Making a Differential Diagnosis- Trichotillomania
Suzanne has been diagnosed with trichotillomania based on resented problems, history, and symptoms. However, it is essential to also consider another diagnosis different from the one established. Thus, the author of this paper will recommend a diagnosis based on the patient’s symptoms, presenting problems, and history known as an Anxiety disorder (habit). Next, the author of this piece will assess the validity of the diagnosis using a sociocultural perspective. Additionally, the author of this article will compare at least one evidence-based and one non-evidence-based treatment option for the diagnosis. Lastly, the author of this essay will propose and provide an explanation for a minimum of two historical perspectives and two theoretical orientations that are inappropriate alternates for the conceptualizations in this case.
In order to establish a differential diagnosis for Suzanne, six stages need to be considered; these are “1) ruling out Malingering and Factitious Disorder, 2) ruling out a substance etiology, 3) ruling out an etiological medical condition, 4) determining the specific primary disorder(s), 5) differentiating Adjustment Disorder from the residual Other Specified and Unspecified conditions, and 6) establishing the boundary with no mental disorder” (First, 2013, p.1).
Suzanne does not present any problems connected with Malingering and Factitious Disorder, and substance abuse can also be ruled out after reviewing all the presented information. More so, her primary diagnosis is trichotillomania, which is defined as “recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop. Hair pulling from the scalp often leaves patchy bald spots, which cause significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair” (Mayo Clinic, 1998-2018, p. 1).
Step six focuses on establishing the boundary with normal, which is no secret to society, and it is more so recognized that “psychiatric symptoms are fairly ubiquitous in the general population most normal people have at least one, many have a few. When present in isolation, a single symptom (or even a few) does not a psychiatric disorder make. Two additional conditions must also be met before a symptom can be considered to be part of a mental disorder” (Frances, 2013, p. 1). Suzanne, being diagnosed with trichotillomania, which is frequently explained as stressful for any person, presents other symptoms, like being depressed at times. Therefore, she would probably never consider herself normal, and in addition, it sets her apart from being normal.
Looking at all the symptoms Suzanne presented, frequently pulling her hair and/or eyelashes, as well as feeling depressed, for example. More specifically, she stated that she had to do a presentation in front of her class about a book she had to assess, which made her extremely nervous and she began pulling her eyelashes, remembering that this occurrence ended up with hurt around her eyelid. These symptoms provide the therapist with knowledge about Suzanne, also possibly dealing with the differential disorder known as an anxiety disorder (habit). Developing a habit of pulling her hair and eyelashes presents the psychoanalyst with possible red flag conduct. In detail, this means she established a “self-destructive “nervous” addiction, which is explained as “a person struggling with anxiety may engage in self-destructive habits. Among these are compulsive nail biting (onychophagia), pulling out hair (trichotillomania), and skin picking (dermatillomania)” (LUCINDA, 2018, p. 1). Suzanne does not take any medication, nor does she believe she needs to take medication. Within her family history, there is no knowledge of any emotional, behavioural or any of those disorders.
To offer an assessment of the validity of the anxiety disorder (habit) diagnosis, it is important to understand the sociocultural viewpoint. This theory is defined as the “understanding why humans behave the way they do” (McKay, 2003-2018, p. 1). The diagnosis suggested is valid because it is suggested in an article that “people pull out their hair either from their head, their face, or anywhere on their body in response to either a habitual need to pull, a compulsive feeling, or anxiety” (Snyder, 2017, p. 1). Also, individuals like Suzanne stated that pulling her hair would calm her down or help when being under pressure.
Furthermore, the editorial suggests that “the most common places that people pick their hair from in trichotillomania are their head. But we also see a lot of eyebrows and eyelashes” (Snyder, 2017, p. 1), which Suzanne often does and mentioned to the therapist. Another interesting proof of the validity of the differential diagnosis is the fact that Suzanne’s trigger is anxiety habit, which often has sociocultural significance because others, like Suzanne’s parents, will notice, even though she tried to hide her habit of pulling her hair and/or eyelashes. More, “that the more you pull your hair, the more bald patches and absence of hair you have, which can lead to social ostracization or criticism” (Snyder, 2017, p. 1), just as Suzanne got from her mother telling her she needs professional help.
