Posttraumatic Stress Disorder- Buck O'Brian



Dr.: Lena Lange-Kram

Client: Buck O’Brian
Age: 36

Differential Diagnosis:
-Acute Stress Disorder- Ruled out; Symptomatic for longer than a month.
-Posttraumatic Stress Disorder- Ruled in; Symptomatic for more than a month.

Primary Diagnostic Features:
-Exposed to a traumatic event.
-Persistent re-experiencing of the event which interferes with the person’s ability to function.
-Duration of one month or longer.

Multi-Axial Diagnosis:

Axis I: Post-traumatic Stress Disorder

Axis II: None

Axis III: Severe Burns over half of his body

Axis IV: Fireman injured on the job

Axis V: GAF = 58

Theoretical Perspectives:

Behavioral Perspective:
The client demonstrates two faulty learning experiences. The client’s symptoms may be a result of classical conditioning. He may have developed a fear response to stimuli present in the traumatic event. This could explain why the client has anxiety symptoms when returning to the fire station and hearing the alarm. The client may also be operantly conditioned. He is avoiding stimuli that causes him anxiety and distress, thus negatively reinforcing his avoidant behavior.

Cognitive Perspective:
The client’s symptoms could be due to his negative beliefs about the traumatic event and his role in it. The client expresses belief of guilt, shame and blames himself for what happened. The client expresses a perceived internal threat that the incident was his fault and he should have known better to follow protocol. He now believes that his co-workers will not want to work with him because he made a mistake.

Biological Perspective:
The client’s symptoms could be due to his nervous system being primed or hypersensitive to potential stressors, similar to the traumatic event he experienced. The client could have low levels of GABA (inhibitory neurotransmitter) or increased levels of norepinephrine (excitatory neurotransmitter), both have been found in individuals exposed to traumatic events. The client could also have abnormalities in serotonin pathways. In addition the client may have brain structure abnormalities in the hippocampus. Hippocampus atrophy has been found in individuals with PTSD.

Sociocultural Perspective:
The client’s symptoms are the result of his working as a firefighter. This work related trauma has led to the development of numerous trauma related symptoms.

Source: Youtube