pelvis, coccyx, right elbow, and three ribs. Although she did not require surgery, she was bed-bound for six weeks and underwent several months of physical therapy. Daily narcotic medication was only moderately helpful.

Before the accident, Ms. Adams had worked at a neighborhood salon for more than 20 years. She was proud to have several devoted clients, relishing the camaraderie with her colleagues, whom she called "my real family." She had been unable to return to work since her accident because of the pain. "These doctors keep telling me I am good to return to work," she said with visible anger, "but they do not know what I am going through." Her voice broke. "They do not believe me. They think I am lying." She added that although friends reached out after the accident, lately, they had seemed less sympathetic. Most of the time, she left the calls to voicemail because she did not feel up to socializing because of the pain. Last month, she had stopped bathing daily and gotten slack about cleaning her apartment. Without the structure of work, she often found herself up until 5:00 a.m. The pain woke her several times before she finally got out of bed in the afternoon. She often felt hopeless about any possibility of living without pain. Ms. Adams did not recall any mental health problems before her accident, although she described a "hot temper" as a family trait. She denied any suicidal ideation or safety risk factors.

Help determine the below:

1. The external or environmental factors that might be relevant in the etiology and maintenance of the client's presenting problems.
2. The internal factors (biological, affective, cognitive) that might be relevant in the etiology and maintenance of the client's problems.
3. Provide the DSM-5-TR diagnosis, including code, for each particular case.
4. Identify the process of ruling out other disorders.
5. A detailed, culturally relevant, evidence-based treatment plan, inclusive of referrals.