SOWK 431 Week 4 Case Study 2 Example

Case Study 2: Posttraumatic Stress Disorder in an Army Veteran Back in School, Criteria, Differential and a Trauma-Focused Plan

Introduction

Danielle Ortiz, a composite 31-year-old Army veteran, always takes the seat nearest the classroom door in her nursing prerequisites. She came to the community college's veterans resource center after failing an anatomy exam she had studied for, telling the social worker she could not remember anything she read. This paper tests Danielle's history against the DSM-5 criteria for posttraumatic stress disorder (PTSD), considers other explanations, weighs her risks and strengths as Corcoran and Walsh (2014) recommend and lays out a plan.

Case Summary

In 2019, Danielle deployed to Afghanistan as a motor transport operator. Four months into the deployment, a roadside bomb struck the vehicle ahead of hers, killing her close friend and wounding two others. Danielle helped pull the wounded from the vehicle. She completed her enlistment and separated in 2021. She now lives with her husband and their six-year-old son, holds a part-time pharmacy job while attending college on the GI Bill. She reports nightmares about the explosion several times a week, startles at loud noises and avoids driving on the interstate. She drinks three or four beers most evenings to fall asleep.

DSM-5 Diagnosis

Danielle's experience meets each DSM-5 criterion for PTSD (American Psychiatric Association, 2013). She witnessed the violent death of a friend and serious injury to others, satisfying the exposure criterion. Intrusion symptoms include recurrent nightmares and intense distress when she smells diesel fuel. She avoids interstate driving and conversations about her deployment. Negative alterations in cognition and mood include persistent guilt, since she believes she should have spotted the device, and detachment from her husband. Arousal symptoms include hypervigilance, an exaggerated startle response, irritability and poor concentration. Symptoms have lasted well over a month and are harming her schoolwork and marriage. The diagnosis is posttraumatic stress disorder.

Differential Diagnosis

Acute stress disorder is excluded because Danielle's symptoms have persisted for years rather than less than a month. Major depressive disorder often co-occurs with PTSD, and her detachment and poor concentration overlap with it, but she reports enjoying time with her son and denies pervasive low mood or worthlessness; depression should be monitored. Her evening drinking requires careful assessment for alcohol use disorder, since many veterans use alcohol to manage sleep and arousal. Traumatic brain injury can also cause concentration problems, so the social worker should ask about blast exposure and refer her for screening through the VA.

Risk and Protective Factors

Biological risks include chronic sleep disruption and nightly alcohol use. Psychological risks include self-blame, which can maintain PTSD by keeping the trauma tied to her sense of worth. Social risks include the strain on her marriage and the isolation of being an older student among teenagers. Protective factors include a supportive husband, a strong bond with her son, steady employment and eligibility for VA health care.

Considerations as a Woman Veteran

Women veterans sometimes feel overlooked in settings designed mainly around men, and some hesitate to describe their service as combat even when it was. Danielle has said that people assume her husband is the veteran. The social worker should affirm her combat experience directly, connect her with women veterans' programs if she wants peer support and follow the VA's practice of asking every veteran about military sexual trauma, since that experience, if present, would shape treatment. Her Mexican American family's views on mental health should also be explored rather than assumed.

Strengths

Danielle completed her enlistment under hard conditions and acted with courage on the day of the attack. She is goal-directed, having chosen nursing because of her experience caring for the wounded. She sought help on her own, which shows insight and motivation. Her faith, though shaken, remains important to her.

Intervention Plan

The American Psychological Association (2017) guideline gives its strongest recommendation for adults with PTSD to four psychotherapies: prolonged exposure, cognitive processing therapy, cognitive therapy and general cognitive behavioral therapy. Schnurr et al. (2022) compared prolonged exposure and cognitive processing therapy in a large randomized trial at VA medical centers and found that both produced meaningful reductions in PTSD symptoms, with prolonged exposure showing a slightly greater average improvement that the authors considered small. Because cognitive processing therapy works directly on beliefs such as self-blame, it may suit Danielle's guilt well, though either therapy is a sound choice and her preference should guide the decision. The plan includes referral to the local VA or Vet Center for trauma-focused therapy, an assessment of her alcohol use with motivational interviewing, TBI screening, a disability services referral for testing accommodations and an invitation for her husband to join a family education session.

The Social Worker's Role

The college social worker serves as a bridge, helping Danielle work through VA enrollment, coordinating accommodations with the disability office and checking in regularly while she waits for therapy to begin. Corcoran and Walsh (2014) emphasize building on resilience, so the worker can help Danielle see her courage and her career goal as resources for recovery, not only her symptoms as problems.

Biblical Reflection

Psalm 34:18 says the Lord stays close to people whose hearts are broken and rescues those whose spirits are crushed (English Standard Version Bible, 2001/2016). For a veteran carrying guilt over a friend's death, that promise offers comfort that does not depend on her having done everything right. If Danielle wishes, a chaplain or pastor could join her support team.

Conclusion

Danielle meets the criteria for PTSD, with possible co-occurring alcohol misuse to assess. Trauma-focused therapy, attention to her drinking and brain injury screening, academic accommodations and family support offer a strong path forward. The social worker should review her progress monthly through the end of the semester.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline

Corcoran, J., & Walsh, J. (2014). Mental health in social work: A casebook on diagnosis and strengths-based assessment (2nd ed.). Pearson.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Schnurr, P. P., Chard, K. M., Ruzek, J. I., Chow, B. K., Resick, P. A., Foa, E. B., Marx, B. P., Friedman, M. J., Bovin, M. J., Caudle, K. L., Castillo, D., Curry, K. T., Hollifield, M., Huang, G. D., Chee, C. L., Astin, M. C., Dickstein, B., Renner, K., Clancy, C. P., . . . Shih, M.-C. (2022). Comparison of prolonged exposure vs cognitive processing therapy for treatment of posttraumatic stress disorder among US veterans: A randomized clinical trial. JAMA Network Open, 5(1), Article e2136921. https://doi.org/10.1001/jamanetworkopen.2021.36921