b’Subject: Management’b’Topic: Ethical Dilemma’b’Home Assignment – Ethical dilemmannPlease write an essay about one Ethical Dilemma. This dilemma might be taken from your own previous experiences or base on the stories provided in media (but not as copy-paste but your own description) and must describe the situation, which has no one clear solution.n nThe length of the dilemma is between 200 and 500 words. nnDilemma itself should consist of at least two types of descriptions: n1. situation (parties involved, environment, what is the problem etc) and,n2. Action (what happened?). nThe description should give enough important information for the cournyzse mates to solve it.’

The Case of Suzanne Summary

        Making a Differential Diagnosis

The decision for Suzanne to seek help reached after several stressful confrontations with her mother due to her hair pulling problem. She is a young female residing in the university housing and is in her second year of study. She suffers from a hair pulling disorder which she began plucking out her eyelashes when tense because it made her relax. She overcame the habit with time but upon joining college, she met Jon who was her boyfriend, and they stopped talking to each other after a month. She felt pain as a result and began her hair pulling habit to feel a sigh of relief, and she would call herself stupid, immature and disgusting for her actions. Her symptoms are thus self-image issues, anxiety, hair, and eyelashes pulling, recurrent hair-pulling leading to hair loss, repeated attempts to stop pulling her hair.

Going by the information that Suzanne provides, her condition appears genuine eliminating the possibility of malingering and factitious disorder. She is honest about her situation as she is displeased by her hair pulling behavior. Her mother is also displeased by her behavior which results in stressful confrontations. Stressful conditions and anxiety influence her behavior despite her efforts to stop. Therefore, she needs help, and this leaves no room for being dishonest for any malicious gain. Her presentation does not arise any suspicious acts that would lead to falsifying information. The fact that she self-referred herself shows her determination to enhance her positive image, please herself and her mother by stopping her hair pulling disorder.

When Suzanne was presenting her problem, she did not report any case of substance abuse. She has no history of any substance abuse, and her problem began a long time ago when she was in her 7th grade. Her psychiatric symptoms which are among self-image issues and anxiety has no close temporal relationship to drug use/misuse.

Her symptoms such as anxiety are identical to many general medical conditions, and this may arise difficulties in the differential diagnosis. From the history recorded by Suzanne, there is no significant medical and familial history for mental illness or mental health hospitalization in any facility. She does not present any history of prescribed medication, medical procedures or previous surgeries. Suzanne advises that her hair pulling behavior was due to envisioning seeing a microscopic bacterial wiggling around under her hair or skin as well as due to her anxiety. The patient’s problem has gradually developed to the point that she saw the need to seek psychiatric help. The patient describes that she has tried to stop severally, but when faced with stressful situations such as when her boyfriend Bob left, her hair pulling re-emerges. Suzanne’s symptoms indicate a  disorder that can however not be linked with the general medical condition.

Substance use and general medical conditions have been ruled out as etiologies which call for determining the primary disorder that Suzanne suffers from. In DSM 5- Handbook of Differential Diagnosis, Suzanne exhibits symptoms that match those of compulsive-obsessive disorder (OCD)(First, 2013).  OCD is characterized by obsessions, e.g., recurrent urges, thoughts which are experienced as intrusive and unwanted that the person attempts to suppress or ignore. The specific disorder under OCD in DSM-5 is trichotillomania (hair-pulling disorder) which is characterized by thoughts which are recurrent and actions limited to hair pulling. The patients’  symptoms cannot be linked with another mental disorder like somatic symptom disorder or anxiety disorder. Suzanne meets the criteria for trichotillomania diagnosis. She has repeated (recurrent) hair pulling resulting in bald patches, she has attempted to stop/control her behavior, and it’s causing her distress.

The hair pulling behavior is a maladaptive response to anxiety and stress after parting with Jon who was her boyfriend. The main contender is adjustment disorder where difficulties may be experienced when coping with a stressful life event. The symptoms include anxiousness, crying, feelings of sadness and loss of self-esteem. The symptoms that the patient presents do not entirely meet the criteria for adjustment disorder or residual other specified or unspecified disorders in DSM-5. With all the above, it is critical to establish the boundary with no mental disorder. From the presented symptoms by the patient, Suzanne has been diagnosed with obsessive-compulsive disorder- trichotillomania as it matches the DSM-5 criteria.

Socio-cultural Perspective

A socio-cultural perspective is an approach that enhances an understanding of why humans behave the way they do. It seeks to understand human behavior and personality development through an examination of the rules of the social groups and subgroups that the individual is a member (Scull, 2018). The manipulation of social, cultural factors can negatively or positively influence an individual’s behavior. The factors integrate sexuality, gender, religion, race, and social standards.  For instance, in the case of Suzanne, her relationship is a social factor that upon breakup influences her personality and behavior negatively such that she results in pulling her hair to relieve her anxiety.  Her relationship with her mother also is strained by her behavioral response, and this has a possibility of influencing her inner conscious.  Her surrounding environment could be the factors that induce her anxieties (Scull, 2018). The culture is a contributing factor in shaping cognitive abilities. The behaviors portrayed by Suzanne can thus be justified by socio-cultural approach as her personal experiences, influences and culture have the potential to shape her.

