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Submit your diagnosis for the client in the case. Follow the…
Submit your diagnosis for the client in the case. Follow the guidelines below.
The diagnosis should appear on one line in the following order.
Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.
Code + Name + Specifier (appears on its own first line)
Z code (appears on its own line next with its name written next to the code)
Then answer the following questions:
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.
Case of Chana
Intake Date: August xxxx
DEMOGRAPHIC DATA: This was a voluntary intake for this 28-years-old single African American female. Chana lives with a 24-years-old female roommate in New York City. She has a bachelor’s degree in Art History and is employed by a major New York museum. Chana was born and raised in Virginia and moved to New York 4 years ago for employment.
CHIEF COMPLAINT: “My roommate suggested I go to therapy. I do not agree. I can handle my life, but she threatened to move out and I cannot afford the apartment by myself.”
HISTORY OF PRESENT ILLNESS: Chana admitted to purging and frequent use of laxatives to try and keep her weight down. Chana reported her weight was being monitored by a nutritionist and she had lab work done to be sure she remained healthy. Chana reports that she was much heavier as a teenager and wants to confirm she doesn’t get like that again.
Chana 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 Chana reported that a coworker “said something nasty and I lost it.” Chana reported that she was angry and “hit everything I knew I couldbut that did not help.” Chana also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend.
Chana complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. This was another reason her roommate wanted her to seek treatment. Chana reported she was emotionally abused as a child and suffered from post-traumatic stress disorder, but she denied a history of flashbacks or nightmares or any avoidance of the person who she says emotionally abused her.
Chana noted that at times over the past year she has very strange experiences of being overwhelmed with fear. At these times she begins sweating, has chest pains and chills, and thinks she is going crazy. It concerns her terribly that these may happen at inappropriate times. Reluctantly, Chana admitted to bingeing several times per month since she was 17-years-old.
PAST PSYCHIATRIC HISTORY: Chana denies any history of psychiatric problems in the past. Chana admits to using alcohol periodically but rarely to excess.
MEDICAL HISTORY: Chana is allergic to penicillin and has a lactose intolerance. She wears glasses for reading.
PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Chana’s parents were married when her mother was 19-years-old, and Chana was born the following year. Two years later, Chana’s sister was born. Chana reports her mother stated Chana’s personality changed; she became stubborn and difficult. Chana’s mother said that Chana began biting, having temper tantrums, and has been moody since then. Chana states she “adores her father” because he was never the disciplinarian. When Chana was 12-years-old, her parents separated for 2 weeks. Chana reported her mother quit college after Chana’s birth and returned to college after her sister’s birth. She said her father worked all the time, and there was a housekeeper who cared for the children.
Chana reports that when she was in high school, her maternal aunt, who was dying of cancer, came to live with the family and this was very stressful for the family. During those years, Chana told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Chana had a temper tantrum and there was no further investigation.
Chana reports she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Chana stated that in college she had a 3.8 GPA and was on the Dean’s list. Chana is currently applying for admission to graduate school and has taken some courses toward her master’s degree.
Currently, Chana is friendly with her roommate but does not have many other friends. “I don’t trust anybody.” Chana states that when she lived in Connecticut during college, she had many friends.
Chana worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, Chana has been employed by a museum. Chana reports she currently has financial problems due to living in New York.
MENTAL STATUS EXAMINATION: Chana presented as a slightly overweight, somewhat disheveled, African-American female. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Chana’s speech was pressured, and she spoke in a loud voice. At times, her thinking was logical; and at other times, it was illogical. Chana denied hallucinations but complained of hearing policemen outside her sometimes. She denied homicidal ideation. She initially admitted to suicidal ideation but then denied it.
Chana was oriented to person, place, and time. Her fund of knowledge was excellent. Chana was able to calculate serial sevens easily and accurately. Chana repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Chana was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate. Chana’s three wishes were: “To be skinny, to have a big house where I can take in all the stray cats, and for a million more wishes.” When asked how she sees herself in 5 years, Chana replied, “Hopefully graduating from graduate school.” If Chana could change something about herself, she would “make myself thin.
Resources
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (DSM-5-TR) (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
“Feeding and Eating Disorders” (pp. 371-397)
American Psychiatric Association. (2022). DSM-5-TR online assessment measures. Links to an external site.https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
Document: Comparing Feeding and Eating Disorders Download Comparing Feeding and Eating Disorders(PDF)
