Clinical and counseling psychologists utilize treatment plans to document a client’s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician’s theoretical orientation, evidenced-based practices, and the client’s needs are taken into account when developing and implementing a treatment plan. Typically, the client’s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.To understand the treatment planning process, assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study “You decide the case of Julia attached and her previous psychiatric diagnosis attached .The Psychological Treatment Plan must include the headings and content outlined below(1)Behaviorally Defined Symptoms(A)Define the client’s presenting problem(s) and provide a diagnostic impression(B)Identify how the problem(s) is/are evidenced in the client’s behavior(C)List the client’s cognitive and behavioral symptoms(2)Long-Term Goal(A)Generate a long-term treatment goal that represents the desired outcome for the client(B)This goal should be broad and does not need to be measureable(3)Short-Term Objectives(A)Generate a minimum of three short-term objectives for attaining the long-term goal(B)Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage(4)Interventions(A)Identify at least one intervention for achieving each of the short-term objectives(B)Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client(C)Explain the connection between the theoretical orientation and corresponding intervention selected(D)Provide a rationale for the integration of multiple theoretical orientations within this treatment plan(E)Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals(5)Evaluation(A)List the anticipated outcomes of each proposed treatment intervention based on scholarly literature(B)Be sure to take into account the individual’s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation(C)Provide an assessment of the efficacy of evidence-based intervention options(6)Ethics(A)Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan(B)Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s)?
CASE 18
You
Decide: The Case of Julia
This case is presented in the voices of Julia and her roommate, Rebecca. Throughout the case,
you are asked to consider a number of issues and to arrive at various decisions, including
diagnostic and treatment decisions. Appendix A lists Julia’s probable diagnosis, the DSM-5
criteria, clinical information, and possible treatment directions.
Julia Measuring Up
I grew up in a northeastern suburban town, and I’ve lived in the same house for my entire life.
My father is a lawyer, and my mother is the assistant principal at our town’s high school. My
sister, Holly, is 4 years younger than I am.
My parents have been married for almost 20 years. Aside from the usual sort of disagreements,
they get along well. In fact, I would say that my entire family gets along well. We’re not
particularly touchy-feely: It’s always a little awkward when we have to hug our grandparents on
holidays, because we just never do that sort of thing at home. That’s not to say that my parents
are uninterested or don’t care about us. Far from it; even though they both have busy work
schedules, one of them would almost always make it to my track and cross-country meets and
to Holly’s soccer games. My mother, in particular, has always tried to keep on top of what’s
going on in our lives.
In high school, I took advanced-level classes and earned good grades. I also got along quite
well with my teachers, and ended up graduating in the top 10 percent of my class. I know this
made my mother really proud, especially since she works at the school. She would get worried
that I might not be doing my best and “working to my full potential.” All through high school,
she tried to keep on top of my homework assignments and test schedules. She liked to look
over my work before I turned it in, and would make sure that I left myself plenty of time to study
for tests.
Describe the family dynamics and school pressures experienced by Julia. Under what
circumstances might such family and school factors become problematic or set the stage for
psychological problems?
In addition to schoolwork, the track and cross-country teams were a big part of high school for
me. I started running in junior high school because my parents wanted me to do something
athletic and I was never coordinated enough to be good at sports like soccer. I was always a
little bit chubby when I was a kid. I don’t know if I was actually overweight, but everyone used
to tease me about my baby fat. Running seemed like a good way to lose that extra weight; it
was hard at first, but I gradually got better and by high school I was one of the best runners on
the team. Schoolwork and running didn’t leave me much time for anything else. I got along fine
with the other kids at school, but I basically hung out with just a few close friends. When I was
younger, I used to get teased for being a Goody Two-Shoes, but that had died down by high
school. I can’t remember anyone with whom I ever had problems.
I did go to the prom, but I didn’t date very much in high school. My parents didn’t like me
hanging out with boys unless it was in a group. Besides, the guys I had crushes on were never
the ones who asked me out. So any free time was mostly spent with my close girlfriends. We
would go shopping or to the movies, and we frequently spent the night at one another’s
houses. It was annoying that although I never did anything wrong, I had the earliest curfew of
my friends. Also, I was the only one whose parents would text me throughout the night just to
check in. I don’t ever remember lying to them about what I was doing or who I was with.
Although I felt like they didn’t trust me, I guess they were just worried and wanted to be sure
that I was safe.
Julia Coping With Stress
Now I am 17 years old and in the spring semester of my first year at college. I was awarded a
scholar-athlete full scholarship at the state university. I’m not sure of the exact cause of my
current problems, but I know a lot of it must have to do with college life. I have never felt so
much pressure before. Because my scholarship depends both on my running and on my
maintaining a 3.6 grade point average, I’ve been stressed out much of the time. Academic
work was never a problem for me in the past, but there’s just so much more expected of you in
college.
It was pressure from my coach, my teammates, and myself that first led me to dieting. During
the first semester, almost all my girlfriends in college experienced the “freshman 15” weight
gain—it was a common joke among everyone when we were up late studying and someone
ordered a pizza. For some of them it didn’t really matter if they gained any weight, but for me it
did. I was having trouble keeping up during cross-country practices. I even had to drop out of a
couple of races because I felt so awful and out of shape. I couldn’t catch my breath and I’d get
terrible cramps. And my times for the races that I did finish were much worse than my high
school times had been. I know that my coach was really disappointed in me. He called me
aside about a month into the season. He wanted to know what I was eating, and he told me
the weight I had gained was undoubtedly hurting my performance. He said that I should cut
out snacks and sweets of any kind, and stick to things like salads to help me lose the extra
pounds and get back into shape. He also recommended some additional workouts. I was all
for a diet—I hated that my clothes were getting snug. In addition, I was feeling left out of the
rest of the team. As a freshman, I didn’t know any of the other runners, and I certainly wasn’t
proving myself worthy of being on the team. At that point, I was 5′6″ and weighed 145 pounds.
