Lisa, a seventeen-year-old freshman at a large state university, was brought to the therapist over Christmas break. Lisa was approximately 5 feet, 8 inches and weighed 90 pounds. She was dressed in sweats with a university logo.
Her hair was attractively styled and her makeup expertly applied.
During the first part of the interview, Lisa sat quietly between her parents allowing them to answer all questions. Mrs. Baker was an attractive woman in her forties. She was petite, thin, and her hair was dyed blond. She was dressed neatly in a conservative suit. Mr. Baker was also dressed in a suit.
He was a tall, muscular man in his forties. Both were employed in sales.
Mrs. Baker reported that she and her husband have brought Lisa to see a therapist at the insistence of Lisa’s dorm counselor. The counselor had called the parents because of her concern over Lisa’s diminishing weight and unusual eating patterns. When she began college, Lisa weighed 115 pounds.
Over the past 4 months, Lisa had lost 25 pounds. The dorm counselor re ported that Lisa did not eat breakfast or lunch. At dinner she got a tray, cleaned the tray with a napkin, centered a plate on the tray, got a bowl, centered the bowl on the plate, and then centered her food in the bowl. Her food varied each evening. One evening Lisa might have selected five green beans.
Another evening it might have been five pickle slices or five slices of apple.
Once the food was centered, Lisa would then get three glasses of ice water, which she lined up across the top of her tray. If any liquid (water, juice) spilled onto the tray, she would begin again. Once the tray had been organized, Lisa sat with her friends and ate. Once she had consumed three of the five pieces of food and all of the water, she pushed her tray away and commented how full she was and that she couldn’t believe she had eaten so much.
Mr. and Mrs. Baker recognized that Lisa had lost weight but stated, “She was always a little chunky and now she looks quite attractive.” The Bakers reported that Lisa was the youngest of five girls and had always been their
“angel.” Lisa had always earned As in school, was a cheerleader in high school, was on the student council, and was elected homecoming queen her senior year. While her grades from college had not arrived, they were confident she had earned all As.
Once her parents had left, Lisa seemed willing to answer the therapist’s questions. Lisa also recognized that she had lost a significant amount of weight and stated that she felt she still needed to lose 5 to 10 more pounds be cause her stomach was fat. When the therapist responded that Lisa did not look fat, Lisa reported that was why she wore sweats. The oversized sweats hid all her fat.
Lisa reported that if she could just lose the weight, her life would be much better. She was pledging a sorority in the spring and her future sorority sisters did not like fat girls. In addition, the guys at the university had be gun asking her out as the weight dropped.
When questioned, Lisa reported that she was majoring in business be cause her parents felt that she would make more money with that major. She was sure all of her grades would be As, because”… college isn’t that hard.” While she was able to report that her eating habits were unusual, she stated that ” .. all diets are weird. It’s the only way I can prevent myself from overeating. I think about food all the time.
Lisa also reported that she jogged 2 to 3 miles each day and rode an exercise bike in the dorm each evening for an hour. She reported that she had begun to ride around 2 a.m. to prevent the dorm counselor from catching her.
Lisa reported that she had not had a period in three months although she knew she couldn’t be pregnant because she was a virgin.
A sample outline would appear like this:
I. Overview
1. Clinical Diagnosis
2. DSM-5 symptoms that are shown in the case study
3. Examples from the case study for each DSM symptom
II. Clinical Formulation (follow a list-type format in the paper)
1. What types of psychosocial stressors might the client be experiencing?
2. Describe these and how they might impact their clinical diagnosis
3. What is the client’s overall level of functioning, currently? How are they able to continue functioning in their regular routine? Describe this and note how their diagnosis might be impacting his/her ability to function.
III. Hypotheses for the Development of the Disorder
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