Introduction
Valeria Hernandez, a 33-year-old single Hispanic female, is experiencing persistent low mood and avoidance of social interactions. She has been feeling depressed for at least a year, which is causing significant distress and impairment in her daily functioning. Her main complaints are feelings of hopelessness, worthlessness, and emptiness. She has lost interest in activities that she used to enjoy, such as spending time with friends and family, and has a decreased appetite, leading to weight gain. Valeria is also having trouble sleeping, waking up in the middle of the night, and having difficulty falling back asleep.
Brief History
Valeria was born in Hanover, New Hampshire, in 1988 and had an expected delivery via Cesarean section. After one month of maternity leave, her grandmother took over her regular care, which continued until she started preschool. When she was five years old, her parents divorced, and her mother was awarded custody. Valeria saw her father only once or twice a year during childhood, but lost contact until three years ago when he shared that he had weeks to live due to cancer.
Overview of Symptoms
Valeria has been struggling with emotions of worthlessness and despondency, and emptiness for at least a year. She has lost interest in activities she once enjoyed and has a decreased appetite, resulting in weight gain. Valeria is also experiencing insomnia, waking up in the middle of the night, and difficulty falling back asleep.
Valeria’s symptoms are consistent with Major Depressive Disorder (MDD), based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Valeria has been experiencing a persistent low mood and a lack of enthusiasm or enjoyment in activities for at least two weeks. Her symptoms cannot be attributed to a substance or medical condition.
DSM-5 Diagnosis and Rationale
Major Depressive Disorder, single episode, moderate, F32.1. Valeria meets the diagnostic criteria for MDD because she has been experiencing a persistent low mood and a lack of interest or pleasure in activities for at least two weeks. She also expresses sentiments of worthlessness, emptiness, and pessimism. Her symptoms are seriously impairing her daily functioning and causing her great distress.
Possible Other Diagnoses for Consideration
Valeria’s symptoms could also be consistent with Persistent Depressive Disorder (PDD), previously known as Dysthymia. However, PDD requires the presence of symptoms for at least two years, which is not the case for Valeria. Her symptoms could also be due to an adjustment disorder, given the significant changes in her life, such as her father’s illness and subsequent death. Still, her symptoms have persisted beyond what would be expected for an adjustment disorder.
Recommended Interventions
Based on the diagnostic formulation, Valeria would benefit from a combination of pharmacotherapy and psychotherapy. Antidepressant medication, such as a selective serotonin reuptake inhibitor (SSRI), should be considered to help alleviate her symptoms of depression. Psychotherapy, such as cognitive-behavioral therapy (CBT), could help address her negative thoughts, feelings of hopelessness and worthlessness, and social withdrawal behaviors. Valeria may benefit from lifestyle modifications in addition to medication and psychotherapy.
Lifestyle Changes
Making lifestyle changes such as exercise, diet, and sleep can also help treat depression and anxiety. Exercise is an effective treatment for depression and anxiety, as it increases the levels of chemicals in the brain that regulate mood. A healthy diet can also improve mood and reduce symptoms of depression and anxiety. Valeria may benefit from consulting a nutritionist to develop a personalized healthy eating plan. Ensuring that she gets enough sleep is also essential, as sleep deprivation can contribute to feelings of depression and anxiety.
Spirituality
Given Valeria’s strong commitment to her Roman Catholic faith, incorporating spirituality into her treatment could be an essential aspect of her recovery. This could involve working with a therapist who understands and respects her religious beliefs and who can incorporate these beliefs into her treatment plan. For instance, the therapist could work with Valeria to develop coping strategies consistent with her faith. This could include establishing a daily prayer or meditation practice, seeking spiritual guidance or support from a trusted religious leader, or engaging in volunteer work that aligns with her values and beliefs.
It is also worth noting that while faith may be an essential aspect of her recovery, it is equally important to recognize that spirituality is not a substitute for evidence-based treatment. While Valeria’s faith may provide her with comfort and guidance, it is also essential that she receives appropriate medical and psychological care.
Mindfulness-Based Interventions
Mindfulness-based interventions can be a recommended intervention for Valeria. Mindfulness is a state of awareness in which an individual actively monitors their thoughts, feelings, and physical sensations in a non-judgmental manner. Mindfulness-based interventions teach individuals how to pay attention to the present moment, free from distractions by past or future events. It has been demonstrated that mindfulness can effectively lessen the signs of stress, despair, and anxiety.