When I started college I had weighed 130 pounds. Both of these weights fell into the “normal”
body mass index range of 18.5 to 25, but 145 pounds was on the upper end of normal.
Was the advice from Julia’s coach out of line, or was it her overreaction to his suggestions that
caused later problems?
Dieting was surprisingly easy. The dining hall food bordered on inedible anyway, so I didn’t
mind sticking to salads, cereal, or yogurt. Occasionally I’d allow myself pasta, but only without
sauce. I completely eliminated dessert, except for fruit on occasion. If anyone commented on
my small meals, I just told them that I was in training and gearing up for the big meets at the
end of the season. I found ways to ignore the urge to snack between meals or late at night
when I was studying. I’d go for a quick run, check Facebook and Twitter, take a nap—whatever
it took to distract myself. Sometimes I’d drink water or Diet Coke and, if absolutely necessary,
I’d munch on a carrot.
Many eating disorders follow a period of intense dieting. Is dieting inevitably destructive? Are
there safeguards that can be taken during dieting that can head off the development of an
eating disorder?
Once I started dieting, the incentives to continue were everywhere. My race times improved, so
my coach was pleased. I felt more a part of the team and less like an outsider. My clothes were
no longer snug; and when they saw me at my meets my parents said I looked great. I even
received an invitation to a party given by a fraternity that only invited the most attractive first-
year women. After about a month, I was back to my normal weight of 130 pounds.
At first, my plan was to get back down to 130 pounds, but it happened so quickly that I didn’t
have time to figure out how to change my diet to include some of the things that I had been
leaving out. Things were going so well that I figured it couldn’t hurt to stick to the diet a little
longer. I was on a roll. I remembered all the people who I had seen on television who couldn’t
lose weight even after years of trying. I began to think of my frequent hunger pangs as badges
of honor, symbols of my ability to control my bodily urges.
I set a new weight goal of 115 pounds. I figured if I hit the gym more often and skipped
breakfast altogether, it wouldn’t be hard to reach that weight in another month or so. Of course
this made me even hungrier by lunchtime, but I didn’t want to increase my lunch size. I found it
easiest to pace myself with something like crackers. I would break them into several pieces
and only allow myself to eat one piece every 15 minutes. The few times I did this in the dining
hall with friends I got weird looks and comments. I finally started eating lunch alone in my
room. I would simply say that I had some readings or a paper to finish before afternoon class. I
also made excuses to skip dinner with people. I’d tell my friends that I was eating with my
teammates, and tell my teammates that I was meeting my roommate. Then I’d go to a dining
hall on the far side of campus that was usually empty, and eat by myself.
I remember worrying about how I would handle Thanksgiving. Holidays are a big deal in my
family. We get together with my aunts and uncles and grandparents, and of course there is a
huge meal. I couldn’t bear the stress of being expected to eat such fattening foods. I felt sick
just thinking about the stuffing, gravy, and pies for dessert. I told my mother that there was a
team Thanksgiving dinner for those who lived too far away to go home. That much was true,
but then I lied and told her that the coach thought it would be good for team morale if we all
attended. I know it disappointed her, but I couldn’t deal with trying to stick to my diet with my
family all around me, nagging me to eat more.
Julia Spiraling Downward
I couldn’t believe it when the scale said I was down to 115 pounds. I still felt that I had excess
weight to lose. Some of my friends were beginning to mention that I was actually looking too
thin, as if that’s possible. I wasn’t sure what they meant—I was still feeling chubby when they
said I was too skinny. I didn’t know who was right, but either way I didn’t want people seeing
my body. I began dressing in baggy clothes that would hide my physique. I thought about the
overweight people my friends and I had snickered about in the past. I couldn’t bear the thought
of anyone doing that to me. In addition, even though I was running my best times ever, I knew
there was still room there for improvement.
Look back at Case 9, Bulimia Nervosa. How are Julia’s symptoms similar to those of the
individual in that case? How are her symptoms different?
Around this time, I started to get really stressed about my schoolwork. I had been managing to
keep up throughout the semester, but your final grade basically comes down to the final exam.
It was never like this in high school, when you could get an A just by turning in all your
homework assignments. I felt unbearably tense leading up to exams. I kept replaying scenarios
of opening the test booklet and not being able to answer a single question. I studied nonstop. I
brought notes with me to the gym to read on the treadmill, and I wasn’t sleeping more than an
hour or two at night. Even though I was exhausted, I knew I had to keep studying. I found it
really hard to be around other people. Listening to my friends talk about their exam schedules
only made me more frantic. I had to get back to my own studying.
The cross-country season was over, so my workouts had become less intense. Instead of
practicing with the team, we were expected to create our own workout schedule. Constant
studying left me little time for the amount of exercise I was used to. Yet I was afraid that cutting
back on my workouts would cause me to gain weight. It seemed logical that if I couldn’t keep
up with my exercise, I should eat less in order to continue to lose weight. I carried several cans
of Diet Coke with me to the library. Hourly trips to the lounge for coffee were the only study
breaks I allowed myself. Aside from that, I might have a bran muffin or a few celery sticks, but
that would be it for the day. Difficult though it was, this regimen worked out well for me. I did
fine on my exams. This was what worked for me. At that point, I weighed 103 pounds and my
body mass index was 16.6.
