Question: DIAGNOSIS OF FEEDING AND EATING DISORDERS - This was a voluntary intake for this 23-year-old single Caucasian female. Karen lives with a 24-year-old female roommate in Las Vegas, Nevada

CASE OF KAREN

DEMOGRAPHIC DATA: This was a voluntary intake for this 23-year-old single Caucasian female. Karen lives with a 24-year-old female roommate in Las Vegas, Nevada. She has a bachelor’s degree in Art History and is employed by a major hotel that has an art gallery.  Karen was born and raised in Virginia and moved to Las Vegas 1 1/2 years ago for employment. 

CHIEF COMPLAINT: “My roommate suggested I go to therapy.  She thinks that something is wrong and I need to address it.  I can handle my life, but she threatened to move out and I cannot afford the apartment by myself.” 

HISTORY OF PRESENT ILLNESS:  Karen admitted to purging and frequent use of laxatives to try and keep her weight down since she was 17 years old.    Karen reported her weight was being monitored by a nutritionist, and is proper for her height, and she has lab work done regularly to be sure she remains healthy. Karen reports that she was much heavier as a teenager and wants to confirm she doesn’t get like that again.

Karen reported that she has a very stressful job. She stated that approximately one month ago she started to have difficulty concentrating at work.  She had several altercations with coworkers as well. Several weeks ago Karen reported that a coworker “said something nasty and I lost it.” Karen reported that she was angry and “hit everything I knew I could, holding back not to hit the coworker - but that did not help.” Karen also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend.

Karen complained of depression with insomnia and reports this has been for years so it is nothing new.  The only change now is she only sleeps a few hours per night.  She reports feeling confused, with decreased concentration, irritability, anger, and frustration. Karen discusses that some of these behaviors have been for years but it has not impacted her like it is now.  She admitted to suicidal ideation recently. This was a reason her roommate wanted her to seek treatment.  Karen reported she was emotionally abused as a child and always felt a sadness in her life.  When she was in her mid teens she thought life was hopeless and she had no future.  Karen wonders sometimes if she has post-traumatic stress disorder, but denies a history of flashbacks or nightmares or any avoidance of the person who she says emotionally abused her. Reluctantly, Karen admitted to bingeing several times per month since she was 17-years-old.

PAST PSYCHIATRIC HISTORY:  Karen denies any history of psychiatric problems in the past.  Karen admits to using alcohol periodically but rarely to excess. 

MEDICAL HISTORY: Karen is allergic to penicillin and has a lactose intolerance. She wears glasses for reading.

PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Karen’s parents were married when her mother was 19-years-old, and Karen was born the following year. Two years later, Karen’s sister was born.  Karen reports her mother stated Karen’s personality changed; she became stubborn and difficult. Karen’s mother said that Karen began biting, having temper tantrums, and has been moody since then. Karen states she “adores her father” because he was never the disciplinarian. When Karen was 12-years-old, her parents separated for 2 weeks. Karen reported her mother quit college after Karen’s birth and returned to college after her sister’s birth. Her father worked all the time, and there was a housekeeper who cared for the children.

Karen told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Karen had a temper tantrum and there was no further investigation.

Karen reports she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Karen stated that in college she had a 3.8 GPA and was on the Dean’s list. Karen is currently applying for admission to graduate school and has taken some courses toward her master’s degree.

Karen worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, Karen has been employed by an art gallery in a hotel.

MENTAL STATUS EXAMINATION: Karen presented as an average weight, somewhat disheveled, Caucasian female. She was relaxed but a bit restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Karen’s speech was slow and she spoke in a depressed voice. Her thinking was logical. Karen denied hallucinations or delusions.  She denied homicidal ideation. She admitted to passive suicidal ideation with no plan.

Karen was oriented to person, place, and time. Her fund of knowledge was excellent. Karen was able to calculate serial sevens easily and accurately. Karen repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Karen was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate. Karen’s three wishes were: “To be skinny, to have a big house, and for a million more wishes.” When asked how she sees herself in 5 years, Karen replied, “Hopefully graduating from graduate school.” If Karen could change something about herself, she would “make myself not having to struggle with weight.”

Then, in 1–2 pages, respond to the following:

Explain how you support the diagnosis by specifically identifying the criteria from the case study.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
Identify the differential diagnosis you considered.
Explain why you excluded this diagnosis.
Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
Explain why you chose the Z codes you have for this client.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.