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F45.1 Somatic Symptom Disorder, with Predominant Pain, Persistent, Sever

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F60.4 Histrionic Personality Disorder

(Z62.891) Sibling Relational Problem

(Z63.0)  Relationship Distress With Spouse or Intimate Partner

Isabella is a 23 year old Hispanic female who has come for an evaluation at her doctors referral. Isabella meets the criteria for somatic symptom disorder with predominant pain, persistent and sever in the following ways: Criteria A, the chronic pain Isabella is experiencing result in significant disruption of her daily life. She states she can hardly move or walk and seems to get no relief for the past 18 months. Has difficulty concentrating at work. Criteria B: excessive thoughts feelings or behaviors related to the somatic symptoms, she has been to many doctors and is very concerned about her illness wanting to know the cause. She believes it has to do with having children. Isabella states her stress levels are very high since this has occurred and the majority of her time is spent on finding answers. Criteria C: The pain has been persistent for more than 6 months because she meets all three in criteria B the disorder is specified as severe and because these symptoms have lasted longer than months she is specified as persistent.

Isabella also presents as one suffering from Histrionic Personality Disorder in the following ways Criteria she must meet five pervasive patterns of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Isabella meets 3. Displays shallow expression of emotion indicated by the MSE report “Thought processes were shallow and the discussion lacked detail. Isabella would go back and forth and become teary eyed (while looking at the interviewer for a reaction)” 4. Consistently uses physical appearance to draw attention to self. “Isabella presented as a casually dressed (although very seductive for the interview.” 5. Has a style of speech that is excessively impressionistic and lacking in detail. “thought process shallow and discussion lacked detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. “Isabella would go back and forth and become teary eyed (while looking at the interviewer for a reaction) then the tears would stop, Isabella’s thoughts would jump around and at times appeared very dramatic.” 8. Considers relationships to be more intimate than they actually are. ” . Isabella noted that she has always “seen the world more intensely than others” and has run into bigger problems than others. Even in relationships she has always treated them with intensity even if others did not.”

Z codes of sibling relationship and Relationship distress due to her believing that her siblings are jealous of her and her boyfriend is always jealous of others around her.

A couple close differentials for Isabella were Narcissistic Personality disorder, She presents as shallow and wants to be the center of attention but does not meet all the criteria for this disorder such as, having a grandiose sense, believing that she is special, preoccupied with power, unreasonable expectations and is often envious of others. She does not meet at least 5 of the criteria. Depressive disorders, although she was tearful on and off it was sudden and she looked for the attention from the SW. She had a depressed mood but affect was restricted. She did not met all the criteria for depressive disorder such as feeling worthless, fatigue, thoughts of death, unworthy, little to no interest in everyday life.

Diagnosing an individual with personality disorder may effect treatment in ways of diving deeper into their past instead of concentrating on a change in there behavior. “PDs start early and continue more or less forever. This fact requires a big shift in our diagnostic method. With most other disorders, we need to notice what has changed about a person; when discerning the pattern of a PD, however, we must instead pay attention to the lifelong background of attitudes and behaviors.” Morrison, J. (2014). Also, before labeling a person with PD one must consider a multitude of other disorders to rue them out. Most PD is unchanging over lifetime, with some lessoning in later years of age. Many times as doctor Rullo said those with personality disorders usually do not seek services for the PD they come in for other concerns and the diagnosis of PD may take years.

Trauma informed services is something that should be implemented when dealing with BPD and PD. As Ferguson noted “To address the stigma of BPD, the complex trauma basis of BPD must be recognized. To address the complex needs of those women with BPD and IPV, whose needs are clearly not being met by existing fragmented services, collaborative, trauma-informed services must be established.

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