Antisocial personality disorder (ASPD) has a characteristic pattern of socially irresponsible, guiltless and exploitative behavior. The disorder is associated with other addictive and mental disorders and medical comorbidities. ASPD usually begins in early life, typically around eight years of age and is termed as conduct disorder in childhood, which generally changes to ASPD at the age of 18 years if the antisocial behaviors are persistent. The disorder tends to improve with advancement in age though it can be chronic and lifelong for most individuals. The earlier the disorder sets in, the poorer the prognosis. Other factors that moderate the disorder include employment, marriage, and early adjudication in the early years of life and degree of socialization (Black, 2015). Symptoms include failure to sustain consistent jobs, failure to conform to the law, manipulating others for personal gain, failing to develop interpersonal relationships that are stable and deception of others. According to the DSM-5 criteria for a diagnosis of ASPD needs a history of childhood CD.
The client, in this case, is a 32-year-old Hispanic female called Rhonda who presents in the clinic for her first appointment, where she reports of being at the end of her rope and does not know what else to do. She has very few friends and feels that everyone has abandoned her. She reports that she helps other people, but it does not seem to work. Her financial situation at the moment is also precarious. She says to have always been in trouble when she was a kid. She is single and has no children. She is in her current job for two weeks only and says she was fired from her previous job since her coworkers were jealous of her.
Rhonda has had various incarcerations for offenses and has been arrested many times for fighting. On mental status assessment, she is oriented to time, place and person. She has a clear, coherent, directed, spontaneous and goal-directed speech. She reports having a terrible mood; her affect is labile and changes rapidly depending on the topic of discussion. She has regular eye contact but appears to stare at times. She denies auditory/visual hallucinations, and no delusional or overt paranoia thought processes noted, and she denies any homicidal or suicidal ideation.
According to the information provided in the scenario, Rhonda would be given a diagnosis of antisocial personality disorder. The reason for selecting this decision is because she portrays most symptoms of classifying this disorder as per DSM-5 criteria. These symptoms include failure to sustain her employment, failure to conform to the law as she has been arrested severally, manipulating others for personal gain like where she expects her friend to loan her to buy a car, failing to develop interpersonal relationships that are stable as seen in her being single at the age of 32 and with no child (Dunbar and Sias, 2015). The hope was to come up with a diagnosis that suits Rhonda, and it was not different from my expectation.
My first decision in managing Rhonda is to refer her to a psychologist for psychological testing. The reason for selecting this decision is to get clarification regarding Rhonda's diagnosis since a psychologist will be in a position to elicit the specific symptoms of ASPD which the PMHNP may not be able to extract and rule out traits that are related to other personality disorders. It can be challenging to make a diagnosis for clients with ASPD since they use manipulation and deceit to
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