Based on your reading of either the DSM-5 or a textbook, what disorder might Julia be
displaying? Which of her symptoms suggest this diagnosis?
After finals, I went home for winter break for about a month. It was strange to be back home
with my parents after living on my own for the semester. I had established new routines for
myself and I didn’t like having to answer to anyone else about them. Right away, my mother
started in; she thought I spent too much time at the gym every day and that I wasn’t eating
enough. When I told her that I was doing the same thing as everyone else on the team, she
actually called my coach and told him that she was concerned about his training policies! More
than once she commented that I looked too thin, like I was a walking skeleton. She tried to get
me to go to a doctor, but I refused.
Dinner at home was the worst. My mother wasn’t satisfied when I only wanted a salad—she’d
insist that I have a ‘’well-balanced meal” that included some protein and carbohydrates. We
had so many arguments about what I would and wouldn’t eat that I started avoiding dinnertime
altogether. I’d say that I was going to eat at a friend’s house or at the mall. When I was at home
I felt like my mother was watching my every move. Although I was worried about the upcoming
semester and indoor track season, I was actually looking forward to getting away from my
parents. I just wanted to be left alone—to have some privacy and not be criticized for working
out to keep in shape.
Was there a better way for Julia’s mother to intervene? Or would any intervention have brought
similar results?
Since I’ve returned to school, I’ve vowed to do a better job of keeping on top of my classes. I
don’t want to let things pile up for finals again. With my practice and meet schedule, I realize
that the only way to devote more time to my schoolwork is to cut back on socializing with
friends. So, I haven’t seen much of my friends this semester. I don’t go to meals at all anymore;
I grab coffee or a soda and drink it on my way to class. I’ve stopped going out on the
weekends as well. I barely even see my roommate. She’s asleep when I get back late from
studying at the library, and I usually get up before her to go for a morning run. Part of me
misses hanging out with my friends, but they had started bugging me about not eating enough.
I’d rather not see them than have to listen to that and defend myself.
Even though I’m running great and I’m finally able to stick to a diet, everyone thinks I’m not
taking good enough care of myself. I know that my mother has called my coach and my
roommate. She must have called the dean of student life, because that’s who got in touch with
me and suggested that I go to the health center for an evaluation. I hate that my mother is
going behind my back after I told her that everything was fine. I realize that I had a rough first
semester, but everyone has trouble adjusting to college life. I’m doing my best to keep in
control of my life, and I wish that I could be trusted to take care of myself.
Julia seems to be the only person who is unaware that she has lost too much weight and
developed a destructive pattern of eating. Why is she so unable to look at herself accurately
and objectively?
Rebecca Losing a Roommate
When I first met Julia back in August, I thought we would get along great. She seemed a little
shy but like she’d be fun once you got to know her better. She was really cool when we were
moving into our room. Even though she arrived first, she waited for me so that we could divide
up furniture and closet space together. Early on, a bunch of us in the dorm started hanging out
together, and Julia would join us for meals or parties on the weekends. She’s pretty and lots of
guys would hit on her, but she never seemed interested. The rest of us would sit around and
gossip about guys we met and who liked who, but Julia just listened.
From day one, Julia took her academics seriously. She was sort of an inspiration to the rest of
us. Even though she was busy with practices and meets, she always had her readings done for
class. But I know that Julia also worried constantly about her studies and her running. She’d
talk about how frustrating it was to not be able to compete at track at the level she knew she
was capable of. She would get really nervous before races. Sometimes she couldn’t sleep, and
I’d wake up in the middle of the night and see her pacing around the room. When she told me
her coach suggested a new diet and training regimen, it sounded like a good idea.
I guess I first realized that something was wrong when she started acting a lot less sociable.
She stopped going out with us on weekends, and we almost never saw her in the dining hall
anymore. A couple of times I even caught her eating by herself in a dining hall on the other side
of campus. She explained that she had a lot of work to do and found that she could get some
of it done while eating if she had meals alone. When I did see her eat, it was never anything
besides vegetables. She’d take only a tiny portion and then she wouldn’t even finish it. She
didn’t keep any food in the room except for cans of Diet Coke and a bag of baby carrots in the
fridge. I also noticed that her clothes were starting to look baggy and hang off her. A couple of
times I asked her if she was doing okay, but this only made her defensive. She claimed that she
was running great, and since she didn’t seem sick, I figured that I was overreacting.
Why was Rebecca inclined to overlook her initial suspicions about Julia’s behaviors? Was there
a better way for the roommate to intervene?
I kept believing her until I returned from Thanksgiving. It was right before final exams, so
everyone was pretty stressed out. Julia had been a hard worker before, but now she took
things to new extremes. She dropped off the face of the earth. I almost never saw her, even
though we shared a room. I’d get up around 8:00 or 9:00 in the morning, and she’d already be
gone. When I went to bed around midnight, she still wasn’t back. Her side of the room was
immaculate: bed made, books and notepads stacked neatly on her desk. When I did bump into
her, she looked awful. She was way too thin, with dark circles under her eyes. She seemed like
she had wasted away; her skin and hair were dull and dry. I was pretty sure that something was
wrong, but I told myself that it must just be the stress of the upcoming finals. I figured that if
there were a problem, her parents would notice it and do something about it over winter break.
