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Running head: CASE REPORT ON “VERTIGO”
A Case Report on “Vertigo”
Timothy P. Tomczak
Genesee Community College
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Multiaxial Evaluation Report Form
AXIS I: Clinical Disorders
Other Conditions That May Be a Focus of Clinical Attention
Diagnostic code DSM-IV name
3 0 0.1 1 Conversion Disorder
__ __ __.__ __ _______________________________________________
AXIS II: Personality Disorders
Mental Retardation
Diagnostic code DSM-IV name
__ __ __.__ __ _______________________________________________
__ __ __.__ __ _______________________________________________
AXIS III: General Medical Conditions
ICD-9-CM code ICD-9-CM name
__ __ __.__ __ _______________________________________________
__ __ __.__ __ _______________________________________________
AXIS IV: Psychosocial and Environmental Problems
Check:
X Problems with primary support group Specify: marital difficulties
__ Problems related to the social environment Specify: _______________
__ Educational problems Specify: _________________________________
__ Occupational problems Specify: ________________________________
__ Housing problems Specify: _____________________________________
__ Economic problems Specify: ____________________________________
__ Problems with access to health care services Specify: _________
__ Problems related to interaction with the legal system/crime Specify:
___________
__ Other psychosocial and environmental problems Specify: ________
AXIS V: Global Assessment of Functioning Scale Score: 62
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A Case Report on “Vertigo”
The client described in the case is a 46-year-old housewife. She and her
husband are currently experiencing marital difficulties. The client has been referred to
me by her husband’s psychiatrist. Her primary complaint is that she experiences
periods of dizziness that have been interfering with her ability to function on a daily
basis. These dizzy spells seem to occur at regular times—most notably at around 4:00
in the afternoon and when discussions turn to the marital conflicts she an her husband
are experiencing. Thorough physical examinations have ruled out any possible medical
conditions.
Diagnosis
I believe that this client is suffering from conversion disorder. Diagnostic criterion
A for conversion disordered listed in the Diagnostic and Statistical Manual, 4
th
edition
(DSM) is listed as, “One or more symptoms or deficits affecting voluntary motor or
sensory function that suggest a neurological or other general medical condition.”
(American Psychiatric Association [APA], 1994, p. 457). Very clearly this client’s
frequent bouts of dizziness fulfill this criterion.
Criterion B states that, “Psychological factors are judged to be associated with
the symptoms or deficit because the initiation or exacerbation of the symptoms or deficit
is preceded by conflicts or other stressors.” (APA, 1994, p. 457). As described in the
case, this client’s dizzy spells occur at regular times—at 4:00 p.m., prior to her husband
coming home from work and when the couple’s conflicts are being discussed.
(And so on, and so forth, and so on and so forth, and so forth….)
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(…and so forth, and so on and so forth, and so forth, and so on and so forth , and so on
and so forth , and so on and so forth , and so on and so forth.)
Treatment Plan
Goals
My immediate concern in this particular case is that fact that the client’s
husband’s demanding nature seems to be directly feeding into the client’s mysterious
dizzy spells. For example, if he weren’t so insistent on having things just so when he
arrived home from work at 4:00, perhaps the client would not respond in the way she
does. Individually, I would try to explain to the husband that his strong reactions are
exacerbating the marital discord and thus his wife’s condition. I would urge him to make
every effort to be less demanding, and try to play a more active role in the household
chores he insists be completed when he gets home from work.
My short-term goal in this particular case is to try and repair the marital discord
that seems to persist in this household. I seems to me that both parties have some
false notions regarding how a household should function. They need to understand that
marriage is a partnership and some degree of compromise and responsibility on the
part of both parties is necessary for the proper functioning of the family. I would also try
to improve communication between the two—it is obvious that they do not seem to be
communicating as effectively as they could.
My long-term goal in this particular case would be to help the client develop a
more functional and mature way of expressing her psychological discomfort. Her
tendency to develop somatic complains in response to stressors must have deep roots
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in her personality development. This will probably be the most challenging aspect of
therapy with this particular client.
Treatment Site
Because the client’s difficulties are not so severe that she is at risk of harming
herself or others, I would recommend treatment on an outpatient basis. Hospitalization
is not necessary.
Treatment Modality
In this particular case I would recommend a combination of individual
psychotherapy, couples’ therapy and perhaps some group therapy with other couples
having marital difficulty.
Specific Treatment Techniques
Although, no particular treatment techniques standout as being especially
effective in treating somatoform disorders, it is clear that biological, emotional and
cognitive factors as well as conditioning play a role in the development of this disorder.
For this reason, an integrative therapeutic approach that focuses on childhood events
that provide the fuel for the development of later somatic symptoms is often
recommended (Halgin & Whitbourne, 2000, p. 217).
(…and so on and so forth, and so on and so forth, and so on and so forth, and so
on and so forth, and so on and so forth, and so on and so forth, and so on and so forth,
and so on and so forth, and so on and so forth, and so on and so forth, and so on and
so forth, and so on and so forth, and so on and so forth, and so on and so forth, and so
on and so forth, and so on and so forth, and so on and so forth, and so on and so forth.)
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References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental
disorders (4
th
ed.). Washington, DC: Author.
Halgin, R.P. & Whitbourne, S.K. (2000). Abnormal psychology: Clinical perspectives on
psychological disorders (3
rd
ed.). Boston, MA: McGraw-Hill.
