A female patient presents to your office with a chief complaint of intense anxiety and fear of driving a car after a
history of a serious car accident. Her anxiety is becoming more disruptive and is now affecting all elements of
her life. She won’t go to the store unless someone else drives her, she quit her job, and she stopped seeing
friends.
Use textbooks as references and consider the following questions as you post your response:
What is one diagnosis that might be appropriate for this patient?
What are the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) criteria for the diagnosis?
What evidence in the scenario supports the criteria for that diagnosis?
What are two differential diagnoses?
Respond to your peers with the following:
What are 3 questions you would ask to help determine if the patient meets criteria for one of the differentials?
Sample solution
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
Sample Answer
Sample Answer
Diagnosis
Based on the provided scenario, one appropriate diagnosis for this patient is Post-Traumatic Stress Disorder (PTSD), particularly given her history of a serious car accident that has led to significant anxiety and lifestyle changes.
DSM-5 Criteria for PTSD
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the criteria for diagnosing PTSD include:
1. Exposure to a traumatic event: Direct exposure to a traumatic event, witnessing the event, learning that the event occurred to a close family member or friend, or experiencing repeated or extreme exposure to aversive details of the traumatic incident.
2. Intrusive symptoms: The presence of one or more intrusive symptoms associated with the traumatic event, such as:
– Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
– Recurrent distressing dreams related to the event.
– Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event were recurring.
– Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
– Marked physiological reactions to reminders of the traumatic event.
3. Avoidance: Persistent avoidance of stimuli associated with the traumatic event, as evidenced by one or both of the following:
– Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
– Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about the traumatic event.
4. Negative alterations in cognitions and mood: Negative alterations in cognitions and mood associated with the traumatic event, as evidenced by two or more of the following:
– Inability to remember an important aspect of the traumatic event.
– Persistent and exaggerated negative beliefs or expectations about oneself or others.
– Persistent distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame themselves or others.
– Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
– Markedly diminished interest or participation in significant activities.
– Feelings of detachment or estrangement from others.
– Persistent inability to experience positive emotions.
5. Alterations in arousal and reactivity: Alterations in arousal and reactivity associated with the traumatic event, as evidenced by two or more of the following:
– Irritable behavior and angry outbursts.
– Reckless or self-destructive behavior.
– Hypervigilance.
– Exaggerated startle response.
– Problems with concentration.
– Sleep disturbance.
6. Duration: The duration of these symptoms is more than one month.
7. Functional significance: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
8. Exclusion: The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Evidence Supporting PTSD Diagnosis
In this case, several elements in the scenario support a diagnosis of PTSD:
– Exposure to a Traumatic Event: The patient has a history of a serious car accident.
– Intrusive Symptoms: Although not explicitly mentioned, her intense anxiety and fear may suggest she experiences intrusive thoughts related to the accident.
– Avoidance Behavior: The patient avoids driving and needs someone else to drive her to stores, indicating avoidance of reminders of the trauma.
– Negative Alterations in Cognition/Mood: The patient’s anxiety is severe enough to affect her job and social life significantly.
Differential Diagnoses
Two possible differential diagnoses for this patient could include:
1. Acute Stress Disorder (ASD): Similar to PTSD but occurs within three days to one month following a traumatic event.
2. Specific Phobia: A marked fear or anxiety about a specific object or situation (in this case, driving).
Questions for Differential Diagnosis
To help determine if the patient meets criteria for one of the differential diagnoses (e.g., Specific Phobia), I would ask:
1. Can you describe your feelings when you think about driving? This question aims to assess whether her anxiety is specifically linked to driving (characteristic of a phobia) rather than broader PTSD symptoms.
2. Have you experienced these symptoms since the accident, or did they develop later? This question helps clarify whether her symptoms align more closely with ASD (which develops shortly after a trauma) versus PTSD.