When we came back to campus in January, I was surprised to see that Julia looked even worse
than during finals. When I asked her how her vacation was, she mumbled something about
being sick of her mother and happy to be back at school. As the semester got under way, Julia
further distanced herself from us. There were no more parties or hanging out at meals for her.
She was acting the same way she had during finals, which made no sense because classes
had barely gotten going. We were all worried, but none of us knew what to do. One time, Julia’s
mother sent me a message on Facebook and asked me if I had noticed anything strange going
on with Julia. I wasn’t sure what to write back. I felt guilty, like I was tattling on her, but I also
realized that I was in over my head and that I needed to be honest.
How might high schools and universities better identify individuals with serious eating
disorders? What procedures or mechanisms has your school put into operation?
I wrote her mother about Julia’s odd eating habits, how she was exercising a lot and how she
had gotten pretty antisocial. Her mother wrote me back and said she had spoken with their
family doctor. Julia was extremely underweight, even though she still saw herself as chunky
and was afraid of gaining weight.
A few days later, Julia approached me. Apparently she had just met with one of the deans, who
told her that she’d need to undergo an evaluation at the health center before she could
continue practicing with the team. She asked me point-blank if I had been talking about her to
anyone. I told her how her mother had contacted me and asked me if I had noticed any
changes in her over the past several months, and how I honestly told her yes. She stormed out
of the room and I haven’t seen her since. I know how important the team is to Julia, so I am
assuming that she’ll be going to the health center soon. I hope that they’ll be able to convince
her that she’s taken things too far, and that they can help her to get better.
How might the treatment approaches used in Cases 2, 4, and 9 be applied to Julia? How
should they be altered to fit Julia’s problems and personality? Which aspects of these
treatments would not be appropriate? Should additional interventions be applied?
Decide: The Case of Julia
The individual in Case 18: The Case of Julia would receive a diagnosis of anorexia nervosa.
Dx
Checklist
Anorexia Nervosa
1.
Individual purposely takes in too little nourishment, resulting in body weight that is very low and
below that of other people of similar age and gender.
2.
Individual is very fearful of gaining weight, or repeatedly seeks to prevent weight gain despite
low body weight.
3.
Individual has a distorted body perception, places inappropriate emphasis on weight or shape
in judgments of herself or himself, or fails to appreciate the serious implications of her or his
low weight.
(Based on APA, 2013.)
Clinical Information
1. Research investigating risk factors for eating disorders have reliably identified body
dissatisfaction as a significant factor in the future development of eating disorders. Some
prospective studies have also found a history of depression and critical comments from
teachers/coaches/siblings to be important predictors (Jacobi et al., 2011). Stice, Marti, and
Durant (2011) identified two separate risk-factor pathways based on whether the individual
experienced high levels of body dissatisfaction. For adolescent girls with high body
dissatisfaction, their risk for developing an eating disorder was amplified by the presence of
depressive symptoms. However, among girls with lower levels of body dissatisfaction, those
reporting significant dieting behaviors were at the highest risk for developing a future eating
disorder.
2. Individuals with anorexia typically struggle with comorbid conditions such as depression
and/or anxiety disorders (Von Lojewski, Boyd, Abraham, & Russell, 2012). In addition, people
with anorexia nervosa may experience low self-esteem, substance abuse, and clinical
perfectionism (Cooper & Fairburn, 2011; Fairburn, Cooper, & Shafran, 2003).
3. Although anorexia nervosa can occur at any age, the peak age of onset is between 14 years
and 18 years.
4. Prevalence: The lifetime prevalence estimates range from 0.5 percent to 3.5 percent. The
DSM-5 reports the 12-month prevalence rate as 0.4 percent. Approximately 90 percent of all
cases occur among females.
5. Surveys suggest that approximately 2 percent to 5 percent of female college athletes may
suffer from an eating disorder (Greenleaf, Petrie, Carter, & Reel, 2009), with the highest rates
among college gymnasts, swimmers, and divers (Anderson & Petrie, 2012).
6. The mothers of individuals with eating disorders are more likely to diet and have
perfectionistic tendencies compared with mothers without a child with an eating disorder
(Lombardo, Battagliese, Lucidi, & Frost, 2012; Mushquash & Sherry, 2013).
7. Anorexia nervosa has a particularly high mortality rate (up to 6 percent). A 20-year
longitudinal study found that a long duration of illness, substance abuse, low weight status,
and poor psychosocial functioning increased the risk for mortality among individuals with
anorexia (Franko et al., 2013).
Common Treatment Strategies
The following treatment strategies are based on “enhanced” cognitive-behavioral therapy (CBT-
E) proposed by Fairburn and colleagues (2008). Although empirical support is still lacking for
any treatment for adults with anorexia nervosa, CBT-E appears to have the most support and
promising future for immediate and long-term recovery (Cooper & Fairburn, 2011; Grave,
Calugi, Conti, Doll, & Fairburn, 2013; Fairburn et al., 2013).
For patients who are underweight, treatment includes three phases:
1. First step: Help to increase the individual’s readiness and motivation for change.
2. Second step: When the patients are ready, increase caloric intake to regain weight while
simultaneously addressing the underlying eating disorder psychopathology, particularly
extreme shape and weight concerns.
3. Third step: Focus on relapse prevention by helping patients develop personalized strategies
for identifying and immediately correcting any setbacks.