Evidence-Based Treatment and Non-Evidence Based Treatment for Trichotillomania

One of the evidence-based interventions for Suzanne is cognitive behavioral therapy to determine the relationship between thoughts, feelings, and behaviors. By changing Suzanne’s’ thought patterns that are associated with pulling out her hair and practice, new thoughts and behaviors in the same familiar situations or when experiencing the same emotions like anxiety, she will essentially be trained to respond in a new way to the original stimulus (Chamberlain et al., 2010). Since the pulling of her hair is frequent, it can eventually become automatic becoming more of a habit, and thus cognitive behavioral therapy can be used to enhance Suzanne to learn her environment where she pulls her hair and changes her habitual behavior as well as thoughts and feelings behind it. 

Another evidence-based treatment can include habit-reversal training which integrates two main phases which are awareness training and competing for response training. In the first step, the consciousness of the behavior is increased by challenging the patient to become actively aware when they are pulling out their hair (Franklin et al., 2011). It integrates self-monitoring techniques like observing when they tend to pull their hair, where they are, their emotional state, the hands and the fingers that they use.  Through awareness training, a detailed record is kept regarding the hair pulling episodes including the cues that trigger it.  These cues may be anxiety, thoughts associated with the hair or boredom.  The second phase is competing for response training. Through pinpointing and becoming aware of the warning signs, the patient can combat the creeping urge to pull with a competing response. This response is designed to make it hard or impossible to a patient like Suzanne to pull. Actions may include keeping a tight fist, placing the hand on the lap or sitting on the hands among others. Other evidence-based treatment to treat trichotillomania may include acceptance and commitment therapy, comprehensive behavioral therapy and group therapy.

Apart from the evidence-based treatment for trichotillomania, there are other alternatives, non-evidence based that exist as viable options.  Their effectiveness has not been ascertained, and thus some herbs, supplements, and treatments can interfere with medication or even increase the severity of symptoms.  They, for instance, include the use of Aloe vera which calms the physical sensations on the skin triggering pilling of hair behavior and use of Chamomile tea which creates an overall calming effect (Ganuza, 2013). Chamomile tea is believed to soothe anxiety and stress reducing the urge to pull hair.

Historical Perspectives and Theoretical Orientation

The biological, historical perspective and are inappropriate alternates to explain the case of Suzanne. Biological and physical basis of behavior is emphasized by this perspective (Richards, 2010). It looks at how genetics influence different behaviors or how the specific areas of the brain may influence personality and behavior. This is not applicable to the case of there is no genetic or any damage to her brain in her symptoms. The evolutionary perspective is also inappropriate as evolution or natural selection cannot explain Suzanne’s symptoms (Kitayama & Cohen, 2010).

In the aspect of theoretical orientations, family therapy cannot be integrated into this case because its only Suzanne who has the problem of trichotillomania. This orientation looks at problems in the context of the family system viewing the entire family as the therapy client. Humanistic therapy can also not be used in explaining trichotillomania. It posits that people have a natural inclination to strive towards self-fulfillment and aims at helping the patients self-actualize through self-examination, self-mastery and creative expression (Kitayama & Cohen, 2010). By emphasizing that the client should focus primarily on how she feels good about herself, the problem cannot be fully addressed.

References

Chamberlain, S. R., Odlaug, B. L., Boulougouris, V., Fineberg, N. A., & Grant, J. E. (2010).                Trichotillomania: neurobiology and treatment. Neuroscience & Biobehavioral Reviews      , 33(6), 831-842.

First, M. B. (2013). DSM-5 handbook of differential diagnosis. American Psychiatric Pub (https://doi-org.proxy-library.ashford.edu/10.1176/appi.books.9781585629992).

Franklin, M. E., Zagrabbe, K., Benavides, K. L., Christenson, Tolin, Toit, et al. (2011).          Trichotillomania and its treatment: a review and recommendations. Expert review of                Neurotherapeutics, 11(8), 1165-1174.

Ganuza, W. (2013). U.S. Patent Application No. 13/667,214.

Kitayama, S., & Cohen, D. (. (2010). Handbook of cultural psychology. Guilford Press.

Richards, G. (2010). Putting psychology in its place: Critical historical perspectives.            Routledge.

Scull, A. (2018). Social order/mental disorder: Anglo-American psychiatry in historical     perspective. Routledge.

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