Comorbidity and Co-Occurring Diagnoses
One-way mental health professionals can reduce errors in mental health diagnosis is by always including a differential diagnosis as part of the diagnosis process. Differential diagnosis is an important step in any diagnosis. Differential diagnosis involves making a list of possible conditions that could be causing a person’s symptoms. Many conditions share some of the same or similar symptoms. This makes the underlying condition difficult to diagnose using a nondifferential diagnostic approach. A differential diagnostic approach is helpful when there may be multiple potential causes to consider.
Students are to establish diagnostic case summary on a client from your field placement. Students should conduct an initial interview and identify the client’s key symptom patterns, the next step in accurate diagnosis is generating a differential diagnosis.
Client Information: Michael is a 18 year old boy in his senior year of high school. Michael lives with his legal guardian who his grandmother. Michaels mom abandoned the family shortly after Michael was born. Michael grew up in the household with his father and his brother who is seven years older. Michael often blames himself for his mom leaving the family. Michael was removed out of his fathers custody after numerous reports of abuse. Michael’s father was not using and substances but would spontaneously beat Michael. Michael moved from Florida to NJ to live with his grandmother who became his legal guardian. Michael has no contact with either of his parents. Michael occasional speaks to his brother. Michael’s grandmother is in her late 70’s and is doing her best to support Michael. Michael has a small circle of friends at school and participates in the chess club, band, helping hands club, takes honors classes but was recently caught smoking in the school bathroom. Michael shared that he smoked marijuana almost everyday throughout his junior year of high school. Michael is looking to build a relationship but has been told her was clingy and struggled detaching from rejection of other females. Michael wants to be able to be loved and feel loved. Michael also has difficulties wanting to get out of bed in the mornings and struggles to keep up with his personal hygiene needs. Michael is frequently challenged with repressive thoughts that he is being judged, not doing something right or will be left behind. Michael now wants to get the help he needs so that he can pick up his grades and apply to college. Michael wants to be able to learn, make changes and build a better life for himself.
Potential diagnoses: (provide description of target needs/behaviors): F41.9 Anxiety disorder,
F32 Depressive episode, F43.1 Post-traumatic Disorder. Youth needs assistance with communication, decision making, focus and self-expression in order to engage in school consistently, improve relationships with peers and become more confident.
To correctly execute differential diagnosis, you must complete two phases:
Phase One: Generate a list of all POSSIBLE diagnoses
Phase Two: Narrow the list to most PROBABLE diagnoses
Phase one requires students to go broad and think of anything that could be possible given the syndromes a client has. That list is then narrowed in Phase Two, detailing the more probable diagnoses.
The diagnostic summary must include the following information:
Brief psychosocial information
Mental Status Exam
Multiaxial diagnoses
Include at least 1 differential diagnosis. This should be written in the form of Rule Out.
Justification of primary and differential diagnoses
using the DSM-5 diagnostic criteria, illustrate a very brief description of how this client’s symptoms meet the criteria.
Example “More talkative than usual or pressure to keep talking. Mr. B talks non- stop for the duration of the interview. He will not be interrupted by clinician. He talks in a tangential manner about the most recent basketball game.
Remaining questions: When referring to differential diagnoses, list questions you still have or information that you still need to acquire to be able to rule in or rule out these diagnoses.