Psychiatric Diagnosis
Wayne Natoya
Psychopathology PSY645:
Hausch-Gwaltney Stefanie Dr. Instructor:
Campus Global Arizona of University
Dec 07, 2021
Introduction
A seventeen-year-old girl named Julia has a problem that requires psychiatric diagnosis and
intervention. She is a college student who participates in sporting events. She started dieting to
lose the extra weight and acquire the ideal body weight she needed to participate optimally in
athletics. However, she was determined to lose weight, which affected her mentally, physically,
and socially. The drastic measures she took was constantly worrying about her weight and
developed unhealthy eating habits. She barely ate any food and was still worried that she was too
fat when she was too thin. These symptoms lead to a suspicion that the patient, Julia could have
anorexia nervosa.
Anorexia nervosa is a condition often classified as an eating disorder. It is characterized by
individuals having misperceptions about their body weight. Usually, their body weight is too low
for their body sizes, but they manifest fear of gaining any additional mass. They put too much
emphasis on the determination to reduce their weight that it disrupts their normative, day-to-day
function (Brockmeyer et al., 2018). The condition is often prevalent in females as teenagers or
young adult women. According to statistical evidence, 75% of those who grapple with the
disease are female (Wonderlich et al., 2020). It is harmful because it precipitates nutritional
deficiencies and other grave complications in the victims, such as dry skin, low blood pressure,
and increased risk of fractures due to brittle bones.
Psychological Concepts in the Patient’s Presentation
The symptoms that Julia, the patient under study, presents with and her history can be
analyzed using psychological concepts. These symptoms included being overly concerned about
how much she weighs. Subsequently, Julia is always anxious about what she eats because of the
fear that it might increase her weight. Further, she isolates herself from other individuals, quickly
becomes irritated, and dissects foods into small portions. Her history indicates that she was often
ridiculed for having excessive weight when she was young. Her coach college also criticized her
significantly when she gained weight when joining the institutions and could not perform well in
athletics. Based on the patient’s presentation and her history, several psychological concepts can
explain her behavior and the symptoms that she presented with.
Behavioral Concept
Julia’s clinical manifestations and mannerisms can be explained using the behavioral theory.
According to the concept, individuals’ surroundings impact their behaviors significantly.
Therefore, the behavioral traits that the patient presented with can be attributed to the aspects
present in her surroundings (Jagielska & Kacperska, 2017). For example, when Julia joined
college, her coach criticized her eating habits and weight. Subsequently, she was out of shape
compared to her teammates. These elements contributed to her escalated loss of weight that
caused her to develop poor eating habits.
Psychodynamic Concept
The psychodynamic theory elucidates that individuals’ choices are usually based on aspects
such as the events that preoccupy their unconscious minds and the encounters they had to
contend with when they were young. Julia’s childhood experiences profoundly influenced her
developing the psychological disorder (Jagielska & Kacperska, 2017). During her childhood, she
was often bullied for being too fat. The teasing that she experienced must have affected her self-
esteem and contributed to her exaggerated desire to lose weight.
Humanistic Concept
The humanistic theory ties the mannerisms that human beings present with to their innate
feelings and self-perceptions. Julia always viewed herself as having excessive weight even when
she had become too thin. It shows that she had a distorted perception of herself that affected her
self-image (Resmark et al., 2017). According to the perspective, human beings must engage in
the actions that pleased them because they were solely responsible for their actions. In the case
of Julia, her happiness lied in becoming as thin as she could, so she focused all her energy on
achieving this goal.
Potential Disorders that the Patient could be having and their DSM-5 Criteria
Anorexia Nervosa
The DSM-5 criterion identifies three specific symptoms that must be present for a patient to
be diagnosed with anorexia nervosa. These clinical manifestations include individuals having a
bodyweight substantially lower than the standard expected weight at their age and height.
Subsequently, another symptom is that those affected must display profound fear of gaining
excessive weight, with no improvement even when their body mass reduces significantly
(Brockmeyer et al., 2018). Additionally, they should also have misconceptions about their body
weight. For example, they claim excessive weight even when it is not true.
Bulimia Nervosa
The DSM-5 criteria provide three significant symptomatic expressions that are should be
present for a diagnosis of bulimia nervosa to be made. Firstly, the patients should be overly
concerned about the size of their bodies. Subsequently, they should have abnormal feeding
patterns characterized by consuming substantial, large amounts of food and engaging in
compensatory behaviors such as self-induced vomiting, misusing drugs such as laxatives and
diuretics to eliminate excess nutrients, or exercising too hard (Wonderlich et al., 2020). Another
significant symptom, according to the criteria, is that those with the condition should be overly
concerned about the appearance of their bodies.
Avoidant Restrictive Food Intake Disorders
The main symptoms that individuals with avoidant restrictive disorders have according to
the DSM-5 criteria include lacking interest in food of a particular kind. They may dislike how it
looks, tastes, or smells. Subsequently, their dietary consumption is not adequate to meet the
needs of his body hence triggering immense loss of weight and mineral deficiencies
(Brockmeyer et al., 2015). Also, they are usually overly concerned about the consequences of
eating.
