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Differential Diagnosis
Differential Diagnosis
Samantha Kiefer
MPTC
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Differential Diagnosis
I found the process of differential diagnosis to be the most complex of all the things we
have learned throughout the semester. I am not becoming an AODA counselor, but will be
working with clients and will need to incorporate this process within my facility. Many of these
illnesses overlap and I sometimes wonder if clinicians make the correct diagnosis? This worries
me going into my field. What if I make a mistake of misdiagnosing someone? I know in my past
I and family members have been misdiagnosed with both mental and medical illnesses. This just
prolongs the problem and affects recovery. I have to wonder how often does this happen? There
are great clinicians out there, but there are definitely some “quacks.” I have met a few. I only
hope that people who need help get the help they deserve. This is why I got into this field.
The meaning of differential diagnosis is a process used by clinicians to determine a
diagnosis where several entities are at work. This is a process of elimination and the most
common diagnosis is considered first. Differential diagnosis is a four step process. First, the
clinician must compile a list of all the client’s symptoms. Second, the clinician must evaluate all
the possible causes. Next, the clinician must prioritize the list of most dangerous diseases to
least. Finally, the clinician must either treat or rule out the most dangerous cause first and on
down the list ("Differential diagnosis," 2013). I have been through these both mentally and
medically. It is a very grueling process and may take some time. This can be extremely
frustrating and may cause a client to give up and stop treatment altogether. One will see this
more often in adult clients because they have a “say” over their lives, children do not.
This case study was a little perplexing. I was able to make a diagnosis, but was on the
fence for awhile. I feel Henry has an alcohol induced anxiety disorder with obsessive compulsive
symptoms. In the DSM-IV manual, the diagnostic code is 291.89. Henry uses alcohol to “relax”
and is negatively impacting his work, home, and social life. He is cold, has rigid demands,
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Differential Diagnosis
bullying behavior, sexual disinterest, and works long hours. Alcohol has affected his ability to
concentrate and be productive at work. This is all causing a strain on his marriage and family.
Henry meets the following criteria; (1) recurrent substance use is negatively affecting his home
and work environment, (2) continues use despite having persistent or recurrent social or
interpersonal problems caused or worsened by the substance abuse.
I also feel Henry has obsessive compulsive disorder. In the DSM-IV manual, the
diagnostic code is 300.3. Henry is a perfectionist who is not satisfied with anyone else’s work.
He is constantly correcting his assistants’ briefs and then cannot keep his schedule. Henry
criticizes their mistakes and no one wants to work with him. He has always been a high achiever
and competitive. He has trouble relaxing on vacations because he needs to plan and map out
everyone’s day and must stick to it. Henry meets the following criteria; (1) thoughts, impulses, or
images are not simply excessive worries about real-life problems, (2) attempts to ignore or
suppress thoughts, impulses, or images or to neutralize them with some other thought or action,
(3) recurrent or persistent thoughts, impulses, or images that are experienced at some time during
the disturbance ("Diagnostic and statistical," 2011)
This is the differential diagnosis I came up with. As I said above, I do have questions
regarding another diagnosis. The way Henry describes his family, as “mechanical dolls and a
suitable mate” along with being punctilious in his manners and dress and slow to talk if others
around him are “stupid” leads me to the question…..Could Henry be narcissistic as well?
I am not sure, so I have to stick by my original diagnosis from above. This would be how
my diagnosis would be written:
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Differential Diagnosis
Axis I
291.89-Alcohol Induced Anxiety Disorder, Many Episodes, Severe Without Psychotic
Features/Alcohol Abuse
Axis II
300.3-Obsessive Compulsive Personality Disorder-Preoccupied with Perfection
Axis III
None
Axis IV
Problems with primary support group, occasional problems, and problems related to social
environment
Axis V
GAF 47
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Differential Diagnosis
References
Diagnostic and statistical manual of mental disorders, fourth edition (dsm-iv). (2011). Retrieved
from http://allpsych.com/disorders/dsm.html
Differntial diagnosis. (2013). Retrieved from http://en.wikipedia.org/wiki/Differential_diagnosis