Co-Occurring Disorders Case Study

Co-occurring disorders are common with most client cases that are presenting with a substance use disorder. Rosa is presenting with a history of several suicide attempts, alcohol use disorder, Post traumatic Stress Disorder (PTSD), and Borderline Personality Disorder (BPD). The client’s most severe symptoms are anger, fear, and shame. It is these symptoms that are complicating her life, causing distress, and self harming behaviors. Additionally, her treatment history is limited since she does not finish her therapy sessions. In her opinion she doesn’t have a problem and she feels that she is smarter than the therapists. She has an intense fear of not being liked or not being viewed in positive regard. She has been unwillingly admitted several

Her most severe symptoms of anger, fear, and shame are leading her to self harming behaviors such as suicide, burning, and overdosing on prescription medication and alcohol. I believe that treating these symptoms to include fear of abandonment, rejection, and being alone would minimize her self-harming behavior. These symptoms are complex due to her early sexual abuse and rape. She has been diagnosed with BPD, PTSD, and Alcohol Use Disorder. Furthermore, she has many symptoms under the criteria of PTSD such as: Intrusive memories; dissociative reactions; recurrent distressing dreams; avoidance of external reminders; inability to remember parts of the traumatic event; persistent negative emotional state (depression, anger, and anxiety); feeling detached; self destructive behaviors; problems with concentration; sleep difficulties; significant distress and impairment in relationships (American Psychiatric Association, 2013). Secondly, Rosa’s symptoms associated with BPD are: instable relationships; impulsivity; frantic efforts to avoid abandonment; unstable and intense interpersonal relationships; unstable sense of self; self harming behaviors (over spending, burning, suicide, sex, substance use, and binge eating); chronic feelings of emptiness; transient, stress-related paranoid ideation; and affective instability (panic, anger, and despair) (American Psychiatric Association,

It is important to keep Rosa in treatment so that her life can improve and prevent future suicide attempts. Her life has become unnamable in all significant areas such as: work, financial, family, and interpersonal relationships. She will benefit from trauma focused therapy although she will need to gain coping skills and stability in her life before this begins. She is benefiting from CBT and DBT and has showed improvement in herself harming behaviors. She does have a strong relationship with alcohol as she has learned that it helps her to feel numb and to avoid unwanted feelings and emotions. Therefore, resolving her feelings of guilt, shame, and fear of being alone will be important in minimizing her substance