Charlie is the high school student that will be assessed and there will be a hypothesized diagnosis for him. There are many things that will be described about his behavior, social interactions, and previous mental health issues. When initially looking at Charlie, he seems as though he does not have any signs of mental health issues but as everything progresses, there are accounts from family and Charlie himself that brings light to what is actually going on.
Post-traumatic stress disorder is described in simple terms by NIMH. They say, “PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.” There are many situations that can affect someone’s mental state to cause this type of disorder. Some examples can be witnessing death or your own life being threatened, witnessing life-threatening injuries or being threatened with them, and being sexually assaulted or being threatened with sexual assault (Durand, Barlow, & Hofmann, 2019). The first and foremost aspect of diagnosing post-traumatic stress disorder is that there is that initial exposure to a very serious situation. The DSM-5 criteria shows that in order for a diagnosis, there will have to be a presence of intrusion symptoms, avoidance symptoms, and the changes in mood and cognition will be negative. These symptoms must be present for at least one month (Durand, Barlow, & Hofmann, 2019).
Charlie shows many of these symptoms throughout the time spent assessing him. He is shown during the entirety of his freshman year of high school, from day one until the last of the school year. During this time, he has very specific flashbacks about his aunt. He is also seen by those around him as a type of avoidant person. An example of avoidance would be how he sits alone at lunch during school to be alone and spend time reading.
Biopsychosocial Factors and Interactions of Factors
When looking at the affects the disorder can have on a physiological level, there can be many factors involved. Durand, Barlow, and Hofmann talk about a generalized biological vulnerability being a part of many psychological disorders, post-traumatic stress disorder is no exception. This term of vulnerability shows that many people can be susceptible to stress or anxiety but when something traumatic happens, people will have a different biological reaction to the incident. In Charlie’s case, he shows signs that he has a high vulnerability. Since he has constant interaction with his aunt who was sexually assaulted by ex-boyfriends, he is exposed to her high-risk situations. This is not a parent with mental health issues but she was an influential person in Charlie’s life. This biological vulnerability made it much more likely for him to develop post-traumatic stress disorder after being sexually assaulted by a very close family member.
Charlie’s aunt is the main source of his trauma which is evident based on conversations and flashbacks that he has when he experiences any type of sexual interaction. She also exposes him to self-harm because it is shown that he sees her scars on her wrists which can leave damage as well since he was very young. It is known that he has already been in the hospital before but the reasons are not told.
Drinking and drugs can have a very large impact on anyone. Charlie does not become an alcoholic from the information that has been gathered but that does not go to say that he did not partake in drinking when at parties with his older friends. He also experimented with drugs, marijana was the most prevalent but hallucinogens were also ingested which caused the flashbacks to become more intense. The DSM-5 states that in some cases, the person will blame themselves for the trauma that happened to them. Charlie does not particularly blame himself for what his aunt did to him but she was killed on her way to get his birthday present which is another traumatic event for him. This is the trauma that he blames himself for and this is verbalized by Charlie himself when he calls his sister and tells her that he killed their aunt. This is an aspect of Charlie’s disorder that can severely affect those around him. When it is under control and he isn’t having very many flashbacks from the way the family interacts, it seems to not affect them as much but a drastic change can affect everyone.
There is a generalized psychological vulnerability when dealing with post-traumatic stress disorder. This is based on the patient’s view of their own world, do they see it as out of control and that trauma is inevitable or do they push on. Those who focus on the unstable aspects have a higher vulnerability to developing a psychological disorder (Durand, Barlow, & Hofmann, 2019). Memory problems are known to be an aspect of post-traumatic stress disorder. An example for Charlie is not related to his initial trauma but it is associated with a very brutal attack on his close friend by bullies in the school. What is known is that Charlie stepped in and defended his friend but has no memory of what he did to the bullies aside from an injury to his right hand consistent with punching. Something that was noted during the observation of Charlie is that he is very hopeful for his future for the majority of the time but when his flashbacks and thoughts begin to affect his functioning, that is when he does a complete turn and is hopeless.
