Dear Kate,
I was intrigued by the case studies you sent me. I wish I had security clearance since much of the information was censored by the military. However, I extrapolated as best I could from what information survived among the blacked-out lines in the reports and have included my thoughts below:
E.W.'s discipline problems with her children, particularly "K", might be helped with family therapy sessions. As you know, these problems can lead to the development of adjustment problems in one or more members of the family so I believe intervention is necessary to keep this condition from escalating.
T.E. definitely shows symptoms of schizophrenia, particularly 'hearing voices' and the belief that she can 'connect to aliens'. I would suggest you start treatment with Thorazine and incorporate cognitive-behavioral psychotherapy techniques into your sessions with this patient.
J.S. seems to have impulse control disorders. Intermittent Explosive Disorder was my first thought when you described his interactions with the gentlemen referred to as Steve and Bob. This patient would benefit greatly from anger management techniques. I am also not surprised by his recent suicide attempt--the fact that he felt this was the only way to 'protect' those around him indicates that he may need treatment for depression as well. Considering your observations concerning this patient's infatuation with his hair, you shouldn't have to worry about Trichotillomania.
R.M.'s case is the most interesting by far. Narcissistic Personality Disorder definitely tops the list; however, the sheer number and variety of anxiety disorders are staggering. I'm surprised the patient can function at all. I see signs of post-traumatic stress, social anxiety, hints of OCD, as well as several phobias, and quite possibly ADHD and oppositional behavior disorder. I hope you have already had this child committed to a secure facility for his safety as well as those around him. I know if he were my patient, I would! With years of intensive therapy he may yet grow up to become a functioning member of society.
I, and the rest of your colleagues, look forward to further correspondence. I don't envy you your job at this institution!
Drew
Information used from Psychology Information On-line: www(dot)psychologyinfo(dot)com