posted by CATHY on .
Please help in answering the questions below, this is the extract.
Jamal is a 27 year old male who presented with some difficulties in his life. His main presenting concern was related to problems with alcohol and illicit drugs. He has reportedly had a long standing history of using recreational drugs with cocaine and marijuana being his drug of choice. However, he has tried other substances in the past. While he does not use drugs consistently, he does tend to have periods where his use gets out of hand and he spends the entire weekend using drugs and alcohol with no periods of sleep at all. This usually leads to difficulties as he then struggles to get to work on the following Monday leading to repeated absences from work. This pattern has been occurring on a regular basis for the past 9 years or so. While he can go for prolonged periods without using substances, he tends to, on average binge out at least once or twice a week a month, for entire weekends at a time. In spite of these difficulties he has managed to go to varsity and obtain a degree in Accounting and currently works as an accountant for a large firm. He does not seem to be using ever increasing amounts of any of the drugs nor does he crave drugs when he is not using them.
Jamal reports that relationships have also been a struggle. He tends to always be unsure of himself and fears that he is not good enough. He worries that people in his life will leave him and want nothing to do with him. He has had a turbulent relationship with his current girlfriend over the over the past five years. She works as a tour operator and he has become aware that his drug binges tend to coincide with the times when she is away for a weekend tour. At these times he feels consumed by intense rage and thoughts of “how can she leave me when I her so badly. Am I not good enough for her...” These feelings then later lead to feelings of guilt, anxiety and fear all in one... and he genuinely feels as though she is not coming back. After a few sessions, it emerged that he has always struggled with his emotions especially in the context of relationships from when he was young. He was physically and emotionally abused by his parents who alternated between being sweet, caring and charming to being rage full, withholding and punitive. He never quite knew where he stood as a child. He developed insecurity in relationships with intense anger, rage and fear when people did not give him the care and attention he needs. He used to burn himself with cigarette butts as a teenager as a way to take the focus off from his parents raging assaults on him and each other. Generally when his girlfriend is around, he feels happy, motivated and somewhat hopeful in short bursts although he is generally plagued with intense anxiety and thoughts about her leaving him all by himself. However, his whole world crumbles when she leaves and his primary aim becomes one of destruction. At these times, he convinces himself that he doesn’t need her. Yet inside he feels desperately that he cannot live without her. He has threatened suicide on occasion. He has also had episodes of spending huge amounts of money on clothes and drugs. While in this frame of mind it was not uncommon to find himself having sexual relations with other women. In sum, Jamal is distressed and overwhelmed. He would like to get his life back on track and to stop hurting so much.
1.What is your differential diagnosis (give two ) Justify your answers
2. What diagnosis best account for Jamal’s current difficulties. Justify your answer