Diagnosis of Patient Based on Presenting Symptoms and DSM-Criteria
The patient Julia’s diagnosis is based on comparing the clinical presentation she presents
with, and comparison with the DSM-5 criteria is anorexia nervosa. This condition has been
identified as the possible diagnosis for the patient. Firstly, the DSM-5 manual indicates that for a
patient to be diagnosed with the condition, the patient must have a substantially low body weight
(Jagielska & Kacperska, 2017). The patient’s history shows that her body weight was too low
that her family members, friends, and educators were concerned, an aspect that matches the first
criteria. Secondly, the DSM manual indicates that patients should be diagnosed with the
condition if they are afraid of gaining weight (Wonderlich et al., 2020). Analysis of the case
study of Julia shows that she was constantly worried about gaining weight, a factor that caused
her to develop erratic eating patterns and stringent exercising regimens.
The third criteria indicate that the patient must have misconceptions about their body
images. This aspect was evident in Julia. She felt that she was too fat even when she was too thin
that other individuals were worried about her health and wellbeing. The aspect that rules out
bulimia nervosa is that the patient does not eat excessive food. On the other hand, the element
that rules out avoidant restrictive food intake disorders is not a possible diagnosis because the
patient is not afraid of eating certain foods, but anything that may cause her to gain weight
(Resmark et al., 2017). The analysis of the different conditions and comparing the manifestations
with the DSM-5 criteria confirms that the patient has anorexia nervosa.
Justification for Using DSM-5 Diagnostic Manual in Making the Diagnosis
The DSM-5 diagnostic manual for diagnosing mental disorders provides standardized
criteria for diagnosing mental illnesses that ensure that the conditions are identified
appropriately. The evidence that supports its validity is that it draws its formula of clustering the
diseases from investigative research. Subsequently, using the DSM-5 diagnostic manual is
significant because it provides a proven structure of diagnosing psychiatric problems that ensures
that medical providers do not diagnose based on assumptions (Schneider et al., 2021). It gives a
strategy for diagnosing the condition that ensures that the actual condition is identified, and the
appropriate intervention is administered. Despite its validity in diagnosing psychiatric disorders,
the DSM-5 diagnostic manual has several limitations. One of the limitations of using the DSM
diagnostic manual is that it can cause healthcare professionals to misdiagnose psychiatric
conditions (Schneider et al., 2021). It may cause individuals to be assumed to have certain
medical conditions because they exhibit some mannerisms.
Summary of the Diagnosis Theoretical Orientations
Based on the behavioral perspective, Julia’s condition was precipitated by the factors present
in the environment, such as her negative childhood experiences (Brockmeyer et al.,
2018). During her childhood, she was bullied because of her body weight, making her desire to
have a leaner body structure, which caused her to develop anorexia nervosa. Subsequently, the
pressure that the coach put on her to perform exceptionally well in her athletics also caused the
condition. She felt she had the lowest weight possible to be successful in the sporting events,
which made her develop poor eating habits that resulted in her developing bulimia nervosa.
On the other hand, based on the humanistic perspective, the patient’s condition was caused
by changes in her behaviors, resulting from her self-perceptions and her feelings about the things
that were happening to her. Julia felt that the food she ate would cause her to gain weight; hence,
she refrained from eating and developed anorexia nervosa. Also, the criticism she encountered
during her childhood and from her college coach made her consider excessive weight even when
she had become too thin.
The psychodynamic concept is also vital in determining the cause of the patient’s condition.
According to the theory, individuals’ childhood experiences significantly impact their behaviors
as they grow older (Brockmeyer et al., 2018). Based on this theory, Julia’s childhood experiences
were the primary cause of her developing bulimia nervosa. She was bullied because of having
excess weight, hence triggering an intense desire to lose her body mass.
Evaluation of Symptoms within the Context of Appropriate Theoretical Orientations
The symptomatic expressions that Julia manifested can be explained using different
theoretical orientations. The first symptom that the patient presented with is a very low body
weight which can be explained using the humanistic perspective (Jagielska & Kacperska, 2017).
Julia perceived her body mass as being too voluminous; hence, she constantly reduced it until
she became too thin. The second symptom she presented with is being overly anxious about her
weight. These behaviors can be explained in the context of the psychodynamic theory that relates
mannerisms of individuals to their childhood experiences. Therefore, the bullying that the patient
endured during her childhood was a significant trigger that caused her to be constantly worried
about her weight. Another notable symptom inherent in the patient is isolating herself from other
individuals. This trait can be explained using the behavioral concept. According to the theory,
the mannerisms of individuals are influenced by the factors in their environment (Resmark et al.,
2017). Julia knew that her friends and family members would question her feeding habits if they
were aware of how frugal it was. Therefore, she isolated herself from other individuals to hide
her detrimental feeding habits.
Evaluation of the Validity of the Diagnosis Using Peer-Reviewed Articles
The article Outcome, comorbidity, and prognosis in anorexia nervosa. Psychiatr Pol, 51(2),
205-18 (2017) studies the issue and anorexia to determine its causes, prevalence, and impacts on
the affected populations. It indicates that the condition is rampant in individuals aged between
fifteen and twenty. The studies carried out by Jagielska and Kacperska (2017) imply that the
total population affected by anorexia nervosa is 1.2%, with the women having the highest
rampancy rates, a total of 0.9%. According to the write–up, the population most vulnerable to the
condition is females aged between the ages of fifteen and twenty, the category population in
which Julia, the girl in the case study, belongs.
On the other hand, the article Severe and enduring anorexia nervosa: Update and
observations about the current clinical reality. International Journal of Eating Disorders, 53(8),
1303-1312 (2020) also contains significant information about anorexia nervosa. According to the
article, anorexia nervosa is characterized by different symptomatic expressions, including
exceptionally low body weight, distorted perceptions about their body weight, and abysmal
eating habits. The symptoms outlined in the article are like those that Julia, the girl in the case
study, manifested, proving the diagnosis’s accuracy.
