Interpretation
Discussion
Mr. M is a 21-year-old single Malay-Chinese male who is currently living in Kuching with his family. He comes from a middle-class family with four members which includes his parents, an elder brother and himself. He is the youngest child in the family. Mr. M’s father is a businessman while his mother is working as an IT Manager. His brother is also working at business-related field. Mr. M is now studying at University Malaysia Sarawak (UNIMAS), as a 3rd year student pursuing Bachelor of Psychology with Honours.
Initially, he is unable to recall any particular problem which he is facing. He thinks he is able to fix it all by himself and the sad feeling comes and go easily. In the past, Mr. M committed parasuicide during his high school era due to the matter of self-worth. He was competitive and he felt that he was worthless compared to the others in terms of academic and outer appearance aspect. For instance, he punched glass before when he was not satisfied with his SPM result. Mr. M always felt that he can do even better, but according to him, this matter does not affect him at all now.
Currently, in terms of achievement, Mr. M focuses only on educational achievement. Having a good Cumulative Grade Point Average (CGPA) is the only matter he cares about. Ever since he entered degree, he thinks that nothing else comes first other than academic performance. The number (CGPA) is the only thing to define his self-worth. Mr. M has not found anything that is more worth than academic. He does not allow his current CGPA to drop.
He does not emphasize on improving social life. Although Mr. M did join some activities like drama club in his university, he does not feel the connection with the others during the interaction process. He sees it as a working relationship but not a platform for him to socialize and create a deeper connection to befriend the others. To him, people come and go in his life. Mr. M also changes his behaviour when he is dealing with different people and situation. He joined drama club intentionally because he is keen in acting while the activities that he joined is merely for benefits, in order for him to continue to stay in the college.
He does feel sad about his social life since it is not similar with what he is expecting especially when people whom he is comfortable with are distanced now, thus he cannot see them often. He feels disconnected but it does not urge him to crave for interaction. Mr. M used to search for it but now he feels like he can just do it on his own without anyone’s help. He often stays and chill inside his room.
In addition, Mr. M also has low connection with his parents as well. He ranked the level of connection same as his connection with his friends which is 3 out of 10. He does not disclose his personal stuff including stress or breakdown to his parents. The reason is not making them feel less worried about him, but it is simply that he does not want to talk about it. According to Mr. M, his family also think that he does not need any comfort or motivation from their side. His parents are also often busy. However, Mr. M does express his personal matters to his ex-girlfriend before, but he does not wish to disclose any information regarding his ex-girlfriend.
When Mr. M faces adversities especially on academic aspect, he thinks that he can overcome it easily. Even though he feels empty at first, but after crying and having a good sleep, he feels better about it. He thinks that one is able to set limit and recognize oneself to deal with mood disturbance, sleep pattern and appetite. Thus, he does not need social life to reframe his thoughts.
Nevertheless, Mr. M unconsciously states that he wants to be someone who does not care about anything and does not get stressed easily, but he still tends to overthink in the end. He also unconsciously states that he cannot accept failure. For instance, although he says that the past does not affect him anymore, but he is still not over the fact that he was not able to pursue medical course. Mr. M does not see failure as a way to improve himself. He thinks that preparing yourself for any consequences will lead to actual failure.
Throughout the session, Mr. M was not fully paying attention. He was listening to music from his laptop at the same time. Besides, he also occasionally touched his hair and rubbed his shoes. He mentioned “I do not know” consistently when he answered the questions. He did not wish to disclose his information most of the times while emphasizing that he had acting experience.
Endorsed Items
BDI
Mr. M endorses the following statements on the BDI:
· I feel sad.
· I feel I have failed more than the average person.
· I don’t enjoy things the way I used to.
· I feel guilty a good part of the time.
· I am disappointed in myself.
· I am critical of myself for my weakness or mistakes.
· I have thoughts of killing myself, but I would not carry them out.
· I am slightly more irritated now than usual.
· I am less interested in other people than I used to be.
· I am worried that I am looking old or unattractive.
Although Mr. M performs well in his academic achievement, he still feels that he has failed more than the average person. This is because he thinks that he could achieve more in terms of other factors. However, he does not really wish to try to achieve those at the current moment. It depends on what is the most important factor that matters for now.
