Neurosis Case

Test report of BDI, BAI and TAT

Hajra Khan (1536)

Department of Applied Psychology, Riphah International University

APSY-4104: Case Report II

Dr. Hina

July 4th, 2021

The client was a 23-year-old girl who found herself being indulged in repetitive

behavior lately. The client also complained about having thoughts that would make her feel

unpleasant. After complete history taking and evaluation of the client, it was reduced that

there was a need for therapeutic intervention. One of the talking therapies, Cognitive

behavioural therapy was utilised to help client recognize and change the maladaptive

behaviour and learn healthy coping mechanisms.

Biodata

Name: H.H

Age: 21

Gender: Female

Education: Under graduation

Number of siblings: 3

Birth order: 3rd

Marital status: Single

Informant: Sister

Reason and source of referral

Client was brought to the clinic by her husband to seek practitioner’s help. Client was

served in multiple ways to help evaluate and diagnose the problem and to plan possible

remedies for betterment of the client’s condition. This report intends to fulfil the partial

academic degree requirement.

Presenting complaints

The client had presented the following complaints by the time she arrived to seek

practitioner’s help:
 ‘Mujhy adat si parh gai hy agr mai rozana mukammal pura ghar or ghar ki hr cheez

saaf na karu mai sakoon sy so bhi nahi sakti’.

‘Mairy ghar waly hr waqt mujh py ghusa krty hy q k un k mutabiq safai ki itni zarurat

nhi hoti pr mujhy lagta hy k hoti hy zarurat,

‘Sirf ye nahi balky rozana k both mamlat mai maira dimagh uljha hua hota hy jese

mujhy wahm hota hy k koi mairi cheezy na chura ly or apna mobile bhi bag mai bar bar

check krti hu halanky mujhy pata hota hy k mairy bag mai hi hy’.

‘Mai room ki setting bhi change kr lu tou do teen dino tak maira dil udas udas rehta

hy’.

‘mai do saalon sy ye experience kar rahi hu laikn ajkal zyada intense ho gya hy’.

Background history

Family history

The client lived among her family members who were all loving and caring. Clients

parents had crossed the age of 50. Both of client’s siblings; brother aged 28 and sister aged 25

were very near and dear to her. Client’s father was a retired government officer who was very

strict and was always feared while rest of the family members shared a sweet relationship.

Client’s mother was more opened and willing to look from children’s point of view whenever

it came to decision making. Furthermore, there has been no such reasonable mental or

physical illness among family members or in forerunners.

General home atmosphere

Client belonged to a middle-class family. The family did not face any financial issues

and lived a stable life. Client’s father was the authoritative figure at home. Although as stated

by the client there was pleasant environment at home, but their father was quite strict and

would not allow them to practice freedom when it came to life outside home. Mostly, client’s

father would not even allow his children to attend co-curricular events at schools or meet
friends at their home. This would make the client and her siblings at home extremely

helpless. Client believed that not allowing children to live a free life to some degree is cruel

and this is exactly what happed to the client. Client also believed that her life was snatched

from her when it was time to grow and socialise. The family still lived the same way but

there was a slight change. Client was mostly helped by her brother who now could live an

independent life and her mother who would do anything to make her children feel relieved

unlike before.

Personal history

The client specified that she was born through normal delivery and faced no physical

illness at the time of birth. Client achieved all her developmental milestone at adequate time

and did not face any difficulty or delaying through any phase. Client was a cheerful yet sober

kid throughout childhood and had a bunch of friends. Client had good relationship with

friends and cousins in family who were her age. Client made a lot of good memories. As

elaborated by client, she had an extrovert personality type and always anticipated meeting

new people which was restricted due to her father’s aggressive and intense overruling

behavior. Client always dreamt of living a less restricted life and these wishes still resides

inside her but now she can not find anyone to accompany her in fulfilling these dreams.

Educational history

Currently, the client was in 6th semester of Bachelor’s in Business and Administration.

Since her childhood, client had a keen interest in studies and always desired achieving good

score. The client had very good friends in school and college with whom she is still in touch.

Client had very respectful relationship with her teachers and it still is. Client has always

remained her teachers’ favourite student mostly because of her excellent grades. Client

believed that she no longer received the same attention from teachers in university although

she is still good in all subjects but the teachers do not show favouritism which the client has
no problem with as per stated by the client. Furthermore, initially in university times client

faced personal attacks due to her extreme obsession with cleanliness. Sooner, client’s friends

begin to understand and would no longer mock her. Other than that, the client has always

remained a very attentive and active student and had healthy relationship with friends and

teachers. Client believed that nowadays her major goal was to complete the degree and

search for a good job so that she no longer relies on her father or brother. Client wished for

well-educated person and self-supporting life without the help of others.

Sexual history

The client attained her puberty at the age of 11. The client did not specify further

sexual history.

Occupational history

Client is currently studying and did not have any job anywhere at all. Soon after

completion of her degree client is looking for a reliable job.

Premorbid personality

The client began facing the issue just before starting her University. Before that, there

was no such issue. There had never been any sort of reasoning between client and her family

members neither had there been any uncertainty between her and her friends. Client was not

very deep into keeping things completely clean and tidy. Client also never experienced

unpleasant and uncertain thoughts.

Medical history

Client was a medically fit person. There has been no such reasonable mental or

physical illness among family members or in forerunners. Client had never been to

psychologist’s help before nor did she ever acquire any sort of serious medical assistance.

