Differential Diagnosis and Clinical Formulation · Capstone Exercise

Four Ps and Two Rivals

One case, seven factors across the 4Ps, a formulation to write, and a colleague's reasoning error to diagnose. The last part is the step that separates a formulation from a plausible story: naming what evidence would distinguish between two competing explanations.

What this exercise practises

Sorting a complex presentation into predisposing, precipitating, perpetuating and protective factors, writing a formulation that names a differential rather than a conclusion, and recognising diagnostic overshadowing in reasoning that is internally coherent and comes from an experienced clinician.

Two parts require writing and cannot be skipped. Nothing you write leaves your browser or is recorded anywhere, and you can copy your own responses at the end.

Estimated time to complete this exercise: 40 minutes

1Seven factors
2Your formulation
3The colleague
4The evidence
5Close

Before you begin

How this one works

This is the capstone. One case, seven factors to place across the 4Ps, a formulation to write, and a colleague's reasoning error to diagnose.
Parts 2 and 4 require writing and you cannot continue past either of them. Nothing you write leaves your browser or is recorded anywhere.
Part 4 is the hardest thing in this module. You will be asked to name two competing explanations and then say what evidence would distinguish between them, which is the step that separates formulation from a plausible story.
Read the case once before you analyse it. It is repeated in full before each writing task.
Nothing is graded. The writing is for you, and you can copy it at the end.

A diagnosis identifies the category and anchors communication, treatment planning and outcomes research. A formulation explains why this person, why now, what maintains it, and what treatment should target. A diagnosis without a formulation applies generic treatment to a presentation that needs individual reasoning. A formulation without a diagnosis loses the shared language. Competence requires both.

References

  1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
  2. Basson, R. (2001). Using a different model for female sexual response to address women’s problematic low sexual desire. Journal of Sex & Marital Therapy, 27(5), 395–403. https://doi.org/10.1080/713846827
  3. Brotto, L. A. (2010). The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Archives of Sexual Behavior, 39(2), 221–239. https://doi.org/10.1007/s10508-009-9543-1
  4. Brotto, L. A., & Basson, R. (2014). Group mindfulness-based therapy significantly improves sexual desire in women. Behaviour Research and Therapy, 57, 43–54. https://doi.org/10.1016/j.brat.2014.04.001
  5. Clayton, A. H., & Montejo, A. L. (2006). Major depressive disorder, antidepressants, and sexual dysfunction. Journal of Clinical Psychiatry, 67(Suppl. 6), 33–37.
  6. Weeks, G. R., & Fife, S. T. (2014). Couples in treatment: Techniques and approaches for effective practice (3rd ed.). Routledge.