Besides, he also stated that he feels guilty a good part of the time. Even though he is doing his very best, he thinks that he can actually do more than that. Mr. M feels sad and disappointed in himself when he is unable to achieve his target, mostly in academic aspect once again. He rarely does not do his best, but he tends to overthink. For instance, if he does not perform well but his result is good, he still thinks that he can do better. Mr. M also adds on that he is guilty for not taking part in socializing which is not disclosing about himself a lot. Although he knows that people usually talk to the others when they face any difficulties so that people can help out, he stays secretive. It is not that he does not want to let others worry about him.
Mr. M also stated that he does not enjoy things the way he used to, mostly relating to games. Now it feels dull to involve in the gaming world to him. He states that he enjoys studying but not in terms of academic achievement because it is something to be expected in order to meet his expectation.
In addition, Mr. M said he is critical of himself for his weakness or mistakes. If there is someone else informing him making a mistake or he feels that he is not good enough, he will take into consideration and improve himself. He could not recall any weaknesses of him at the current moment. He will only realize it when he makes a mistake or being told by the others.
Regarding the fact that Mr. M put that he has thoughts of killing himself but would not carry them out. It is a misinterpretation because he does not have suicidal thoughts for the past two weeks. He mentions that sometimes he looks into the concept of death, wondering if it leads to nothing or there is something there expecting us during the afterlife world. However, this does not lead him to appreciate the current living world through improving himself.
Mr. M said he is slightly more irritated now than usual. He admits that he is getting a bit more sensitive especially towards anything that truly affects him, but it depends on situation. He mentions that he cannot tolerant with people asking stupid questions. If those kinds of people have an argument with him, he will get angrier. However, he does not react his anger out swiftly. If the person does not listen to proper basic instruction for several times, he will simply do it by himself.
He is less interested in other people than I used to be. It is not that he does not want it; he just feels like he does not constantly need it since he is able to solve the problems by himself. Mr. M admits that he is lacking close friends whom he can freely express his inner feeling. There is less proper interaction when he grows up, he states that it is a process of maturation as he now chooses who to be interacted with.
Lastly, Mr. M worried that he is looking old or unattractive. He personally thinks that his outer appearance is not appealing but this thought of his is not too extreme because he states that there are others who look worse than him. He does try to improve his outer appearance, for instance, through skincare and dieting. Nevertheless, Mr. M believes that beauty is in the eye of the beholder. He accepts for who he really is. He is also not interested in finding a love partner at the current moment and does not has interest in having sexual experiences.
BAI
Mr. M endorses the following subjective and panic-related symptoms of anxiety on the BAI:
· Unable to relax (Mild)
· Fear of Worst Happening (Mild)
· Nervous (Mild)
Mr. M feels unable to relax mildly when there is workload especially in terms of assignments. Even though it still has a long time to reach the due date, he is unable to relax until he has done it. Thus, he prefers to do work earlier and dislikes last minute work. Besides, when he receives some information and is not able to disclose to the others, he will also be unable to relax.
Apart from that, Mr. M also has a mild effect on fear of worst happening. He is afraid that he is unable to perform well academically. He shows disapproval towards the grading system as feedback is not given to the students on their assignments. He could not know whether he is doing right or wrong for assignment or exam. As for future, he plans to live independently at the age of 35, thus he is worried of the adversities that he might face along the way.
In addition, Mr. M feels mildly nervous for presentation. He does not feel nervous in participating events or competitions because he has not been joining those for the past two months.
Multiaxial Diagnosis
Even though client endorses the following statement “I am less interested in other people than I used to be” on the BDI which is on the mild side, Mr. M’s statements on his unwillingness to socialize with the others keep on arising throughout the interview session. Given this response, the possibility that the client has Schizoid Personality Disorder (SPD) should be considered. Schizoid Personality Disorder (SPD) is a pervasive pattern of detachment from social relationships in the beginning by early adulthood. Mr. M had met almost all of the symptoms (6 out of 7 symptoms) of SPD as shown below:
“Neither desires nor enjoys close relationships, including being part of a family”, “Almost always chooses solitary activities”, “Has little interest in having sexual experiences with another person”, “Takes pleasure in few activities”, “Lacks confidants other than first-degree relatives”, and “Show emotional detachment” (American Psychiatric Association, 2013).