Present illness history

certain mental attack. As she started experiencing outbursts and argumentation with her

friends and family it was then when she realised that something was not right. Gradually the

symptoms got more severe, client would even experience anxiousness, loss of weigh and

appetite. The client and her family members at this time felt that there was need of proper

help from a practitioner.

Psychological assessment

The assessment was carried out both formally and informally.

 Informal assessment

 Formal assessment

Informal assessment

Informal assessment was carried out by using behavioural observation and mental

status examination.

Behavioural observation

The client was well dressed suitable according to weather conditions of the region, sat

straight and had potential to answer each question thoughtfully. The client talked politely in a

respectable manner and maintained eye contact as desired. Sensible answers that were

relevant to the questions being asked were exchanged.

Formal assessment

In formal assessment following psychological tests were used:

 Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

 Beck Anxiety Test (BAI)

 HTP

1) Yale-Brown Obsessive-Compulsive Scale (Y-BOCD)

behaviour of client. The results reflect deviated status of the client’s both thoughts and

behaviour from that of normal individuals. Score above 16 are considered as clinically

significant symptoms. The client obtained 28 score which indicates moderate to severe level

of OCD i.e.

Score over 24 = moderate to severe level of OCD.

Qualitative assessment. Overall quantitative scoring of the test represents moderate

to severe level of OCD. The test also consisted of symptoms checklist and after reviewing the

checklist it was deduced that the client has contaminating obsession; keeping things

excessively clean and checking compulsion; always reassuring things again and again.

2) Beck Anxiety Inventory

Quantitative assessment. The scale consisted of 21 items which assessed anxiety

level of client. The client obtained 32 scoring which represents moderate level of anxiety.

33 moderate anxiety

Score of 22 to 35 = Moderate anxiety

Qualitative assessment. The client obtained 32 scoring which represents moderate

level of anxiety however the issue requires much attention because the scoring is very nearer

to the category ‘potentially concerning level of anxiety’.

3) HTP

Qualitative assessment. To have a brief look over three of the drawings, it can be

inferred that three of the figures have some mutual coherences that are central placement of

the drawings, shading and out of the three drawings tree has been drawn first which indicates

the rigidity, anxiety and the concerns of the client about her growth and development issues.

Out of the three drawings, tree was drawn first which symbolizes the concerns of client with

growth, development and issues of life and death. Size of three drawings is relatively large
which demonstrate greater self-esteem and a higher level of energy of the client. Overall

shading represents that the client has anxiety. Also, the similar indicators that are found in

three of the figures show that the client has problems related to insecurity and defensiveness

of self.

Risk factors for relapse

Apparently, there seems no such factors that would increase the chances for relapse as

the client is super anticipant for her normal living. There also is a need of social support by

immediate family members and those who are in touch with the client. Homework is usually

assigned in such interventions where the client is needed to cooperate. If these factors are

missing, treatment or intervention may not be very effective and there would be thus greater

chances for relapse.

Diagnosis

The client has been diagnosed with following disorder:

300.3 (F42) Obsessive Compulsive Disorder

Anxiety Disorder

Prognosis

The prognosis of the client’s problem seems to be favourable due to the presence of

few supportive factors. Client had super supportive siblings and mother and had an insight

that this problem needed to end. Client was looking forward to living her life without being

always cautious and worrying about things.

Case formulation

Client who always remained very conscious about keeping her house clean always

experienced unpleasant feelings whenever she saw any part of the house and thing filthy.

Client was also obsessed with checking on things like mobile phone in her purse again and

again. The client would even feet upset whenever she would change her room settings. This
probably gives client diagnosis of Obsessive-Compulsive Disorder particularly related to

contamination and cleaning/washing compulsions. Tests also indicated that the client has

anxiety and OCD.

Management plan

For treatment of the above-mentioned disorders in diagnosis section is to be split into

three sections which would include about 10–15 sessions. The first section ensures to obtain

all the possible data from client through a collaborative way. Practitioner and client would

work together on identifying root causes of the issue. Next section provides implementing

appropriate treatment as planned; Cognitive Behavioural therapy combined with exposure

therapy and some lifestyle changes and self-help techniques. Third section focuses on

terminating the sessions and planning strategies for the prevention of relapse.

CBT will focus on breaking the cycle of unrealistic thoughts and negative behavior

by finding new ways of thinking. More positive thinking would be encouraged e.g. panic

attacks are unpleasant but are not fatal and will pass. Negative or irrational thoughts are to be

identified; situations or events that trigger fear are recognized. Irrational thoughts are then

challenged; this questions the evidence for frightening thoughts. Negative thoughts are then

replaced with more positive thoughts. This will ensure that the client eliminates fearful

thoughts by facing the triggering situation at modest level initially. The proportion would

increase gradually until the client has all fears dismissed. This will eliminate anxiety

tendencies within the client developed due to OCD. Further lifestyle changes and self-help

techniques would be utilized to mitigate the problem. Regular home exercise and healthy diet

are to be maintained. Client would be taught coping mechanisms such as creative

visualization which involves resisting the urge to think about negative thought but to think of

place or situation that makes the client happy and peaceful. Lastly, the sessions will focus on
terminating the intervention being provided and prevention of returning to the old ways of

thinking and behaving.