In the end, many folks might pull their hair or bite their nails, which is not a problem. Nevertheless, in Suzanne’s case, it is a huge issue because it interferes with her everyday life. For example, She always tries to hide her hair-pulling disorder from her parents or uses this custom to relieve stress and calm her down. Also, the therapist needs to suggest ways to Suzanne on how about dealing with pressure and stress, particularly in school. For instance: Take time for self-care, change thinking within learning, decrease goals rather than having them set too high, and “Stay balanced during exam periods.
The importance of taking breaks and working in time to relax during your busiest and most stressful periods can’t be overestimated, Stiffelman urges. No matter how hard you push yourself, nobody can maintain constant focus, and you will burn yourself out if you try. Take frequent, short breaks for fun activities so that you’ll be able to go back to your writing or studying refreshed.
Every patient diagnosed with a mental disorder, like Anxiety disorder (habit), should be treated with an evidence-based option. For example, Cognitive Behavioral Therapy is defined as “how we think about a situation affects how we act and that, in turn, our actions can affect how we think and feel. The therapist encourages the adoption of healthier, more realistic ways of thinking that lead to more positive behavior” (Neubauer, 2015, p. 1). Thus, it is essential for Suzanne to involve her parents in the problem she is dealing with, which will then assist her in finding the right help, as her mom did. However, Suzanne’s mother found out by accident because of the hair patches, rather than being approached by her daughter, because she knew she needed help” (Teen, 2013, p. 1).
On the other hand, there are none-evidence ways, such as prescribing medication, which would not help at all or even be contraindicative. Not only would Suzanne be subjected to unethical decision-making from the therapist. Other issues need to be considered by the therapist, such as “non-evidence-based practice suffers from an inability to confirm or refute beneficence. How can we truly stand by the statement that the treatment is serving the best interests of the patient when there is no evidence to substantiate it?” (Is Non-Evidence-Based Clinical Practice An Ethical Dilemma? 2013, p. 1). Furthermore, in an article, it is explained that the APA code of conduct needs to be followed by all therapists. For example: “respect for autonomy (“Informed consent”), nonmaleficence (“first, do no harm”), beneficence (“taking actions that serve the best interests of the patient”), and justice (“giving to each that which is his due”). Non-evidence- based practice involves the utilization of assessment and treatment strategies that have little to no scientific support” (Is Non-Evidence-Based Clinical Practice An Ethical Dilemma? 2013, p. 1).
The following will provide two historical perspectives and two theoretical orientations that are inappropriate alternates for the conceptualizations in this case. There are various methods that can assist therapists in treating individuals like Suzanne, being diagnosed with an Anxiety disorder (habit). For instance: “Habit Reversal Training is a behavioral technique in which the client learns to respond to feared situations in a new way while extinguishing previously learned maladaptive behavioral responses to cues or triggers. It is used to reduce unhelpful repetitive behaviors, such as tics, hair pulling, and nervous habits” (Neubauer, 2013, p. 2). Another approach is called “The FRIENDS program”. This method focuses on increasing social and mental abilities, encouraging strength by working with “physiological, cognitive, and behavioral strategies to assist children, youth, and adults in coping with stress and worry” (Neubauer, 2013, p. 2).
