DSM-5 Case Study

Case Study

Introduction

The DSM is a comprehensive classification of all conditions defined as mental disorders. It establishes a unified standard in the identification of hallmark symptoms related to DSM criteria and their assessment, provides a diagnosis and proposes certain objectives in treatment. The usage of DSM allows psychology practitioners efficiently interacting with clients and colleagues while performing the examination, treatment or research. In addition, the specialists constantly update it in order for it to follow scientific explorations and practices regarding different mental conditions. Thus, the latest edition of DSM is the fifth revision (DSM-5), which was published in May 2013 (Regier, Kuhl, Kupfer, 2013). In contrast to the International Classification of Diseases, it provides an advanced description, diagnostic utilities and validity in regard to mental conditions and disorders. The following paper provides the insight into the case of application of DSM-5 towards the case of gambling disorder. It discusses the provided case from the standpoint of diagnosis and treatment. Along with that, it explains specific aspects of the case and provides an evidence-treatment plan supported with the discussion of a relevance of multicultural factors. Such approach would allow exploring the opportunities provided by DSM-5. One suggests that the application of the diagnostic criteria defined by DSM-5 allows performing a comprehensive and efficient identification and treatment of the discussed mental condition.

Case Study

The discussed case study involves the condition of gambling disorder that deteriorated the quality of life of a client and was a primary negative concern for his family. As presented by Horbay (n. d.), Sam is a man of age above forty who has a wife and two children. Since adulthood, he had an experience of playing card games and betting on horses, and finally started to gambling at the casino. From time to time, he had debts that severely affected the budget of his family, but he, finally, almost coped with the problem. However, the appearance of a casino near his home increased his past interest towards gambling, which started to progress rapidly. Due to the easy access to the local casino, his addiction to gambling turned into problems within his family. Sam’s wife and children were cautious about his behavior. In addition, problems with his wife and the employer were endangering his family life and career. Despite he did not recognize the reason for the problems, he went to the counseling service.

Several counseling sessions revealed the symptoms of gambling disorder according to the DSM criteria. The counselor used Blaszczynski’s pathway model for identifying the role of gambling in the life of the client. Thus, the specialist revealed “a pathway 1 development of gambling behaviours” bound with pathway 3 patterns (Horbay, n. d.). The reason for these assumptions was the transition from a non-stressed to easily stressed person because of numerous financial stresses associated with gambling. Additionally, the client experienced risk and challenge motivation because of addictive behavior. Along with that, the counselor performed several interviews aimed at the stimulation of reflective thinking. Likewise, such discussions were assisted with the practice of solution-focused brief therapy (Horbay, n. d.) At the same time, the counselor used the principles of Prochaska and DiClemente’s stages of change and therapeutic relationship models (Horbay n. d.). Therefore, he used the approach of non-argumentative encourage of the change of the client’s attitude towards gambling.

Furthermore, the analysis of family dynamics indicated that the client entered into the relationship with his wife having the experience of the disorder. The emergence of the local casino resulted in the recession of symptoms that began to progress. Therefore, the quality of family relationship severely deteriorated. The critical point was when his wife asked him either to go to a counselor or leave the family. In addition, Sam reported ambivalent attitude towards his behavior associated with gambling. He did not recognize it as the source of the problems with the employer and wife. At the same time, since his wife took the control of the budget of the family, the client started to hide his credit cards and debts. Horbay (n. d.) indicates that the cases of gambling are different from any other addictive disorders because gamblers have variable reinforcement because of the nature of the behavior. The scholar claims that “The gambler may have experienced numerous cycles of positive reinforcement … followed by extreme negative consequences … may also have “solved” these problems by having a big win … and so may now believe that by persisting in gambling, he or she can solve the current problems” (Horbay, n. d.).

DSM-5 Diagnostic Criteria Associated With the Case

According to the DSM-5 diagnostic criteria (Gambling Disorder DSM 5, n. d.), the client has made repeated efforts to control or stop gambling that jeopardized his family relationship and job. This criterion is classified in DSM-5 numerical code as 312.31 (F63.0). Further specification of hallmark symptoms identifies the case as persistent and in early remission. The diagnosed criteria suggest that the severity of the revealed symptom is mild. However, as identified by Potenza (2008), this is a vase of severe form of gambling, which is pathological. The basis for this assumption is that the client had jeopardized his relationship and job. However, according to the changes of the 5th revision of DSM, this case should be diagnosed as a “gambling disorder” (Briefing Note: Changes in DSM – V Re: Gambling, n. d.). The reason for reclassification is the need for provision of greater basis for diagnosing and treating this mental condition. Further explanation of the ICDM-9-CM code of the diagnosis reveals that it refers to “mental, behavioral and neurodevelopmental disorders”, 290-319, “Disturbance of conduct, not elsewhere classified”, 312 (2015 ICD-9-CM: 312.31 Pathological gambling, n. d.). In addition, the index 312.3 stands for disorders of impulse control, not elsewhere classified. Furthermore, this index is conversed into F63.0, which is ICD-10-CM classification. One also suggests that an additional tool for the diagnosis of gambling may be the South Oaks Gambling Screen (SOGS), which is an instrument of 16-items to “rule in” or “rule out” an individual as someone with problem-gambling (Gambling Disorder, 2015). The major aim of SOGS is revealing the hidden issues of gambling such as borrowing, concealing debts from the family and others.

