Case of Nico

Mary Vanaja, MA

BASIC INFORMATION OF THE CASE

What are the identifiable information of the subject?

NATURE OF THE CASE

What are the presenting problems?
What are the symptoms present?
Don’t forget: how long? How frequent? How recurring?

DIAGNOSIS
What is the diagnosis per DSM 5? Please mention ALL that can be applied.
Please be mindful of the codes. See pdf document inside the “References” folder
(file name: Tips in Coding per DSM 5)
Please be mindful if there are MEDICAL disorders/diseases present.

CAUSES
What are the “possible” causes as stated in the case and/or as informed by your
knowledge in psychology.
*Do note that you have to use your knowledge in Developmental Psych, Theories
of Personality, Gen Psych, Biological Psych in the process of conceptualizing

TREATMENT
What are the treatment programs/activities mentioned?
If none, based on your existing knowledge, what are the “possible” treatment
options?
How effective? Possible limitations?
Be realistic, not too theoretical
Do note that you can maximize desk research in here. For 3rd year students, you
can use your knowledge in Counseling and Psychotherapy; and Psychological
Assessment.

(START)
Nico is a twenty-seven-year old, single male. He is currently unemployed, living with
both parents and younger sister. During the time of the interview, his answers were short
and limited. At times, he mumbled his response quietly. He recounted his experiences with
a blank expression and flat affect, saying that it is difficult for him to express his emotions.

Before the Gloom

Growing up, Nico described both parents as being preoccupied with their respective
careers. They usually spent most of their time at work and left Nico and his younger sister
in the care of their nanny. When Nico was two years old, his mother had to work abroad
and stayed overseas for one year. However, when she went back to the Philippines, her
job required her frequent out-of-the-country business trips. Because of this, she was
physically absent for the most part of Nico's childhood until Nico was seven years old.

Being left in the constant care of their nanny, Nico and his sister experienced physical
maltreatment. Furthermore, their nanny also threatened them and warned them not to
complain to their parents. After two years of receiving this abusive treatment, they
eventually told their mother about it. As soon as their mother learned of this ongoing
maltreatment, she immediately dismissed the nanny. Having turned over a new leaf, their
nanny eventually returned to them later on and has been with the family up to the present.
Despite this negative experience, Nico reminisced that his early childhood was generally
happy, filled with positive memories. He shared that his fond memories of preschool were
that of, "playing in the swing and the Family Day wherein we had a sleep over and games
for families."

However, the tides changed when Nico entered grade school. He attended one of the
most prestigious exclusive schools from grade school until high school. During grade
school, he experienced being bullied by his classmates. He was mostly subjected to verbal
abuse—teasing and mocking. His classmates made fun of him. Due to this hostile
treatment from his peers, he felt unmotivated to go to school. According to Nico, "I didn't
look forward to going to school, and it was very difficult. I was bullied from Grade One to
Seven by several classmates. They taunted me about my middle name." When his mother
learned of the bullying situation, she brought the issue to the attention of school
authorities. As a consequence, the bullying incidents decreased. One reason that made him
vulnerable to being bullied at the time was that he had very few friends. Nico said that he
thinks his peers do not want to be friends with him because he was an average student .
Academically, Nico perceived himself to be an underachiever. He mentioned that he often
received verbal reprimands from his parents when he was not able to perform well in
school. His dream at the time was to be successful like his father. However, he found
himself short of achieving this due to his average academic performance. Nico then felt
the stress of dealing with both academic pressure and issues related to peers. He also
struggled with harboring the idea that he failed in meeting his parents' and his own
expectations.
Things started to look up when Nico entered high school. Even though the bullying did
not stop, he learned to deal with the situation by immediately reporting these incidents to
the administration. He also became more focused in his studies, which resulted in improved
grades. Nico recounted, "My academic achievement in high school made my parents very
proud." Aside from this, his social life also improved significantly as he established
meaningful friendships and made fond memories. He shared that, "I had more friends and
fun times, like sleeping over at my friend's place or at other times friends came over to my
place." Overall, Nico's high school was filled with a sense of achievement, competence, and
belongingness.

The Impending Gloom

Due to Nico's diligence and achievements in high school, he was able to enter a
prominent university. His general view of college life was that it was a routine. He said
that he devoted much of his focus, effort, and time with his studies. At home, Nico said
that the family atmosphere was stressful because his parents often fought and had
arguments. Although closer to his mother, he and his sister usually took their father's side.
He described his mother as lenient, yet imposing. However, Nico said that he preferred his
father's parenting style because he seemed to be more understanding, despite being a strict
disciplinarian.

