Diagnosing PTSD

Answer 1: Darwin is a 65-year-old Black male who describes his life as incredibly difficult, attending a total of five separate high schools within a four-year time period ("Background," n.d.). Without money to attend college, he joined the Marine Corps in the hope that this would provide him the ability to pay for school ("Background," n.d.). Curious to understand the intricacies of fighting in a war, Darwin volunteered and was sent to Vietnam. 

Before combat, Darwin describes his personality as generally upbeat, frequently joking ("Background," n.d.). After combat, Darwin became overwhelmed with the trauma of war, especially riddled with guilt over the fact that his decisions sometimes resulted in others' death ("Background," n.d.). Ultimately, this experience was incredibly traumatic and changed the course of Darwin's life. 

Due to the fact that PTSD often causes an intense feeling of hopelessness, trauma victims often use destruction as a way to feel a sense of power ("Background," n.d.). Darwin recounts these kinds of experiences with others, almost murdering a young woman over an argument about a pen ("Background," n.d.). Darwin clearly has immense feelings of guilt form these early encounters after the war. 

Trying to forget his pain, Darwin attended school to get his Master's in economics ("Background," n.d.). He describes a feeling of darkness and nightmares about his experience, and that he was losing touch with reality ("Background," n.d.). Still, he continued to seek out a normal life; serving on a board of directors for a school and getting married ("Background," n.d.). However, he couldn’t shake the trauma and describes falling apart before the age of 60 ("Background," n.d.). He was arrested for a DUI and reported troubles at work and feeling of wanting to kill the people around him ("Background," n.d.). Though he is able to discuss his trauma, it is clear the events from the war still deeply impact his life today. 

 Answer 2: Darwin shows clear signs of PTSD as his presenting problem when examining his interviews. He often describes feelings of bleakness and hopelessness and seems to see the outside world as a threat. Cognitively, he lacks to ability to accurately and realistically comprehend how to handle a difficult situation. Further, he lacks the ability to cope with his feelings of powerlessness. 

This powerlessness is likely why he feels so angry and can become enraged even at the slightest problem. He is essentially re-traumatized when a triggering situation happens and acts aggressively in response to recollections of his experience in Vietnam. He seems to lack almost complete and utter control of this aggressiveness, particularly at the moment. It appears to take great strength and willpower for him to walk away from the situations that make him angry. 

He also experiences cognitive dissociation, likely as a means of avoidance. The dark feelings are so overwhelming for him that his brain literally shuts off and refuses to deal with the reality of his trauma. It is also evident that Darwin feels an overwhelming sense of guilt and remorse, internalizing the responsibility for others who were wounded or killed under his command. These cognitive distortions did not allow him to effectively understand his experiences. 

These feelings caused Darwin to become self-destructive, getting arrested for a DUI and in general having trouble creating healthy behaviors. His recklessness came in many forms and was likely a result of his constant irritability. Whether in his social interactions or experience with isolating himself, Darwin clearly has trouble balancing a normal life with his traumatic experience.

 Answer 3: Darwin presents clear signs that he is suffering from PTSD when examining his symptoms and comparing them to the criteria from the DSM-5. In combat, Darwin was exposed to senseless violence and was responsible for the death of other men. This fits into Criterion A which is coded as a stressor, which includes exposure to death (BrainLine Military, n.d.). Next, Darwin reports having intrusive thoughts of his time in Vietnam as well as dissociation and nightmares. These all fall into the second category of Criterion B notated as intrusion symptoms (BrainLine Military, n.d.).

Darwin also reports certain day-to-day events and interactions reminding him of his traumatic experience in Vietnam. When he feels a reminder of his combat days, he attempts to avoid these feelings so as not to bring up the thoughts from his experience. The DSM-5 categorizes this under Criterion C, known as avoidance (BrainLine Military, n.d.). 

Further, Darwin describes an inability to feel happy or positive a large portion of the time - something that has changed his overall personality. He complains that this inability came only after his experience in Vietnam. Coupled with his reported feeling so alienation and that he is somehow inherently bad because of his experiences fall into the category of Criterion D, which deals with negative moods (BrainLine Military, n.d.). 

His behavior is at times aggressive; he recalls almost killing a woman over an argument about a pen. The DSM-V describes this as reactivity, under Criterion E ("Brainline, n.d.). His symptoms have lasted for years, which expands much beyond the one month period the DSM requires (BrainLine Military, n.d.). This has caused what the DSM refers to as functional significance, under Criterion G which describes prolonged distress. Further, these symptoms can be excluded as the cause of his other life experiences, Criterion H in the DSM (BrainLine Military, n.d.). Darwin would best benefit from a treatment that combines therapy with prescription medication under the watch of a doctor.

References

Background (n.d.). [Mp4 Recording]

BrainLine Military. (n.d.). DSM-5 criteria for PTSD. Retrieved from http://brainlinemilitary.org/content/2014/06/dsm-v-tr-criteria-for-ptsd.html