what is the etiology and treatment of sexual disorders?

Assignment 2: LASA: Etiology and TreatmentIn M3 Assignment 2 RA, you reviewed a case study about Jessica, made primary and secondary diagnoses, and identified differential diagnoses for each principal and secondary diagnosis. The skills you developed and the feedback you received after completing this required assignment, will significantly help you in completing the following LASA. For example, both assignments (RA and LASA), require you to complete similar tasks such as identifying the principal and secondary diagnoses, providing rationale for the diagnoses, and offering differential (alternative) diagnoses.In this assignment, you will discuss the etiology and treatment of your principal and secondary diagnoses for the following case study using a minimum of five peer-reviewed sources on etiology and a minimum of five peer-reviewed sources on treatment. Your paper should have separate sections for the etiology of each principal and secondary diagnosis, therapeutic modalities for each principal and secondary diagnosis, justification of the selected therapeutic modalities for the disorders, application of the treatment for the disorders, and a reference page for your sources. Your citations and references should be in APA style, and your paper should be 8â??10 pages in length.Click here to read the second case study (Psychological Evaluation for Homer Brine).Once you read the case, complete the following tasks:
Identify a principal and secondary diagnosis for the assigned case study with rationale for each diagnosis.
Describe multiple elements of the etiology for the principal and secondary diagnoses. Explain how the etiology contributed to each (principal and secondary) diagnosis.
Identify a specific therapeutic modality for each principal and secondary diagnosis.
Apply therapeutic modality to treat each of the principal and secondary diagnoses in the case study.
Identify at least one differential (alternate) diagnosis for the principal and secondary diagnoses.
Discuss key cultural factors that may influence diagnosis and treatment.
Write in a clear, concise, and organized manner; demonstrate ethical scholarship in accurate representation and attribution of sources; and display accurate spelling, grammar, and punctuation. Include citations in text and at the end of the document in the correct APA format.Submission Details:
By the due date assigned, save your diagnoses as M5_A2_Lastname_Firstname.doc and submit the document to the Submissions Area.
LASA is worth 300 points and will be graded according to the following rubric.Because this assignment is worth 30% of your overall grade in the course, it is particularly important to view the rubric for additional clarity on the requirements and point values for each component of the assignment.

Assignment Component

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Maximum Points

Identify a principal and secondary diagnosis for the assigned case study with rationale for each diagnosis.
Identifies at least one principal and one secondary diagnosis that are rationally linked to the case provided. Provides detailed information about how diagnoses were reached and how the clientâ??s symptoms fit the diagnostic criteria. Evidence is presented in a logical manner that builds a solid case which supports diagnostic impressions.


Describe multiple elements of the etiology for the principal and secondary diagnoses. Explain how the etiology contributed to each (principal & secondary) diagnosis.
Presents a clear understanding of the possible origins of the principal and secondary diagnoses. Demonstrates ability to integrate and conceptualize all of the information presented. Clearly states how the diagnoses/ presenting issue began (ETIOLOGY) and what may be maintaining them.


Identify a specific therapeutic modality for each principal and secondary diagnoses.
Chooses a viable therapeutic modality that has applications to the principal and secondary diagnoses and is appropriate for the client.


Apply therapeutic modality to treat each of the principal and secondary diagnoses in the case study.
Demonstrates a clear application of the selected therapeutic modality for treatment of the principal and secondary diagnoses of the person in the vignette.


Identify at least one differential (alternate) diagnosis for the primary and secondary diagnosis.
Clearly discusses other diagnoses (differential diagnoses) that were ruled-out as well as specific reasons for eliminating these diagnoses.


Discussed key cultural factors that may influence diagnosis and treatment.
Describes cultural factors that may influence the diagnoses and identifies cultural issues that may require additional exploration. Outlines how the cultural factors influence treatment options.