In college, Nico also often dreamed of being in a romantic relationship. During his
sophomore year, he felt smitten towards a girl. At the time, his friends discouraged him
from pursuing her. After receiving rejection from the girl, his friends backstabbed him by
saying he would not be able to move on with his life. Nico contradicted his friends'
accusations and shared that in reality, he really wanted to move on and recover from his
heartbreak. However, the process of overcoming the romantic rejection was hindered by
constant thoughts about the her as he found it difficult to forget about her. As Nico was
trying to recover, his mother started to notice unusual behaviors that have affected his
physical, emotional, and cognitive functioning. She described that he started losing weight,
being in a depressed mood, and having difficulty focusing on his studies. Eventually, these
difficulties took a toll on his academics and he failed one of his major subjects. He also
behaved in ways that were contrary to his personality, such as being too talkative and being
overly sociable with others, despite his quiet nature. His mother was then worried because
she sensed that he was not himself anymore.
It was also at this time when Nico started engaging in suicidal behaviors. At the
beginning, he found himself doing risky behaviors, such as driving very fast. Later on, he
said that when he felt overwhelmed with problems, he threatened to throw himself from the
8th floor balcony of their condominium. There was also a similar incident in school where
he attempted to jump off from an overpass. Fortunately, the suicide attempt was prevented
and the school administrators notified his parents of the incident. Nico's parents then
became concerned about his repeated suicide ideations and attempts. This event prompted
his family to address his issues by referring him to professional help. His psychiatrist then
diagnosed him with bipolar disorder, and as he underwent pharmacological and
psychological treatment, he took a one year leave from school.

It is important to note that Nico's mother has also been dealing with a psychological
condition, the diagnosis of which was not disclosed. She regularly takes medication in order
to manage the symptoms of her condition. She manifests symptoms similar to depression
and also revealed that a mood disorder runs in the family. Having her own struggles with
depressive symptoms, she was able to recognize the changes in Nico's behavior as he was
going through his own emotional issues.

In the Middle of the Storm

When Nico began with therapy, one of his immediate concerns was to normalize his
physiological processes, especially his eating pattern. He said, "I am putting on weight
because of my irregular eating habit, especially when I am sad." He wanted to get back in
shape because he thinks that it will motivate him to work towards the other goals that he has
set for himself. He was afraid that if he gains weight, it might bring his motivation down. In
this regard, his family supported him by encouraging and monitoring his diet.
In terms of his emotions, Nico expressed that he had difficulty controlling his anger.
When his anger is triggered, he would try to keep quiet and inhibit himself from reacting.
However, there were times when he was unable to control his anger. During these moments,
he would have an outburst, characterized by shouting intensely towards the person who
triggered his anger. Upon later reflection, he said that his difficulty dealing with anger
mirrors the way that his mother expresses her anger. His mother's harsh manner of
discipline can be described as driven by anger, such that she usually shouted at them for
making a mistake.

Nico also described being constantly hounded by painful thoughts and feelings. He
said that he dealt with this internal experience in different, yet contrasting ways. One way
was through immersing himself in his internal world. He said that he had the tendency to
ruminate and soak in these negative thoughts and feelings. When the experience became
intolerable, he tried to cope by distracting himself through unhealthy activities. Another
way was through detaching himself from his internal world. When confronted with
overwhelming emotional stress, Nico shared that he would "disconnect" from reality for a
time. He would then live in a different world that is not cluttered with unbearable thoughts,
feelings, and painful memories.

Nico's tendency to disconnect from reality also extended to his social world. He chose
to isolate himself from friends and former classmates, in order to avoid questions like:
"What have you been doing?" Having to answer these questions triggered thoughts that he
turned out to be a failure and that he was not able to achieve his dream of having a
successful life. Nico also added that he avoided social situations because he considered
himself unworthy of his friends' and loved ones’ attention and time . He acknowledged that
he is detached and that he does not feel "normal." He knew that he was distant from the
reality of many people, as he spent most days in his room. Similarly, his mother dealt with
her own emotional struggles by spending most of her time sleeping and watching TV. Each
member of their family also tended to have independent lives, as each of them exists in
isolation, despite being under one roof. In general, Nico exhibited an awareness of his
emotional experience. However, he felt at a lost on how to deal with these internal struggles
and issues.

The Aftermath

After taking a one year leave from school, Nico was able to return to school, finish his
senior year requirements, and graduate. Since graduating from college, Nico had worked in
three different companies, where he stayed within a range of ten months to two years. He
said that he felt compelled to resign from his job due to varying reasons.
Nico reminisced that he loved the first company where he worked for. Through that
work experience, he was sent to another country for training. Despite the positive
experience from that work place, he felt that, "I couldn't catch up with my companions. I
was lagging behind and didn't want to ask for help every now and then. They would think I
am stupid. So I thought the best option is to resign. When I think of it, I feel like a failure"
In his next employment, he initially enjoyed it and was able to perform his assignments
competently. His sense of accomplishment suddenly ended when he shouted at a client
during a professional transaction. The incident reinforced in him that he had poor
interpersonal skills and therefore, he was not competent enough to handle public relations,
Both the incident and his realization about his limitation forced him to resign from this job.
In his third job, Nico was expected to contribute in events management. He found it
difficult to satisfy the demands of the job because the tasks required creativity, which he
believes his not his strongest suit. Eventually, he became dissatisfied with the condition and
pressure from his job. This in turn, made him decide to quit.
At present, Nico has been unemployed for more than a year. When he looks back on
these experiences, he relives a sense of being a failure being inadequate, and of being
helpless. He also added that he feels sad for the way that his life has turned out. These
negative thoughts and frustrations about himself serve as triggers that fuel intense feelings of
sadness. He has mentioned being led deeper into depression, such that-he has stopped
seeking employment, spent most of his time in his room, and became withdrawn into his
own world. He fervently hopes to get his usual self and life back, as he went back to his
psychiatrist for consultation and treatment.