Psychological report - PTSD PDF

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PTSD...

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Melissa Zouaoui Student in Abnormal Psychology Course

3040 Sherbrooke Street West.

Tel. (514) 991-1608

Dawson College CONFIDENTIAL-PSYCHOLOGY REPORT

Name of “client”: Lieutenant Dan Taylor Suspected Diagnosis: Posttraumatic Stress Disorder (PTSD) Where was this client found? From the movie “Forrest Gump” Reason for referral: Lieutenant Dan Taylor is a Catholic Caucasian male in his mid-forties. He does not occupy any professional position at the moment. This is the third inpatient admission for this patient. He was assessed twice for post-traumatic stress disorder symptoms ensuing his military service in the Vietnam War. He is admitted for the third time following an incident in which he displayed reckless and self-destructive behavior.

Assessment Procedures: A semi-structured diagnostic interview was conducted. Corroborative information was gathered from others who know him. Behavioral observations were also made. Lieutenant Dan Taylor was assessed using the PTSD CheckList comprising 17 items that correspond to the key symptoms of PTSD, according to the DSM-IV diagnostic. Precisely, the checklist used to assess the patient, the PCL-M, is a self-administered test specific to PTSD caused by military experiences. He was asked

to answer 17 questions by rating the level of distress of each event over the past month. Responses range from 1 (not at all) to 5 (extremely). Categories 3 (moderately) or above are treated as symptomatic. Lieutenant Dan Taylor scored 14 times in those categories, which places him in the “severe” PTSD symptomatic range.

Background Information The first signs of the present illness have been established after Lieutenant Dan Taylor's service in the United States Military. He has been discharged due to an injury after a grenade explosion, that made him lose both his legs, confining him to a wheelchair. During his service, he has also witnessed soldiers getting killed. Once he returned home, he has been admitted twice to the hospital for PTSD symptoms. He was treated by psychologists and has been prescribed medication that turned out to be ineffective. The comorbidity of certain disorders is expected to be high to those of PTSD, therefore, it is relevant to be aware of the extent of the patient's symptoms. Lieutenant Dan exhibits symptoms of anxiety, depression and substance abuse disorder. After his service, he came back to America and lived in New York in poverty. He currently occupies no profession and has no stable income. He is unmarried and reports no social support. He displays no social activities nor hobbies. He expresses religious beliefs throughout the movie.

Behavioral observations / mental status examination

Dan Taylor’s appearance comes across as unkempt and filthy. He wears stained clothes, has greasy hair and ungroomed facial hair. His consideration for manners is absent as his physical position and body language seem nonchalant and insensible. He manifests difficulty staying concentrated and maintaining good and consistent eye contact with the psychologist. Lieutenant Dan Taylor lacks orientation and attentiveness as he is unconscious of the environment surrounding him. He seems to be forgetful of cues given which could be due to his disorientation of time and place. The patient exhibits a bad emotional state. His emotive tone is tensed and defensive. His mood shifts quit a lot as he shows frustration and sadness over a small amount of time. The patient's stress and anger manifested itself more when asked questions about past experiences. The restricted and apprehensive answers of Lieutenant Dan disclose inappropriate emotional responses. He reveals a bad range of affect with distorted and contradictory speech.

Diagnosis: “Posttraumatic stress disorder (PTSD) is classified as an anxiety disorder (APA, 2000) and is sometimes understood as a disorder of arousal”. “According to the DSM-IV-TR (APA, 2000), the diagnosis of PTSD requires meeting the following criteria: exposure to trauma (actual or threatened death or serious injury, leading to the experience of intense fear, horror or helplessness), symptoms of reexperiencing, avoidance or numbing, and hyperarousal. The other two criteria refer to the duration of symptoms

(longer than 1 month) and their impact on the person’s life (clinically significant distress or impairment in important areas of functioning)”. Lieutenant Dan displays several symptoms that meet the criteria of Posttraumatic Stress Disorder.

The onset of characteristic symptoms is preceded by his direct experience of a traumatic event. His experience during the Vietnam War provided direct “exposure to trauma (actual or threatened death or serious injury, leading to the experience of intense fear, horror or helplessness)” SOURCE. In the case of Lieutenant Dan, the traumatic experience had developed “dysphoric mood states and negative cognitions that can be distressing”. He exhibits those symptoms in the movie when he confronts Forrest angrily about rescuing him during the war. He claims that he had a destiny and says that "he should have died with honor, with [his] men". After that rage outburst, he cries and tells Forrest that now he has to live " a legless cripple". Consequently, he manifests fear of the future and believes he has no set path to follow. He holds persistent and exaggerated negative beliefs about himself. In the movie, he refutes the belief that he could live a better life and get out of welfare. These disruptive and negative thoughts convey his feeling of helplessness of the future.