Academic Writing

Writing is generally clear and in an organized manner. It demonstrates ethical scholarship in accurate representation and attribution of sources; and generally displays accurate spelling, grammar, punctuation. Errors are few, isolated, and do not interfere with readerâ??s comprehension. Citations in text and at the end of the document are in correct APA format.
Writing is generally clear and in an organized manner. It demonstrates ethical scholarship in accurate representation and attribution of sources; and generally displays accurate spelling, grammar, punctuation. Errors are few, isolated, and do not interfere with readerâ??s comprehension. Citations in text and at the end of the document are in correct APA format.



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Psychological Evaluation
Confidential: For Professional Use Only
Date of Birth:
Date of Evaluation:
Homer Brine
A. Adler, PhD
Reason for Referral
Brine was referred by the Division of Family Services for a psychological evaluation to assess his current
level of cognitive, behavioral, and emotional functioning and to provide recommendations for outpatient
mental health services and family reunification.
Background History
The following background information was obtained from an interview with Brine and a review of available
Brine is a forty-three-year-old Caucasian male who was referred for a psychological evaluation by the
Division of Family Services to assist with providing recommendations for outpatient mental health services
and family reunification. He became involved with the Division of Family Services after he was arrested for
sexually abusing his daughter. Brine was informed that the results of the evaluation would be utilized to
develop opinions and conclusions regarding the likelihood that he would revictimize his daughter. In
addition, he was told that the report or the examiner might appear at his court proceedings to give evidence
regarding his past, present, or potential future mental state. Brine chose to participate in the evaluation
recognizing the nature of the evaluation and its purpose.
Brine was born in York County, Pennsylvania, in a rural farming community near the Maryland state line. He
was the older of two children raised in a â??traditional Christian home.â?? When Brine was a young boy, his
family moved to Wheeling, West Virginia, due to his fatherâ??s employment with a mining company. Brineâ??s
mother was a â??stay-at-home momâ?? who was actively involved in her sonsâ?? school-related activities. Brine
described his parents as hardworking people who always supported him. He reported that he had begun
having school learning problems in middle school related to comprehending and retaining learned
materials. Brine described himself as a â??quietâ?? child who â??always had difficulty in school.â?? He described
being involved with special educational services throughout his secondary education (middle school and
high school). He received small group instruction and individualized assistance with learning arithmetic
skills, developing memory skills, and improving his comprehension. Brine was an impulsive, distractible,
and active boy who had difficulty completing school assignments and interacting with peers in the
classroom. He obtained part-time employment after school and during summer vacations and worked for
the Natural Services Department cleaning campgrounds. Although Brine enjoyed working for the Natural
Services Department, he was unable to obtain full-time employment after his high school graduation due to
his learning problems.
Brine continued to live with his parents after he graduated from high school, moving back to York County,
Pennsylvania, with his family after his father lost his job (was laid off). He reported having felt awkward in
social situations throughout his teenage years, choosing not to date due to a fear of being rejected by his
female peers. Brineâ??s difficulty with social skills not only affected his interactions with others but also
interfered with his ability to communicate with his coworkers and supervisors in a work-related environment.
He has had difficulty maintaining employment as evidenced by his history of losing jobs due to poor
attendance and insubordination. After many failed vocational pursuits, Brine and his family began working
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Maladaptive Behavior and Psychopathology
© 2013 Argosy University
Psychological Evaluation
with the Office of Vocational Rehabilitation (OVR) to assist him with job training and social skills
development. He described having participated along with several work crews doing janitorial work at local
schools, office buildings, and small businesses. Brine stated that he enjoyed working independently due to
the difficulties he faced in relating to his coworkers. He often needed assistance with handling interpersonal
conflicts and managing his anger (negative mood).
While at OVR, Brine met his wife, Kelda Brine, after an introduction by mutual friends. Their relationship
progressed rapidly and within months, they began living together. Brine described his wife as a â??mentally
retardedâ?? and â??slowâ?? woman who â??needs a lot of guidance.â?? She reportedly has difficulty with decision
