Assignment:
Instructions: This is an open-book and untimed exam. Your primary resources for this exam are the DSM-5-TR, course notes and books, and your personal notes taken during this class. You must do your own work in completing the exam; you may NOT receive help from others.
The exam requires you to complete a diagnosis list in the format indicated in the DSM-5 TR (with rationale for each diagnosis) for two Case Studies. The rationale must connect the symptoms to the criteria in the DSM-5 TR. Indicate the symptom, then indicate the criteria met in the DSM-5 TR indicated in parenthesis such as (A1, B3, C1. etc.). This exam will take some time to complete so plan accordingly. Please Do not rush through this exam.
Be sure to write the number that identifies the case study otherwise, it cannot be graded. Each student will have a different combination of case studies so identifying the cases you are assigned will be very important.
Each case will have at least one primary diagnosis and at least one secondary diagnosis and/or Z- code. Some cases may have more than one of each. Each case study, then, will have from 2-4 items on the diagnosis list.
Case 1:
Audrey is a 26 year old single female who was referred for assessment by her primary care physician (PCP). Audrey is attempting to be approved for gastric bypass surgery, but her eating patterns have been a concern of her PCP for 4 years, and he has refused to refer her to a surgeon unless she is assessed and actively participates in any recommended treatment. Audrey is openly angry at her PCP "He has no business getting into my personal business. He has been telling me for years to lose weight. I have been on a 100 diets and have never been able to lose more than 40 pounds, so surgery is my only hope of a normal life." Audrey reported she is 5'6" tall and weighs 340 pounds. She reported her weight has been a struggle her entire life but has progressively gotten worse over the past 4 years, spinning out of control about 2 years ago. "I hate being this fat and want to be normal again. Just because my doctor thinks I have a problem with food... that means I have to stay huge forever?"
Audrey stated that at the age of 22 she began having periods of feeling a loss of control while eating. She struggled with her weight and food choices since early childhood, reporting most of the people in her nuclear family are obese and "eating junk was how I grew up". Even though weight has been a long term struggle, she clearly remembers the first time she felt out of control while eating. She stated that currently these "episodes" of being out of control and consuming "a large amount of food" occur 4-5 times per week. She noticed that for the first two years after her first episode she only lost control and "ate everything in the world" once per week, but over the past two years the episodes have increased to the current level. Audrey reported that an episode will last around 60-90 minutes and she will eat "everything I can get my hands on. It does not matter what it is, as long as it is food." She stated that during these times she will eat very quickly and will not stop, even after she feels full "to bursting". She stated that after an episode she cannot look in a mirror for days without having thoughts like "I am gross. I hate myself. If I keep this up I will die. Sometimes I feel like I cannot stand the guilt and self-hate after an episode." Audrey often feels depressed after an episode and will sometimes cry. She reported no suicidal ideations or history, but often feels overwhelmed and tries to think of a way to escape herself. Audrey reported that these episodes occur while she is alone "I never do this crazy stuff in front of people" and the episodes will often start when she is not hungry. Audrey denied any purging type behavior "At the beginning I made my self-throw up twice, but throwing up is too gross and using laxatives is disgusting." She reported no history of restricting her calorie intake or exercising to compensate for calories consumed. She reported no history of significant depression or anxiety outside of the eating episodes. She has never had a manic episode or any type of thought disorder/ loss of touch with reality. Audrey reported she drinks 2-4 beers a week and has not been drunk since graduating from college at 22 years old.
She works full time as a sales associate, which is getting difficult because of the amount of time she has to stand. "My doctor told me my weight is destroying my hips and knees, and I know standing 10 hours a day does not help, but I do not think I can get another job. Who would want to hire someone who looks like I do?" Audrey has begun calling in sick to work one day every other week and her supervisor has given her a written warning. She reported a high level of anxiety about possibly losing her job. "My supervisor really likes me because I am kind and do a good job, but she is getting tired of me calling in sick. She agreed to give me the time off work if I got the surgery. She is excited that I might get my weight under control. But if I keep calling in sick she will have no choice but to fire me. That is what my doctor does not understand, this surgery could make everything right again."