The scientific merits of the selected articles that prove the validity of the content that has
been extracted from them include the fact that they are scholarly articles that have been peer-
reviewed and proven to be containing accurate information. Subsequently, the articles base their
conclusions about the ailment on the information they have compiled by carrying out scientific
studies. They document the steps used while undertaking the studies, such as the participants
encapsulated in the research and the findings that emerged (Resmark et al., 2017). Therefore, the
study can be replicated to deduce whether it is factual, an aspect that increases the validity of the
information present therein.
Risk Factors Associated with the Diagnosis
The risk factors that make individuals susceptible to developing anorexia nervosa include biological
factors such as genetic composition. People with specific genes are at a higher risk of developing the
disorder. Therefore, because genetic materials are hereditary, the chances of individuals whose relatives
have the disease developing it are significantly high (Wonderlich et al., 2020). Another significant risk
associated with the condition is psychological factors such as engaging in dieting plans and starving
oneself. Venturing into stringent routines to lose weight may precipitate dangerous habits that are
difficult to overcome. Additionally, a history of personal anxiety, depression, perfectionism, and
body dysmorphia issues. Environmental factors such as the process of transitioning to a new place,
such as a new school, also increase the possibilities of individuals developing the condition (Resmark et
al., 2017). Pressures from family members for their daughters to fit a certain ideal body type that
they see fit. For female athletes, pressure from coaches in certain sports that requires perfection
and favors a certain body type with restrictive diets and training regiments are also
environmental risk factors. Further, social factors such as the ideations of certain body types also make
young people prone to want those desired body types. These ideations of certain socially defined
“ideal body” types are often portrayed on social media content consumed by adolescent
teenagers and women. Peer pressure and bullying are also social factors.
Evidence-Based and Non-evidence Based Treatment for the Condition
The evidence-based treatments for young people like Julia who have anorexia nervosa will
be cognitive behavior therapy (CBT), support groups psychotherapy, individual and family
therapy. Family therapy will be one of the best options for Julia because it entails creating
counseling sessions for patients and their families to determine the genesis of the condition and
the interventions that can be used to overcome it and to address the social, psychological,
environmental issues that contribute to causing anorexia nervosa (Resmark et al., 2017).
Psychopharmacology options such as antidepressants and anti-anxiety medications can help
control the symptoms of depression and anxiety that may aggravate and contribute to the cause
of anorexia nervosa. On the other hand, the non-evidence-based treatment for anorexia is taking
supplements such as vitamins to replace the nutrient deficiencies resulting from the patient’s
limited dietary intake. Additionally, other non-evidence-based options will be body awareness
therapy such as yoga, relaxation therapy and acupuncture which although some studies show that
they can be effective, there are still more evidential research to be done for their effectiveness for
condition such as anorexia nervosa.
Well-Established Treatments for the Condition and their Outcomes
The well-established treatment protocol for managing anorexia nervosa includes using
psychological therapies that will help change the patients’ perceptions towards food and their
body sizes, including therapeutic models including CBT, support groups, and individual and
family therapy. These therapies work by changing patients’ thought patterns to embrace positive
thoughts and eliminate negative ones like distorted self-perceptions (Resmark et al., 2017).
These methods have a high likelihood of successfully treating the condition because it helps in
changing the way the patients think hence fast-tracking the healing process. Another treatment
process is administering medication such as antidepressants and antipsychotic agents that help
reduce the negative thought patterns and improve the condition of the patients (Wonderlich et al.
2020). However, the treatment process does not often elicit positive outcomes in managing
patients with the disease because many do not view the illness as an ailment requiring medical
intervention.
Conclusion
Julia’s case is a classic case of anorexia nervosa. The symptoms she presents with align with
those inherent in the DSM-5 criteria for the condition. Therefore, it is significant to analyze the
theoretical basis of the condition under different theoretical orientations to determine its genesis.
This will aid in deducing the treatment process that can control it effectively and elicit positive
outcomes in the patient and other patients with the same condition.
Annotated Bibliography
Brockmeyer, T., Friederich, H. C., & Schmidt, U. (2018). Advances in the treatment of anorexia
nervosa: a review of established and emerging interventions. Psychological
Medicine, 48(8), 1228-1256. https://doi.org/10.1017/S0033291717002604
This article examines different treatment approaches used in the management of anorexia
nervosa. It analyzes various interventions and their efficacies in managing the conditions
in diverse populations based on compiling different scholarly articles with the
information. The content is reliable because Brockmeyer et al. (2017) are experts in
psychology who have the expertise needed to investigate the issue comprehensively and
gather valid results.
Jagielska, G., & Kacperska, I. (2017). Outcome, comorbidity, and prognosis in anorexia
nervosa. Psychiatr Pol, 51(2), 205-18. https://doi.org/10.12740/PP/64580
In this write-up, the authors elucidate what anorexia entails and the population in which it
is prevalent. It provides valid evidence on the rampancy of the condition in different
people by compiling content from scholarly articles that contain the information. As
experts in child psychiatry, the authors are knowledgeable in psychology; thus, their input
on the subject is reliable.