Mr. M lacks interaction with the others, including his family and he prefers to be alone most of the times. During necessary times, he also prefers to solve it by himself rather than expressing out to the others. In addition, even though Mr. M was involved in love relationship, he never has the urge of having sexual experiences with his partner. He still has the same thought till now. The only activity which makes Mr. M feels happy is drama club because he likes to be involved in acting, other than that he does not takes pleasure in other activities because they are only for beneficial purposes. He also admits that he is lacking close friends and even confronts back regarding the definition of close friends. Mr. M also avoids himself in engaging emotional connections, where he sets a boundary between him and the others which leads to difficulties in create and maintain personal relationships. Nevertheless, even though he appears to be indifferent to the criticism of others, he does unconsciously state that he still tends to overthink and desires to be someone who does not care about anything.
Apart from that, Obsessive-Compulsive Personality Disorder (OCPD) is being ruled out. Obsessive-Compulsive Personality Disorder (OCPD) is a pervasive pattern of preoccupation with perfectionism, orderliness, interpersonal and mental control, at the expense of flexibility, openness and efficiency, in the beginning of early adulthood. Mr. M’s conditions only match 2 out of 7 symptoms. He is excessively devoted to work and productivity till the point where he excludes friendship. Besides, he also shows rigidity and stubbornness for not accepting failure in academic achievements. Nevertheless, although he is focusing on his academic aspect and wish to achieve well in it, he does not show perfectionism until the fact that he could not finish his assignments. When it comes to reluctant to delegate tasks unless it is being submitted like the ways of his doings, Mr. M also does not fulfil this as it depends on the quality of work according to him, he will do it by himself only when the quality of the work is really unacceptable. He will also throw away anything that is worn out unless they have sentimental value.
Narcissistic Personality Disorder (NPD) is also being ruled out based on client’s statement. Narcissistic Personality Disorder (NPD) is a pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration and lack of empathy, beginning by early adulthood. Even though Mr. M focuses on self-achievement, he does not exaggerate achievements or to be expected to be recognized as superior without commensurate achievements. He states that he is not the type who boasts about his achievement. He used to become competitive and felt jealous due to others’ achievement but now he sees it as something to be expected or a goal to be reached for the sake of his self-worth.
Besides, although Mr. M had experience in involving in committing parasuicide when he was in high school due to low self-worth while compared to the others, he does not repeat the same behaviour anymore. Thus, this rules out non-suicidal self-injury disorder (NSSID).
As for Axis III, there is no general medical conditions that are concerning the disorders in Axis I and II mentioned. However, there are 3 significant psychosocial and environmental problems in Axis IV: problems with a primary support group (neglect of child), problems related to the social environment (inadequate social support), which led to the impact to the disorders diagnosed. Since both Mr. M’s parents are busy and think that he does not need any comfort or motivation from their side, it causes him to seldom share out his personal thoughts and getting support from his friends to overcome an adversity. He has to endure it all by himself.
Lastly in Axis V, Global Assessment of Functioning (GAF) was given to rank Mr. M’s condition before and during treatments with scores of 80 and 90 respectively. A score of 80 was given for the condition before treatment because Mr. M has transient symptoms which are expected reactions to psychosocial stressors. During treatment, through his condition showed some improvements where Mr. M takes initiative to make connection with the others, a score of 90 is given since he shows minimal symptoms with good functioning.
Conclusion
During the first session, Mr. M was not willing to disclose his information which could be proven by The Ministry of Health Malaysia regarding that it is hard to detect males in terms of showing symptoms in having mental health disorder because males tend to hide their feelings and wants to maintain their masculine images especially when they are facing mental problems.
Mr. M shows improvement in the second session where he carries out intervention in terms of taking the initiative to socialize with the others. He states that socializing is like a double-edged sword where it helps to improve his mood, but his work is delayed. However, he knows how to prioritize between both elements.
The client endorses no statements reflecting suicidal ideation even though he involved in parasuicide (non-suicidal self-injury disorder) in the past. The combination of low level of mood disturbance and anxiety further proven that Mr. M is not in clear danger.
Mr. M mimicked the symptoms of Schizoid Personality Disorder. However, Mr. M fails to endorse all the symptoms in Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Normal level of ups and downs (mood disturbance) and low level of anxiety indicates that Mr. M is experiencing minimal amount of distress. In the next session, further collaboration with another instrument will be planned.
References
American Psychiatric Association. (2013). Desk reference to the diagnostic criteria from dsm-5. Washington, DC: American Psychiatric Association.
Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.
Beck, A.T., Steer, R., Brown, G. (1996). Beck Depression Inventory. Second ed San Antonio, TX, E.U.: Psychological Corporation.
The Ministry of Health Malaysia. (2019). Males and Mental Health. Retrieved from http://www.moh.gov.my/
By: Ng Yi Xian 61744
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