Lieutenant Dan's case demonstrates “symptoms of reexperiencing”. He has repeated, disturbing memories of the accident. In the movie, Dan has intrusive thoughts distracting him of the present moment. In this scene, he is being arrested by a police officer, and when asked about his handicap, he bursts out of anger. While causing a scene in front of the police officer, images of the war are shown; implying that he is

reexperiencing the traumatic events. In another scene, Dan wakes up from a bad dream totally startled and perturbed. He has dreamed of the war and started being agitated when Forrest came to rescue him. He also experiences “avoidance [and] numbing.” He has difficulty thinking about or talking about stressful events form the past and actively avoids feeling related to it". When asked questions about his accident, he would circumvent the subject and would have trouble to stay calm. His reactive mood is an example of affective instability. As observed, he has difficulty expressing himself; he stutters and has distorted speech when asked to remember past traumatic events. This also responds to the criteria implying "trouble remembering important parts of a stressful experience from the past". He fails to recall how the event happened and seems hesitant when asked when it happened. Lieutenant Dan also keeps away from relationships. Throughout the movie, his interactions with Forrest are characterized by resentment and bitterness. Dan Taylor experiences feelings of irritability and has extremely intense angry outbursts. In the movie, Forrest tries to become friends with the Lieutenant, but he is actively avoiding feelings of friendship and compassion. The patient seems to avoid those feelings, especially towards Forrest, because it reminds him of what happened during war.

Lieutenant Dan also demonstrates symptoms of “hyperarousal”. Years after his accident, Dan joins Forrest to become a shrimp boat captain. Held in a hurricane out at sea, he sits on top of the sails of the boat. As Forrest fights to keep the boat afloat, Lieutenant Dan screams, “This is a showdown between you and me!”. He recklessly

and fearlessly sits on the railings of the boat, laughing maniacally as he challenges God to sink the boat. During this scene, he demonstrates self-destructive behavior.

The duration of the symptoms has persisted for years following his injury. In the movie, it is measured from the accident to his encounter with Forrest Gump.

The final criteria states that the symptoms must have a “clinically significant distress or impairment in important areas of functioning”. Following the war, Lieutenant Dan displays feelings of being cut off from other people.” And a Loss of interest in things that [he] used to enjoy. Prior to meeting Forrest, Dan’s only other contact were prostitutes. He also shows symptoms of social withdrawal and a lack of social support; he admits that by saying that he has no surviving friends nor family. He also is unwilling to look for another line of work and admits being content with living in welfare and expresses a lack of motivation.

Summary and Recommendations Results of psychological evaluation reveal an extended history of posttraumatic stress disorder characterized primarily by exposure to trauma, symptoms of reexperiencing, avoidance, and hyperarousal. Currently, Mr. Taylor appears to be extremely distressed according to his responses to the self-administered PCL-M checklist. He seems to respond positively to every criterion described by the DSM-V for PTSD. I recommend for the patient the Eye Movement Desensitization and Reprocessing (EMDR) treatment; a therapy that reduces symptoms such as avoidance or intrusive memories.

memories. The therapy sessions include imaginary confrontations with traumatic experiences. In addition, the sessions are externally supervised by professionals using videotapes. I am confident that exposure-based treatment like EMDR will dramatically decrease symptoms such as depression and anxiety in the patient. In addition, I believe it will improve Lieutenant Dan Taylor’s emotional perception and help him better control his impulses and tolerate frustration (Stingl, M., Hanewald, B. & Kruse, J., & Sack, M., 2020). Furthermore, I encourage the patient to surround himself socially. I maintain that, under appropriate therapy and proper follow-up with the patient, he will get better. I am concerned for his safety; due to his negative thoughts and self-destructive ways, I think keeping him under observation is needed.

Melissa Zouaoui

20- 11- 2020 References

Cichy, A. (2014, December). Psychological Disorders in Forrest Gump. Owlcation. Retrieved from https://owlcation.com/social-sciences/Psychological-Disorders-andForrest-Gump Forest Gump. Directed by Robert Zemeckis, performances by Tom Hanks and Gary Sinise. Paramount Pictures, 1994. Stingl, M., Hanewald, B., Kruse, J., & Sack, M. (2020). Positive side effects in traumafocusing PTSD treatment: Reduction of attendant symptoms and enhancement of affective and structural regulation. Psychological Trauma: Theory, Research, Practice, and Policy. doi:10.1037/tra0000700

Zawadzki, B., & Popiel, A. (2012). Temperamental Traits and Severity of PTSD Symptoms: Data from longitudinal studies of motor vehicle accident survivors. Journal of Individual Differences, 33(4), 257-267. doi:10.1027/1614-0001/a000074...