Question
What diagnosis can be be given for the following vignette? Robert is a 21-year-old Mexican-American, single, cis-gendered male who is questioning his sexual orientation. He
What diagnosis can be be given for the following vignette?
Robert is a 21-year-old Mexican-American, single, cis-gendered male who is questioning his sexual orientation. He was raised Catholic and describes himself as feeling very connected to his Catholic faith, yet not currently practicing. Robert was an only child whose parents separated when he was 11 years old. His parents' divorce created significant financial stressors for his mother who was his primary caregiver. During his adolescence, he felt isolated and was often bored at school. He became involved with a tagging crew at in high school and states that his connection with his peers was very important to him and allowed opportunities to establish an identity which he expressed by covering the school buildings with graffiti. He was once caught by the police for vandalism and placed on probation. This conflict worsened his relationships with his parents. Around this same time, his father moved away from the area and maintained little contact with Robert.
Robert was able to successfully graduate high school and earned a scholarship for low- income minority students to attend community college. After his first two years, he transferred to a large university. He is currently a Junior at a large university. He is an average student and currently has a 2.9 GPA. He is majoring in education and plans on applying to graduate school for a career in academia. Because of financial concerns, he has had to take on a part-time job on 3rd shift.
Over the past six months, his behavior has changed significantly, such that professors, friends and family have been increasingly concerned. He has struggled academically and has become more anxious and depressed. Though originally very enthusiastic about college and his long-term career plans, he states that he is no longer interested in pursuing a degree and has no motivation to continue with school. He has missed several days of class and while previously not a drinker, he has started to drink alcohol socially and sometimes when alone. He has no family history of drug or alcohol abuse. Robert reports having trouble concentrating on homework, difficulty sleeting and decreased appetite. His grades have dropped considerable and socially, he has become more withdrawn. Upon recommendation of his academic advisor, he decided to schedule an appointment with the university counseling center.
During the first session, Robert reports that he feels obligated to complete the full four years of college, but recently has felt increasingly "trapped" and uncertain of himself. He reports onset of panic attacks and increase in feelings of sadness, hopelessness and low self-esteem. He has never participated in counseling before and appears anxious and nervous in the first meeting.
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