making and lacks appropriate parenting skills. Brine and his wife argue frequently due to her irresponsibility
and irritable mood. They have a history of verbal and physical aggression toward one another, which has
included pushing, saying hurtful things, and threatening to kill each other. Brine acknowledged having made
statements that he did not mean and feeling remorseful after their arguments. Brine acknowledged that he
was unable to set appropriate boundaries or create a structured environment at home. Although his parents
often attempted to help him with establishing limits in his home, his wife would refuse. Brineâ??s mother and
wife have a strained relationship due to their inability to communicate and their differences in parenting
styles. Consequently, his wife has refused to accept help from her in-laws due to the fear that they â??would
take her daughter away.â?? After the Division of Family Services became involved with his family, his wifeâ??s
biggest fear came trueâ??their daughter was removed from the home and placed with his parents.
Brine stated that he was incarcerated because he sexually molested his kidâ??he was in the closet naked
with her. He described having had a pornographic magazine that he showed to his daughter and reportedly
touched her inappropriately. Brine stated that he did â??not rememberâ?? touching his daughter at that time;
however, he admitted to having his daughter touch him in his private area in the past. He spoke of their
sexual relationship beginning when his daughter was seven years old. Brine had told his daughter â??not to
talk about itâ?? to anyone. He reported that his wife had walked in on them two years ago, saw what was
happening, and didnâ??t say anything. He stated that his wife probably did not understand what was
happening or did not want to know about it. Brine described the abuse as including both contact and
noncontact acts. The sexual abuse involved multiple incidents over time as the activity progressed from
less invasive to more invasive (began with exposure and fondling and had moved to digital and oral
penetration). Although Brine denied having engaged in sexual intercourse with his daughter, he stated that
she â??would be able to describe what it isâ?? due to having walked into their (her parentsâ??) bedroom without
their knowledge.
Brine and his wife have been referred counseling for marital therapy and assistance with parenting. He
described having difficulty setting limits for his daughter and struggling with decision making. He reported
that his daughter â??is in charge at home,â?? often ignoring her parents when she is told that she cannot do
something. He has disciplined his daughter by taking something away from her, making her sit in her room,
yelling at her, or thumping her on the head. The two household rules that are enforced include not going out
of the yard without permission and going to bed at 8:00 p.m.
Brine denied recent alcohol or drug use, stating that he only experimented with alcohol and marijuana as a
teenager. Legal history is significant for a previous charge of Arson (1990) that resulted in a ten-day jail
sentence and a year of supervised probation and his current charge of incest.
Behavioral Observations
Brine is a forty-three-year-old Caucasian male of average build who appeared to be older than his stated
age. He has short-cropped dirty blonde hair and several missing teeth and was dressed in an outfit issued
by the county jail (orange jumpsuit). He was pleasant and cooperative during the evaluation, appearing
motivated to answer all questions posed to him in an honest and forthright manner. Brine seemed alert and
well rested, exhibiting no unusual mannerisms and relating quite appropriately to the examiner. He
maintained good eye contact, smiled appropriately, and made spontaneous comments about various tasks
that were presented to him. Brine would refuse to complete items that he described as difficult due to his
fear of making mistakes (arithmetic section on the Wide Range Achievement Testâ??Third Edition [WRAT3]). He was asked to read the instructions for the 16PF Questionnaire, and from his performance on that
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Maladaptive Behavior and Psychopathology
© 2013 Argosy University
Psychological Evaluation
task, it was apparent that his reading ability was of a level sufficient to enable him to complete the
instrument without assistance. He reported that he was not taking any medication that could have hindered
his performance during any phase of this evaluation. From an environmental perspective, the temperature
and lighting of the room where Brine completed the 16PF Questionnaire and Parenting Stress Index (PSI)
conformed to room conditions used in the standardization of that instrument. Therefore, given the
aforementioned behavioral and environmental observations, it is believed that the results of this evaluation
provide an accurate estimate of Brineâ??s cognitive, behavioral, and emotional functioning.
Review of Prior Assessments
Brine was previously evaluated in July 2005 to determine his level of cognitive functioning and to determine
whether he was competent to stand trial. The results from this previous evaluation suggest that Brine is
functioning within the Low Average range of cognitive functioning (Full Scale IQ of 85) with a significant
