Diagnosis of Feeding and Eating Disorders
Assignment: Diagnosis of Feeding and Eating Disorders
In this Assignment, you continue your practice with diagnosing mental disorders in the area of feeding and eating disorders. Remember that this area presents some new challenges, such as the disorders being mutually exclusive, as covered in this week’s Discussion.
Note: Remember that symptoms can occur in many disorders. As a result, all disorders in the DSM-5-TR covered up until this point may factor into your diagnosis (for example as a possible additional disorder you diagnose).
To Prepare
Review the case study for this week.
Start by familiarizing yourself with the disorders from the DSM-5-TR found in the Learning Resources this Week.
Look within the noted sections for symptoms, behaviors, or other features the client presents within the case study.
If some of the symptoms in the case study cause you to suspect an additional disorder, then research any of the previous disorders covered so far in the course.
This mirrors real social work practice where you follow the symptoms.
Review the correct format for how to write the diagnosis noted below. Be sure to use this format.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months
By Day 7
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)
Remember this case has 3 F codes 2 Z codes
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.
Week 8 – Case of Diamond – 3 F codes 2 Z codes
Case of Diamond
Intake Date: August xxxx
DEMOGRAPHIC DATA: This was a voluntary intake for this 28-years-old single African American female. Diamond 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. Diamond 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: Diamond admitted to purging and frequent use of laxatives to try and keep her weight down. Diamond reported her weight was being monitored by a nutritionist and she had lab work done to be sure she remained healthy. Diamond reports that she was much heavier as a teenager and wants to confirm she doesn’t get like that again.
Diamond 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 Diamond reported that a coworker “said something nasty and I lost it.” Diamond reported that she was angry and “hit everything I knew I could—but that did not help.” Diamond also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend.
Diamond 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. Diamond 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.
Diamond 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, Diamond admitted to bingeing several times per month since she was 17-years-old.
PAST PSYCHIATRIC HISTORY: Diamond denies any history of psychiatric problems in the past. Diamond admits to using alcohol periodically but rarely to excess.
MEDICAL HISTORY: Diamond is allergic to penicillin and has a lactose intolerance. She wears glasses for reading.
PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Diamond’s parents were married when her mother was 19-years-old, and Diamond was born the following year. Two years later, Diamond’s sister was born. Diamond reports her mother stated Diamond’s personality changed; she became stubborn and difficult. Diamond’s mother said that Diamond began biting, having temper tantrums, and has been moody since then. Diamond states she “adores her father” because he was never the disciplinarian. When Diamond was 12-years-old, her parents separated for 2 weeks. Diamond reported her mother quit college after Diamond’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.
Diamond 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, Diamond told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Diamond had a temper tantrum and there was no further investigation.
Diamond reports she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Diamond stated that in college she had a 3.8 GPA and was on the Dean’s list. Diamond is currently applying for admission to graduate school and has taken some courses toward her master’s degree.
Currently, Diamond is friendly with her roommate but does not have many other friends. “I don’t trust anybody.” Diamond states that when she lived in Connecticut during college, she had many friends.
Diamond worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, Diamond has been employed by a museum. Diamond reports she currently has financial problems due to living in New York.
MENTAL STATUS EXAMINATION: Diamond 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. Diamond’s speech was pressured, and she spoke in a loud voice. At times, her thinking was logical; and at other times, it was illogical. Diamond denied hallucinations but complained of hearing policemen outside her sometimes. She denied homicidal ideation. She initially admitted to suicidal ideation but then denied it.
Diamond was oriented to person, place, and time. Her fund of knowledge was excellent. Diamond was able to calculate serial sevens easily and accurately. Diamond repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Diamond was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate. Diamond’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, Diamond replied, “Hopefully graduating from graduate school.” If Diamond could change something about herself, she would “make myself thin.”
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