Since Valeria is experiencing anxiety and stress brought on by insecurities about her vocational future and everyday decision-making, mindfulness-based interventions can help her reduce her stress and anxiety by increasing her awareness of the present moment. Mindfulness can help Valeria to focus on what she can control in the present moment rather than worrying about the future. She can be taught to practice mindfulness through exercises like deep breathing, meditation, and yoga. It can also help Valeria to become more self-aware and develop a more positive relationship with herself. Mindfulness can help her accept her thoughts and emotions without judgment, which can reduce negative self-talk and self-criticism.
Support Groups
Support groups can be an effective intervention to address her presenting problems. Support groups offer a safe space for individuals to share their experiences, thoughts, and feelings with others who are facing similar challenges. In support groups, participants can receive emotional support, practical advice, and encouragement to help them cope with their difficulties. These groups can help people feel less alone and isolated in their struggles, providing a sense of belonging and connection.
Valeria can benefit from joining a support group for individuals who are experiencing stress and anxiety. In these groups, she can share her concerns and receive emotional support from others who are also struggling with similar issues. She can learn coping strategies and practical advice from others in the group. By hearing others’ stories, she can realize that she is not alone in her struggles, which can help her feel more supported and understood.
These groups can provide a space for her to share her experiences and feelings with others who have gone through similar struggles. She can learn from others’ experiences and get practical advice on managing her symptoms. Additionally, these groups can provide her with a sense of optimism and hope for the future, helping her continue her treatment.
Art Therapy
Through art therapy, Valeria can explore her emotions and work through past traumas, such as the loss of her grandparents, strained relationships with family members, and her experience with acute peritonitis. Art therapy can also help her gain insight into her insecurities about her appearance and weight gain, which may be contributing to her avoidance of romantic and sexual relationships. By creating art, Valeria can express herself nonverbally, which can be helpful for those who struggle to articulate their feelings verbally.
Art therapy can also provide Valeria with a sense of accomplishment and help improve her self-esteem. As a diligent student who graduated from Dartmouth College and is now pursuing a doctoral program at the University of Michigan, Valeria may benefit from using her intellectual and creative abilities in new ways. Creating art can provide her with a new challenge and a sense of achievement, helping her feel more positive about herself and her abilities.
Cognitive-Behavioral Therapy
Another potential intervention for Valeria is cognitive-behavioral therapy (CBT). CBT is a type of cognitive behavioral therapy that aims to alter harmful thought patterns and behaviors contributing to anxiety and depression (Curtiss et al., 2021). CBT is a treatment for a broad spectrum of mental health issues, including anxiety disorders and depression.
Interpersonal Therapy
In addition to CBT, interpersonal therapy (IPT) may also be a valuable intervention for Valeria. The goal of IPT is to improve interpersonal connections and communication abilities. IPT can be particularly effective for individuals struggling with social anxiety or struggling to form and maintain meaningful relationships.
Pharmacological Treatment
Finally, medication may also be an essential part of Valeria’s treatment plan. Although medication should never be the only treatment used for anxiety and depression, it can effectively manage symptoms and improve overall functioning. A psychiatrist or other mental health professional can work with Valeria to determine whether medication is appropriate and, if so, what type of medication may be most effective.
Conclusion
In conclusion, Valeria Hernandez is experiencing symptoms associated with Major Depressive Disorder, and a combination of pharmacotherapy, psychotherapy, lifestyle changes, mindfulness-based interventions, and support groups can help alleviate her symptoms. Given Valeria’s religious beliefs, incorporating spirituality into her treatment plan is also recommended. It is essential to acknowledge that while faith may provide solace and direction, it is not a substitute for evidence-based treatment and care.
Valeria’s history of significant life changes, such as her father’s illness and death, highlights the importance of addressing potential adjustment disorders in individuals experiencing depressive symptoms. By implementing a comprehensive treatment plan tailored to her individual needs, Valeria can regain her sense of well-being and enhance her daily functioning. It is crucial to understand that each individual’s treatment plan should be tailored to their unique circumstances, and regular evaluation of treatment effectiveness is essential. With the proper care and support, Valeria can recover from her depressive symptoms and improve her overall quality of life.
Reference
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184-189.