difference evident between his verbal and nonverbal reasoning abilities (Verbal IQ of 80 and Performance
IQ of 94). At this time, Brine demonstrated uneven cognitive development with scores ranging from the
Borderline to Average range with relative strengths in his perceptual organization and a relative weakness
in his processing speed.
Tests Administered
16PF Questionnaire: Fifth Edition
Clinical Interview
Mental Status Examination Results
Brine came across as an anxious man who wanted to cooperate with the evaluation despite feeling
uncomfortable at times. He spontaneously and candidly spoke of the inappropriateness of his actions
toward his daughter and of the problems in his marriage. He spoke of his difficulty in coping with stressful
situations and of not having adequate problem-solving or parenting skills. He appeared genuine in his
request for assistance, often stating that he â??knows he needs help.â?? He spoke of the difficulty he had in
comprehending information and of his wifeâ??s cognitive limitations. He described his wife as having difficulty
with making decisions and with being responsible. He described his daughter as having been â??in chargeâ?? at
home, stating that she often told her mother what to do. His responses were unrehearsed and no loose
associations in his cognitive processes were observed. Brine was oriented to person, place, and time and
denied having experienced auditory or visual hallucinations. He stated that he had had thoughts of suicide
since he had been incarcerated, however, he would never attempt to hurt himself in any way. His affective
display was appropriate and within normal range. He reports having had several mutual fulfilling
relationships and indicated that he got along quite well with a variety of people. His medical history is
significant for acid reflux disease and a repaired hernia.
Assessment Results and Interpretations
Intellectual Functioning
Brineâ??s WRAT-3 performance showed high schoolâ??level reading skills, seventh gradeâ??level spelling skills,
and third gradeâ??level arithmetic skills. He achieved an Average range standard score on the reading
subtest, a Low Average range standard score on the spelling subtest, and a Deficient range standard score
on the arithmetic subtest. Results suggest that his academic functioning is below average and discrepant
from his intelligence test scores. A significant discrepancy exists between Brineâ??s potential and
achievement as measured by standardized tests and supported by interview and observation. This
suggests that Brine may have a specific learning disability.
Personality Assessment Results
The 16PF Questionnaire was administered to assess Brineâ??s personal attitudes, beliefs, and experiences.
Page 3 of 4
Maladaptive Behavior and Psychopathology
© 2013 Argosy University
Psychological Evaluation
Brineâ??s 16PF Questionnaire profile suggests that he is not experiencing a level of psychological distress
that would warrant clinical attention. However, his profile should be interpreted with caution due to his
responses, indicating that he may have been inattentive to item content or may have answered randomly.
Brineâ??s responses indicated that he is interested in activities that involve fewer interactions with people. It is
likely that he prefers to work independently as opposed to working closely with others. He might be
described as a skeptical man who has difficulty trusting. Brine has difficulty understanding the emotional
cues of others or relating to their feelings. He might experience feelings of insecurity or feel uncomfortable
in social situations. When under stress, he may became reactive and have difficulty considering another
personâ??s point of view.
Parenting Assessment Results
The PSI was administered to assess the degree of stress in his parentâ??child relationship. Brine is currently
reporting that he is experiencing a great deal of life stress due to being financially overwhelmed, having a
limited support system, and being recently involved with the court system. He views his daughter as
hyperactive, demanding, and unable to adjust to changes in her physical or social environments. Brine
describes his daughter as having qualities that make it difficult for him to fulfill his parenting role. In addition,
he endorsed several items, which indicate that the source of his stress and potential dysfunction of the
parentâ??child systems may be related to dimensions of his childâ??s functioning. He does not experience his
child as a source of positive reinforcement due to the failure of their interactions to produce good feelings in
himself. This may be caused by her inability to respond to events in a predictable manner, which causes
Brine to misinterpret his daughterâ??s behaviors. Brine describes himself as an incompetent parent who is
often depressed and feels unable to observe and understand his childâ??s feelings or needs accurately.
Overall, he acknowledged having difficulty in managing his daughter and balancing his own needs with
those of his family. The parentâ??child system is under stress and is at risk for dysfunctional parenting
Page 4 of 4
Maladaptive Behavior and Psychopathology
© 2013 Argosy University

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