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Born on the Fourth of July

Just out of high school, Ron Kovic enlists in the Marines to serve in the Vietnam War. The trauma of battle leaves Ron not only paralyzed from the waist down, but emotionally and mentally scared as well. His trauma continues during his recovery period in a veteran’s hospital where patient neglect is a daily occurrence. Ron is further confused and alienated upon returning home by the antiwar movement, which sharply contrasts with his deep sense of patriotism.

He spends the next decade adjusting to disability and a changing culture while living with the burdening trauma of combat memories. His journey of emotional anguish takes him through many struggles, eventually to experience healing and reawakening of his political passions.
Client name: Ron Kovic

Psychiatric diagnosis: Post Traumatic Stress Disorder (PTSD).

DSM-IV-TR Criteria:

  1. Client has been exposed to a traumatic event in which both of the following were present:

    • The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

    • The person’s response involved intense fear, helplessness, or horror.

  2. The traumatic event is persistently re-experienced in one (or more) of the following ways:

    • Recurrent or intrusive distressing recollections of the event, including images, thoughts, or perceptions.

    • Recurrent distressing dreams of the event.

    • Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).

    • Intense psychological distress at exposure to internal cues that symbolize or resemble an aspect of the traumatic event.

    • Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

  3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as evidenced by three of the following:

    • Efforts to avoid thoughts, feelings, or conversations associated with the trauma.

    • Efforts to avoid activities, places, or people that arouse recollections of the trauma.

    • Inability to recall an important aspect of the trauma.

    • Markedly diminished interest or participation in significant activities.

    • Feeling of detachment or estrangement from others.

    • Restricted range of affect.

    • Sense of foreshortened future.

  4. Persistent symptoms of increased arousal as indicated by two of the following:

    • Difficulty falling or staying asleep

    • Irritability or outbursts of anger

    • Difficulty concentrating

    • Hypervigilance

    • Exaggerated startle response

  5. Duration is more than one month.

  6. The disturbance causes clinically significant distress or impairment in social, occupations, or other important areas of functioning.


Your name:      
Name of the client you are assessing: Ron Kovic

Name of the movie: Born on the Fourth of July

What is the chief complaint?

What questions would you raise during history taking? You might base your questions on the:

History of your client’s present (and presenting) illness

Past psychiatric history, its treatment, and treatment outcomes

Psychosocial history

Past significant medical history


What observations do you have about the client’s behavior?


In your opinion, is the diagnosis given above accurate?


Could the client have any other psychiatric disorder? If so, list and include supporting DSM-IV-TR criteria.


What treatment plan would you outline?


With what expected outcomes?



Copyright 2008, Lippincott Williams & Wilkins Born on the Fourth of July -

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