Audrey is the third of five children born to her mother, who has been married three times. Audrey has a different father than all her other siblings, being the only child born to that union. Her mother and step-father are currently married. She is close to her younger two sibling and her two older sibling went to live with their father when Audrey was 10 years old. "We are not close, but the rest of the family talks weekly. We all have weight trouble." Audrey has not dated since she began having the "eating episodes". She stated that she is afraid to let anyone close to her right now because she might have an episode in front of them and would "die of embarrassment". Audrey has two close female friends, one with whom she recently confided her eating struggles. "She was very understanding and said she would support me no matter what. She is the first person I have told besides my mom and my doctor." Audrey agreed that her "eating episodes" are not normal, have contributed to her obesity and is willing to do whatever it takes to get the referral for surgery. Need Assignment Help?
Case 2:
Frank is a 27 year old, unemployed single male, who was released from jail three weeks ago after being arrested for a felony assault and battery. Frank is out on bond and has court in two months for a probation violation. He was ordered by the judge to attend an assessment and any recommended therapy as a condition of his bond. He was also ordered to abstain from alcohol and submit to random drug testing. Frank's probation officer, who made the appointment, stated that if Frank misses any appointments or violates any conditions of his bond, he will be immediately jailed.
Frank reported "I do not see what the big deal is. I got into a fight. I get into a lot of fights. This time it got a bit out of hand and I put the other guy in the hospital. It is not my fault that the jerk picked a fight with someone who was a better fighter than he was." Frank reported he does not know the individual he assaulted, stating that he was" just some idiot at the bar", and does not know the status of the individual's well-being. "I am not calling that stupid hospital and checking on that loser." Frank has been getting into physical fights since he was 10 years old. He was in detention for over two years for various assaults and other law violations prior to 18 years old and has been in and out of jail for the past 10 years. He stated that he has spent about 4 of the last 10 years in jail "a lot less than I should. I am just that good! I can break the law, steal, fight and sell drugs and not get caught. I figure 4 years is not bad considering how much I have really done." Frank indicated that he has been purposefully breaking the law since he was 12 years old, when he was expelled from school. He did not complete high school and has never held a job for longer than 2 months at a time, stating, "They never pay what I can make selling drugs or stolen stuff on the streets. So why bother?" Frank expressed no remorse for any of his illegal or aggressive behaviors "this is who I am. The ladies love me. The cops fear me. What more could I ask out of life."
Frank has never been in a serious relationship, even though he has three children with three different women. He has not contact with his children or their mothers. Frank reported he is the "world's best liar" and that he has never been truthful with anyone. He gets into physical fights on a monthly basis and is often called "an impulsive hot head" by others. Frank reported no significant relationships and views others as simply pawns in "the game of getting what I want and deserve". Frank stated he is never without a girl when he wants one, but often feels they are "more trouble than they are worth". Frank stated that he has never planned anything and that "I live for the moment. Whatever happens at this moment is what I will deal with." Frank reported that he was taken to a psychiatrist and counselor before he was expelled from school. He did not participate in treatment and refused to take his medications. His mother was never around and his father was in jail, so there were no adult figures to force compliance with treatment or school boundaries. Frank remembered being given some "label" about "being a really bad kid. Especially after I killed the cat at 11 years old and then broke my teacher's nose at 12 years old" but he does not remember what he was diagnosed with at that time.
Frank indicated that the one thing about his life that does bother him is that he has been unable to secure a place to live. He is currently residing in a homeless shelter and has to be out of the shelter from 8 a.m. until 8 p.m. every day. He does not enjoy being homeless, but cannot find a place that will rent to him due to his multiple felony convictions and pending aggressive act. Because he often refuses to pay rent for the last 3-4 months he lives in a place, he has developed a reputation in the low income housing and private housing arena.