Self-esteem can be difficult to judge since some people are more comfortable in different situations as compared to others. There are many who suffer from post-traumatic stress disorder who have negative feelings about themselves because of the trauma they experienced. Relationships are also difficult for sufferers which can then affect their self-esteem even more because they may feel abandoned. Charlie is confident when he is writing but when it comes to speaking out in class he becomes withdrawn. An example for Charlie’s negative feeling that were observed could be when he becomes ostracized from his group of friends for disrespecting one of the girls. This experience triggers his flashbacks and causes him to lose control of his emotions which is the cause of his aggression when defending his friend.
Personality is very important, especially when seeing the influences on someone’s psychological disorder. There are some aspects of a personality that are viewed as positive but they can then be turned to where it is detrimental. This is shown through Charlie, he is a very generous person and wants everyone in his life to be as happy as they can be. One specific time, one friend asks him what he wants since he never asked her on a date and his only answer was because he wanted her to be happy, not thinking about his own happiness. This can affect someone because they are never trying to take care of themselves which can lead to hurt and they can regress into a dark place like Charlie does.
It is shown in research, that if there is a strong support system in place for after someone experiences trauma, then they are less likely to develop a psychological disorder. When there are people who begin to place blame and create a negative environment, they are at a higher risk (Durand, Barlow, & Hofmann, 2019). There is, however, research that shows that if the trauma is coming from within what would be someone’s support group, that can deter them from feeling supported and they have a high risk of developing a disorder despite possibly having supportive people in their life (Charuvastra & Cloitre, 2008). This seems to be true with Charlie. His family is very supportive, they ask him how he is doing when there are particularly high-stress times in his life, such as the anniversary of his aunt’s death which also happens to be his birthday. When the trauma comes from within his “support”, there can be distorted memories. His aunt made it seem as though what she was doing was normal and that it just meant that she loved him. At such a young age, this can be very confusing and can then exacerbate the symptoms for the disorder.
Initially, it seems as though Charlie’s new friends are helping him stay distracted from his past and he gets to be a new person since they do not know what happened to him. There is a point where the friendship seems to crumble and it sends Charlie spiraling. When looking at whether or not the people around him help or hurt is not black and white. During the course of his freshman year, he experiences so many changes within himself and in his social interactions that it is difficult to say what exactly the friendships did to Charlie.
Interactions of Factors
Biological, psychological, and social factors are all weaved together in post-traumatic stress disorder. They can affect each other very easily. Charlie’s constant focus on everyone else’s happiness can affect his social interactions because some people may view it as dangerous or risky that he does not focus on taking care of himself. His aggression can affect this as well in almost the same way because it may cause people to withdraw from him fearing that he may lose control on them one day. The effects of each of these factors on both the person with the disorder and those around them can be drastic. There can be times when someone is in treatment and taking their medication and they are functioning almost normally and no one would even know they have a disorder. On the opposite side, they can be exhibiting all the negative symptoms of post-traumatic stress disorder and can cause many problems within their life.
Medication and psychotherapy are the two main forms of treatment. Charlie is seen taking medication, it is most likely an antidepressant because they are the most common for post-traumatic stress disorder. People are all different so their treatment may vary depending on whether they respond best to medication, psychotherapy, or a combination of the two (Post-Traumatic Stress Disorder, n.d.).
There is not a set course for post-traumatic stress disorder. This varies from person to person and can last anywhere from a few months to someone’s full life (Post-Traumatic Stress Disorder, n.d.).
The interaction of the biopsychosocial factors is the main contributor for the diagnosis being proposed for Charlie. The evidence provided shows that he is exhibiting many major signs of post-traumatic stress disorder. These factors include, family member with mental health issues, partakes in drinking and drugs, vulnerability to develop a psychological disorder, and many more. The original trauma comes from a close family member who is the one with mental health issues. There is a strong support system for Charlie but as was observed, it was not enough for him.
- Durand, V. Mark, Barlow, D. H., & Hofmann, S. G. (2019). Essentials of abnormal psychology. Available from https://ng.cengage.com/static/nb/ui/evo/index.html?eISBN=9780357164853&id=345099254&nbId=889322&snapshotId=889322&
- Post-Traumatic Stress Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
- Charuvastra, A., & Cloitre, M. (2008). Social bonds and posttraumatic stress disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722782/