Psychopathology

Case Study: Blanche Blanche is a 30-year-old administration assistant working full-time at a government department. She reports weight concerns since her parents divorced when she was aged 15 years, and reports trying “every diet” in an attempt to lose weight since this time. Although she reports some periods of weight loss, she reports being unable to maintain these changes over time. In recent years Blanche reports that her weight has increased, with her current BMI 34 kg/m2 . Blanche lives alone and has a strained relationship with her family. She reports significant issues in her relationship with her mother in particular, who she says frequently makes negative comments about Blanche’s weight. Blanche reports a few friends that she can rely on, but says that they are all “skinnier than me” so she doesn’t like to go out in public with them. Blanche’s daily eating schedule is typically unstructured. She skips breakfast each day and eats salad at her desk for lunch at work. When Blanche gets home from work she says that she intends to go to the fridge for a small snack such as an apple. However, she finds that after eating the snack she is “unable to stop eating” and continues to eat a large amount of food. She reports this as lasting on average for an hour, and eating rapidly during this time. For example, she reports recently that she had an apple, a slice of cheesecake, several biscuits, a peanut butter and jam sandwich and two or three glasses of chocolate milk over a 2 hour period. Blanche reports that she feels “out of control” during these periods, and then guilty and angry. Blanche also reports that she feels “full” and “nauseous”, and has been sick because she was “so full” on a couple of occasions. Blanche reports these episodes as occurring four to five times a week, and reports that she also “loses control” during dinner sometimes which impacts upon her sleep. She reports that she “never feels hungry”. Blanche also says that to cope with stress she “treats” herself with chocolate, cheesecake and icecream. However, she reports that this frustrates her and she tries to avoid these foods so she is “not tempted”. Although Blanche has thought about going without food for long periods or taking laxatives, she has not tried any of these. Blanche reports guilt and sadness in relation to her eating, and says she dislikes her weight and shape. She reports that she avoids social outings as a result. Blanche reports that she has never told anyone about her eating behaviour, even though these symptoms have been occurring each week for the past three years. She reports one other period during adolescence in which similar episodes were occurring, which was just after her parents divorced. Blanche reports feeling “really upset” about these symptoms. Blanche’s GP has told her she is at risk of cardiovascular disease and diabetes due to her current body weight, and her high blood pressure and high cholesterol. As a result, she has recently commenced taking blood-pressure- and cholesterol-lowering medication. Blanche told her GP that she would like to join a gym but is fearful of being judged by others. Blanche has also reported feeling down and finding it difficult to concentrate at work over the past couple of months. She says this occurs for short periods on some days. Blanche reports to her GP that she believes she needs more intensive treatment to manage her eating and to cope with negative emotions, but she is fearful of talking about this with a therapist. She reports that she would be willing to see a psychologist to help her lose weight. To compound things, Blanche’s boss has told her that she may be let go due to funding cuts. respond to a number of questions (see below) relating to assessment and diagnosis, aetiology and treatment. Students are expected to conduct a literature search and apply this to the case study. Information about the required information students must address under each heading is provided below. Assessment and Diagnosis a. Based on the available information, specify the primary DSM-5 diagnosis and relevant differential (or alternative) diagnoses (including DSM-5 codes), as well as comorbid psychosocial, and/or physical health problems that are present in the case. Present this information using the table below (see example template below) DSM-5 Primary Diagnosis Code xxx DSM-5 Differential/Alternative Diagnoses Code xxx Code xxx xxx disorder xxx disorder xxx disorder Physical illnesses relevant to the diagnosis and treatment Other psychosocial factors relevant to the diagnosis and treatment b. Outline and justify the primary diagnosis using the symptoms (i.e. key features) present in the case study c. Explain what differential diagnoses (or alternative diagnoses) were considered in making this primary diagnosis and justify using symptoms described in the case 2 2. Aetiology a. Review and critique research evidence describing biopsychosocial factors involved in the aetiology of the primary diagnosis you have made b. Integrate this research with information in the case study and discuss what factors may help explain the aetiology of the disorder in this case 3. Treatment a. Describe, using empirical literature, the main treatment options for the primary diagnosis you have made b. Present and critique evidence relating to the short- and long-term outcomes for individuals treated with these different possible treatment options c. Integrate this research with information from the case study and discuss which treatment option would be best in this case. Justify this by outlining the main considerations in making this recommendation.