Specific Aspects of the Case, Evidence-based Treatment and Multicultural Factors

One it is important to discuss the peculiarities of the case that might require consultations with other professionals and provide the evidence treatment plan including the analysis of multicultural factors. Thus, it is evident that the client had a long history of gambling addiction, with recessions associated with the easy accessibility of the affecting factor. For this reason, additional consultations with the practitioners of psychology may be required. The need for it might be explained with the aim of recreating a history chart of the disorder’s progress since the client’s childhood. One presumes that some triggers of the past might invoke the feeling of competitiveness and euphoria towards gambling. In addition, a family visit to the counselor is required in order to specify the patterns of internal relationship and communication. The aim of establishing such patterns is the need for supportive and non-conflict models of behavior implemented by the wife and the children of the client. Possibly, there might be the need for consulting a medical specialist for prescribing sedative medicine to the client and his wife since both of them became irritable. It appeared that this irritation drastically affected family relationship. At the same time, the principles of management of irritation and low stress resistance might also require some explanations from specialists in psychology.

After the analysis of the evidence and diagnosing a client, the evidence-based treatment plan should be provided. The primary goal of this plan is the change of the attitude of the client towards gambling and further change of his behavior. The implementation of the plan requires several stages where the first one is the implementation of a solution-focused therapy. Its primary aim is to stimulate the client’s realization that his problems with the family and job are direct consequences of gambling. Thus, the counselor should express empathy and avoid argumentation. The need for such measures is connected with the client’s sense of not belonging to people that suffer from gambling. Next, as the client realized the need for the change, supportive consultation treatment should be provided for stimulation of action and engagement. After that, the implementation of therapeutic relationship should gradually restrict the influence of gambling on the client’s delays to work because of night sessions and the casino. A possible solution is a provision of a decisional balance sheet (Horbay, n. d.) that allows clearing the client’s ambivalence towards the problem. In addition, the scaling questions are used to define the aspects of the problem that are of primary concern for him. Finally, relapse prevention strategies should be implemented in order to support the self-efficacy of the client and make his deliberate action the cause of his freedom from gambling. Additionally, the counselor should set long-term goals of monitoring the status of his wishes and concerns about gambling. In case he has any wishes or ideas about the issue, he may either implement self-regulation strategies or meet a counselor.

Finally, it is crucial to discuss the multicultural factors that impacted the client and may assist the progression of his condition. Thus, the first concern is the emergence of a casino in the neighborhood. It can be suggested that this fact might deteriorate the condition of many people and not only the client. Therefore, there should be some legal regulations and restrictions for building such institutions within the area of living blocks. Along with that, the family factor has also played its role since the wife of the client attempted to influence through intimidation. She might have another decision, which is leaving the family. In this case, the condition of the client would have been uncontrolled and quickly deteriorating. Additionally, it was evident that the client was cooperative. Thus, he stated that he “has to do something” about his gambling behaviors” (Horbay, n. d.), which indicated his active position. Otherwise, the arguing client would regard the attempts of treatment with hostility, which could result in negative consequences. Therefore, it is fair to assume that the DSM-5 classification helped the counselor in identifying the mental condition and providing further methods of treatment.

Conclusion

Summarizing the presented information, it can be concluded that the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders is an efficient tool for counseling. It allows identifying the peculiarities of mental disorder and proposes a certain pattern for further treatment. The discussed case of gambling disorder shows that the application of DSM-5 allowed its identification and supported the counselor with the toolkit for managing the revealed condition. Further analysis revealed that the counselor used a wide range of assisting tools such as evaluation through pathway models and solution-focused brief therapy. Additionally, one has to say that there are more tools for managing this mental condition such as South Oaks Gambling Screen. Furthermore, the discussion of multicultural factors and evidence-based treatment allow to state that the cooperative behavior of the client resulted in his rehabilitation. Therefore, one presumes that the application of DSM-5 enhances the probability of correct identification of a mental disorder and supports the counselor with a useful toolkit for condition management.

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