Diagnosing a Case Presentation for the External Assessment
In the external assessment, students are given a scenario. A 17-year-old named Priya has for eight months experienced persistent low mood, loss of interest in netball, sleeping 11 hours a night yet still feeling tired, and difficulty concentrating in class. She has stopped seeing friends and describes herself as "worthless." Her GP notes no recent major life event, no substance use, and no manic episodes. A classmate suggests Priya has "just been sad because of exam stress." Priya's teacher wants to know whether this is a psychological disorder and which category it best fits. The scenario also notes that Priya's mother has a history of depression.
1. Using criteria for psychological disorder, justify whether Priya's presentation should be classified as a disorder rather than ordinary sadness.
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Classification should be justified using recognised criteria rather than a single symptom. Priya's presentation meets several criteria simultaneously.
Duration and persistence: symptoms have lasted eight months, far beyond typical sadness that fluctuates with events, indicating a persistent pattern rather than a transient emotional reaction.
Clinically significant distress and impairment: she has withdrawn from friends, lost interest in netball, and is struggling to concentrate in class. These represent functional impairment across social and academic domains, not merely subjective unhappiness.
Cluster of symptoms: low mood, anhedonia, sleep disturbance, fatigue, concentration difficulty, and feelings of worthlessness form a coherent symptom cluster consistent with a depressive disorder rather than isolated sadness.
Absence of alternative explanations: the GP notes no substance use, no recent major life event, and no manic episodes, which helps rule out substance-induced conditions and bipolar disorder.
The classmate's explanation of exam stress is insufficient because ordinary stress reactions are typically time-limited and tied to a specific stressor, whereas Priya's symptoms are pervasive and persistent. The family history is a risk factor that supports further assessment but is not itself diagnostic. Conclusion: the presentation meets criteria for a depressive disorder and warrants clinical assessment, though a teacher cannot diagnose and should refer appropriately.
2. Explain why a teacher should not diagnose Priya, and describe the appropriate professional response.
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A teacher lacks the training, clinical authority, and contextual information to diagnose a mental health condition. Diagnosis requires systematic assessment against standardised criteria, consideration of differential diagnoses, and ruling out medical and substance-related causes, all of which fall to qualified clinicians. A teacher's judgement could be inaccurate and could lead to labelling, which risks stigma and self-fulfilling expectations, and could delay proper care.
The appropriate response is to recognise the signs, document observations factually (attendance, withdrawal, concentration difficulties), and follow school safeguarding procedures by referring concerns to the school counsellor or wellbeing coordinator and, where appropriate, communicating with Priya's family. The teacher should maintain a supportive and non-judgemental classroom environment and avoid discussing diagnostic labels with the student or peers. This reflects the distinction between identifying warning signs, which laypeople can do, and formal diagnosis, which requires clinical expertise.