Case+Study+Examples

Mark, a 22 year old boy was awaiting trial for car theft and armed robbery. His case records included a long history of arrests beginning at age 9, when he had been picked up for vandalism. He had been expelled from high school for truancy and disruptive behaviour. On a number of occasions he had run away from home for days or weeks at a time – always returning in a dishevelled and "rundown" condition. To date he had not held a job for more than a few days at a time, even though his generally charming manner enabled him to obtain work readily. He was described as a loner with few friends. Although initially charming, Mark usually soon antagonized those he met with his aggressive, self-oriented behaviour. Shortly after his first therapy session, he skipped bail and presumably left town to avoid his trial.
 * CASE STUDY EXAMPLES **
 * Case study A **


 * Case Study B **

A 19-year old youth sporting a punk-style haircut and T-shirt with "Twisted Sister" written across the front was brought, by ambulance, at midnight to a hospital emergency room. He was accompanied by a 23-year-old male friend who called the ambulance because he was afraid his companion "was going to die like that basketball player who died from a cocaine overdose).

The patient was agitated and argumentative, his breathing was irregular and rapid, his pulse was rapid, and his pupils were dilated. Reluctantly, the patient's friend admitted they used a lot of cocaine that evening.

By the time the patient's mother arrived, his condition had improved somewhat, although he created a commotion in the emergency room with his loud singing and gesticulations. The mother, looking dishevelled and smelling of alcohol, was distraught and tearful. She told a disorganized story about her son's problems at home: he was disobedient and resentful of authority, unwilling to take part in family activities, and violently argumentative when confronted about his carrying on and partying at all hours of the night. She reported that he had been arrested twice for shoplifting and once for drinking while intoxicated and that he spent almost all of his time with an older crowd. "They drag race a lot and hang out in the streets," she said.

Divorced for almost 15 years, the mother admitted that not having a stable father figure in the household made disciplining quite difficult. She suspected that her son used drugs because she had heard him talk to his friends about drugs, but she did not have any direct evidence. She claimed that her son was not all bad, that he was a fairly good student and even a star member of the basketball team. (In fact, the son was quite successful in deceiving his nonvigilant mother into believing that. Actually, the patient never completed high school, had poor or failing grades, and never played on the school's basketball team.) When asked about her own drinking habits, the mother became defensive and claimed she drank only occasionally and in small amounts.

Within 24 hours the patient was physically well and quite willing to talk. He stated, almost boastfully, that he had been using alcohol and other drugs regularly since age 13. He told of repeated instances in which he and his friends had each consumed an entire case of beer in a day ("I can drink a lot before I feel anything. We call ourselves the 'Andre the Giant Club'.") in addition to using other drugs. These drug orgies had often included a dangerous game called "hurricane drug racing," in which intoxicated contestants engaged in drug racing on side roads until somebody "chickens out" to avoid an oncoming car. During this heavy drug use, it was common for him to skip school because of the drug activity; when he had to be in school, he typically was intoxicated. To help support his drug involvment, he had devised various schemes for acquiring money, such as "borrowing" money from friends that would never be repaid or stealing car radios from the student parking lot, plus blatant stealing of money from his mother. This behaviour was justified by a "Robin Hood" attitude: "I take from people who have a lot of money anyway."

Despite the patient's admission of heavy drug involvement, he stopped short of admitting that he had a real problem. In response to a question about his ability to control drug use, he replied in a hostile manner, "Of course I could. No problem. I just don't see any damn good reason to stop."

Somewhat fidgety and restless, the patient said he was finished with the interview. Before the interviewer had the opportunity to press him further about seeking treatment, the patient began to roam around the hospital unit, looking for someone who had an extra cigarette. (From DSM-IV-TR Casebook)

Sarah Mackin