Resmark, G., Herpertz, S., Herpertz-Dahlmann, B., & Zeeck, A. (2019). Treatment of anorexia
nervosa—new evidence-based guidelines. Journal of clinical medicine, 8(2), 153.
https://doi.org/10.3390/jcm8020153
This essay discusses the new stipulated guidelines for treating anorexia nervosa. It
analyzes different forms of therapies that are effective in treating the condition, including
evidence-based and non-evidence-based practices. The authors, who are well-established
https://doi.org/10.1017/S0033291717002604
https://doi.org/10.12740/PP/64580
https://doi.org/10.3390/jcm8020153
professionals in the psychology field, provide an in-depth explanation of the different
interventions compiled from undertaking adequate scientific research on the topic.
Schneider, L. H., Pawluk, E. J., Milosevic, I., Shnaider, P., Rowa, K., Antony, M. M., … &
McCabe, R. E. (2021). The diagnostic assessment research tool in action: A preliminary
evaluation of a semi structured diagnostic interview for DSM-5 disorders. Psychological
Assessment. https://psycnet.apa.org/doi/10.1037/pas0001059
This article analyzes the significance of using the DSM-5 diagnostic manual in
identifying psychiatric conditions. It explores the benefits and demerits of using the
manual, including providing a factual basis for deducing patients’ mental disorders and
suitable interventions. The content present in the write-up is dependable because it has
been documented by professionals in the psychiatric field who have adequate knowledge
on the topic.
Wonderlich, S. A., Bulik, C. M., Schmidt, U., Steiger, H., & Hoek, H. W. (2020). Severe and
enduring anorexia nervosa: Update and observations about the current clinical
reality. International Journal of Eating Disorders, 53(8), 1303-1312.
https://doi.org/10.1002/eat.23283
This article has a compilation of important information on anorexia nervosa. It is a peer
reviewed write-up that discusses the symptoms patients with the condition present with.
It also scrutinizes the treatment process that can effectively treat the condition.
https://psycnet.apa.org/doi/10.1037/pas0001059
https://doi.org/10.1002/eat.23283
References
Brockmeyer, T., Friederich, H. C., & Schmidt, U. (2018). Advances in the treatment of anorexia
nervosa: a review of established and emerging interventions. Psychological
Medicine, 48(8), 1228-1256. https://doi.org/10.1017/S0033291717002604
Gorenstein, E., & Comer, J. (2015). Case studies in abnormal psychology (2nd ed.). New York,
NY: Worth Publishers. ISBN: 9780716772736.https://redshelf.com.Case 18: You
Decide: The Case of Julia.
Jagielska, G., & Kacperska, I. (2017). Outcome, comorbidity, and prognosis in anorexia
nervosa. Psychiatr Pol, 51(2), 205-18. https://doi.org/10.12740/PP/64580
Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The
Guilford Press. Retrieved from https://redshelf.com
Resmark, G., Herpertz, S., Herpertz-Dahlmann, B., & Zeeck, A. (2019). Treatment of anorexia
nervosa—new evidence-based guidelines. Journal of clinical medicine, 8(2), 153.
https://doi.org/10.3390/jcm8020153
Schneider, L. H., Pawluk, E. J., Milosevic, I., Shnaider, P., Rowa, K., Antony, M. M., … &
McCabe, R. E. (2021). The diagnostic assessment research tool in action: A preliminary
evaluation of a semi structured diagnostic interview for DSM-5 disorders. Psychological
Assessment. https://psycnet.apa.org/doi/10.1037/pas0001059
Wonderlich, S. A., Bulik, C. M., Schmidt, U., Steiger, H., & Hoek, H. W. (2020). Severe and
enduring anorexia nervosa: Update and observations about the current clinical
reality. International Journal of Eating Disorders, 53(8), 1303-1312.
https://doi.org/10.1002/eat.23283
https://doi.org/10.1017/S0033291717002604
https://ashford.instructure.com/courses/93050/modules/items/4706798
https://redshelf.com/
https://doi.org/10.12740/PP/64580
https://ashford.instructure.com/courses/93050/modules/items/4706798
https://redshelf.com/
https://doi.org/10.3390/jcm8020153
https://psycnet.apa.org/doi/10.1037/pas0001059
https://doi.org/10.1002/eat.23283
Clinical and counseling psychologists utilize treatment plans to document a client’s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician’s theoretical orientation, evidenced-based practices, and the client’s needs are taken into account when developing and implementing a treatment plan. Typically, the client’s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for the Psychiatric Diagnosis of Julia. A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.
Comment by Figure E:
Behaviorally Defined Symptoms
Define the client’s presenting problem(s) and provide a diagnostic impression.
Identify how the problem(s) is/are evidenced in the client’s behavior.
List the client’s cognitive and behavioral symptoms.
Comment by Figure E:
Long-Term Goal
Generate a long-term treatment goal that represents the desired outcome for the client.
This goal should be broad and does not need to be measureable.
Comment by Figure E:
Short-Term Objectives
Generate a minimum of three short-term objectives for attaining the long-term goal.
Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.
Comment by Figure E:
Interventions
Identify at least one intervention for achieving each of the short-term objectives.
Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.
Explain the connection between the theoretical orientation and corresponding intervention selected.
Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.
Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.
It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.
Comment by Figure E:
Evaluation
List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.
Be sure to take into account the individual’s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.
Provide an assessment of the efficacy of evidence-based intervention options.
Comment by Figure E:
Ethics
Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.
Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).
The Psychological Treatment Plan
Must be 8 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style 7.Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least five peer-reviewed sources in addition to the course text.
Must document all sources in APA style 7.
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Formatting
Title Page
Citation
Outline