Additionally, in Suzanne’s case, the “Habit Reversal Training” Would be a great way to help her. After all, she is dealing with the hair-pulling habit, which needs to be reversed. Therefore, this behavioral technique in which the client learns to respond to feared situations in a new way while extinguishing previously learned maladaptive behavioral responses to cues or triggers and nervous habits” (Neubauer, 2013, p. 2). Another way to treat Suzanne with found medications was first started in the 1980s. “Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, sertraline, and others here introduced and began to be prescribed widely for depression due to their mild side effects and few drug interactions (relative. to established antidepressants). Clinical observation led to the discovery that SSRIs were also effective in reducing anxiety symptoms, and their use was broadened to treat anxiety disorders and other conditions” (Gee et al., p. 20).
In summary, the client Suzanne received from the therapist the trichotillomania diagnosis, which is grounded on furnished issues, history, and signs. However, it is necessary to also take a look at one other disorder dissimilar from the one she is diagnosed with.
References
First, M. B. (Ed.). (2013) DSM-5: Handbook of Differential Diagnosis. Washington, DC: American Psychiatric Publishing. doi:10.5555/app.books.9781585629992.mf00pre\
Gee, B. A., Hood, H.K. & Antony, M. A. (n.d.). Department of Psychology, Ryerson University. Anxiety Disorders – A Historical Perspective.
McKay, A. (2003-2018). Study.com. Sociocultural Perspective: Definition & Examples Retrieved from: https://study.com/academy/lesson/sociocultural-perspective-definition- examples-quiz.html
LUCINDA. (2018). Lucida Treatment. Subtle Signs That May Indicate an Anxiety Disorder Retrieved from: https://www.lucidatreatment.com/resources/mental-health- resources/subtle-signs-may-indicate-anxiety-disorder/
Mayo Clinic. (1998-2018). Mayo Foundation for Medical Education and Research. Trichotillomania (hair-pulling disorder) Retrieved from: https://www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc- 20355188
Neubauer, K. (2015). Dartmouth Trauma Interventions Research Center. Evidence-Based and Evidence-Informed Psychosocial Treatments for Childhood Disorders Retrieved from: https://www.dhhs.nh.gov/dcyf/adoption/documents/evidence-based-tx-for-children.pdf
No Author. (2013). Allan Besselink. Is Non-Evidence-Based Clinical Practice An Ethical Dilemma? Retrieved from: http://www.allanbesselink.com/blog/smart/854-is-non- evidence-based-clinical-practice-an-ethical-dilemma
Snyder, C. (2017). Business Insider. This psychological disorder makes people pull out their own hair Retrieved from: http://www.businessinsider.com/trichotillomania-hair-pulling- disorder-psychologist-eyebrows-eyelashes-head-2017-10
Teen. (2013). HUFFPOST. Academic Pressure: 5 Tips From An Expert On Coping With School Stress Retrieved from: https://www.huffingtonpost.com/2013/02/27/academic-pressure-5- tips-_n_2774106.html
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Question 
For this Case Study Discussion, you will propose a differential diagnosis with a minimum of 3 possible conditions or diseases. You will prioritize these diagnoses and explain which you would recommend.
Focused SOAP NOTE with the following:
Differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.
Making a Differential Diagnosis
Define what you believe is the most important diagnosis. Be sure to include the first priority in conducting your assessment.
Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.
Your differential diagnosis, what you believe the most important diagnosis is and why, additional diagnostic tests and treatments, and rationales are what this assignment and grading are focused on. Your critical thinking for this assignment
References:
MUST BE SCHOLARLY ( do not use WebMD, MAYO Clinic, Cleveland Clinic, or any public website that is not scholarly)
Case Study: Obstetrics
Phillipa Hudson is a 29-year-old female presenting today at your clinic with a positive home pregnancy test. Her medical history is negative. The surgical history is negative. Gyn history 1st menses age 12, with cycles coming every 28 days and lasting for 5 days. Her pap and std history are negative. She has been taking a woman’s gummy vitamin for the past year.
Her OB history is as follows:
See attachment #2.
Phillipa relates her last period (LMP) was 12-25-2022. She reports breast tenderness, fatigue,
and nausea (which is what made her suspect she was pregnant).
***Complete using attachment #1 for focused note***