Psychological Treatment Plan It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Bruce, 2014) for additional assistance in comple

Running head: PSYCHIATRIC DIAGNOSIS 0

Psychiatric Diagnosis

Heather Yant

PSY 645 Psychopathology

Instructor: Shirley Sexton

8/4/18

Psychiatric Diagnosis

The client in the case study is about Julia, a student who managed to get a scholarship due to her exemplary in athletic sports (Gorenstein, & Comer, 2015). According to the case, Julia parents wanted her to be involved in sports like soccer, but she could not manage because she was a bit chubby. Julia even when she was young she never realized that she is chubby, but her friends used to tease on her about baby fat. The purpose of this psychiatric diagnosis is to identify the symptoms and behavior exhibited by the patients, match recognized symptoms of potential disorders in the diagnostic manual (Morrison, 2014). An in-depth overview of the disorder within diagnosis, treatment option for the diagnosis and sound rationale that explains why a determination was made.

Symptoms and behaviors exhibited by the client.

Symptoms and behaviors exhibited by the client in psychology uses theories to explain the human thought, emotion, and behavior better. The psychological theory describes the current practice of the client and predicts the future response of the client. Julia’s behavior and future prediction of her behavior can be well explained by Erik Erikson's stages of psychological development (Fitzsimmons-Craft, 2011). Erikson describes how social interaction and relationships play significant roles in the development and growth of human being. According to Erickson’s theory, people experience a conflict that serves as a turning point for development. Julia when she was in high school she used to be chubby and was not aware that she was overweight. Julia during her high school days she managed to succeed in studies.

Criticism from her friend and the need to make her parents proud of her made her start running as an approach of managing her weight. At first, Julia finds it so hard to cope, but she gets used to it what is causing her turmoil. She emerged as the best runner in her school. Julia’s parents controlled her life, and they did not like her be around boys except when they are in a group. Julia’s parents used to text her through the night to check in. Julia’s parents was much concern about her life, and they needed the best from their daughter. According to Erikson when children attained teenage or adolescent age, they develop a sense of self; and those children that receive proper encouragement and reinforcement through personal exploration usually build self-independence and control (Fitzsimmons-Craft, 2011). Before Julia received a scholarship to States University, she was 17 years of age.

The wanting to build self-independence suggests that she wanted to develop a sense of dependence because her parents were in support of her exemplary in sports. Julia feels that she was much pressured than before because of the scholarship dependent on running and maintaining good grade average. She felt stressed because she felt she should not manage school work and athletic activities. The pressure originated from the school coach and teammates because she had started to gain more weight. Julia even dropped some of the races because she was not fit to participate in the competitions. The coach requested Julia to inform him of the kind of foods she ate so he could help her out. Julia needed to prove to everyone that she can maintain a good body and that resulted in engaging in restrictive diets.

The coach also recommended additional workouts so that she can lose extra pounds and get back into shape. This stage influenced Julia’s behavior and even predicted the future behavior she adopted in the early adulthood stage. The Sixth stage according to Eriksson is about intimacy and isolation (Fitzsimmons-Craft, 2011).. Personality is created in this stage, and the action taken is passed to the subsequent step. Julia was more committed to reducing extra weight each goal she set for herself, and could not realize she was losing a lot because even her clothes were not fitting anymore. The coach was much pleased because she was able to improve race time. Julia felt part of the team and less like an outsider. The isolation behavior started when she needed to reduce more weight to meet her new weight goal of 115 pounds.

Julia came up with a new scheme of dividing time when she will eat and sometimes she even skipped the food. The plan for splitting time was hard to do in the presence of her friend, so Julia decided to eat alone in the room. Splitting time up meant that she would try to interact with her friends and get back on track socially without being so avoidant but it made it hard for Julia with her eating habits. Some of her friends were more worried because Julia’s habit of eating alone prolonged up to the time she was not around her bed to be sleeping. Even when Julia met her goal of 115 pounds she even felt that she was overweight and she needed to lose more weight. The addiction to remain fit was contributed by self-actualization. Julia also experienced some stress which was attributed to school work and athletic track. She was afraid of failing or not being able to answer exams as required an incidence she experiences before. Therefore she works on both school work and in losing more weight.

The weight loss surprised her mother because Julia lost a lot and she looked so thin; her mother was not happy, and she immediately called the school dean to ascertain her behavior and what contributed to her significant weight loss. The parents especially her mother kept a close eye on Julia, and she even communicated to her friend Rebecca on Julia’s behavior. Rebecca openly confessed that Julia eats alone, she likes to live in isolation, and she is involved in a severe exercise which has resulted to the current condition. The idea of Julia’s parents to snoop over her life did not please her because he believes that her parents should give her privacy. Julia before was on good terms with her friends due to the accusation of being underweight made her close friends be pushed away and she felt happy being alone.

Matching the identified disorders in diagnostic manual

Julia’s case is complicated because she showcases symptoms that resembled depression, Anorexia nervosa, and Bulimia Nervosa. The other signs of Julia according to the situation in fear, of gaining more weight, worry more about her weight, eat less and exercise more, never noticing that one is underweight or overweight, and stress for meeting school goals and be able to please her coach and her parents. The identified disorder for this case includes Anorexia Nervosa. Anorexia Nervosa disorder is an eating disorder that is characterized by weight loss and difficulties in maintaining an appropriate body image weight (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). Children in the adolescent stage are commonly diagnosed with this condition because some may lose weight to meet cultural status or due to pressure from the environment.

The anorexia disorder symptoms include worrying more about weight, eating less and less, and exercise more and more to burn off calories. Additionally, the client may have that urge to continue losing weight even when the weight already recorded is below the safe weight for the client. Also, a client or Julia in this case of Anorexia disorder may withdraw from a social situation which involves eating for example family gatherings, and lunch in the college cafeteria with friends. The client may fear to be close to family during eating together because he or she does not want any family member to tell him or her how much to eat. Furthermore, the client may as well wear baggy clothes to hide their body. Also, the client may exclude specific food groups and make foods so that one can only take food that would not increase one's weight.

The client said to experience anorexia nervosa avoid meal times, especially at school. Finally, the client may notice they experienced obsessive difficulties such as having to stick to routines and times and difficulty in studying. Julia’s symptoms and behavior match the indicated symptoms of anorexia nervosa disorder; this is because Julia eats less; exercise more to burn some calories. Also, Julia has that urge or losing more weight even when she has lost the required weight, and she does not recognize when she is too thin. Julia withdraws from social situations which involve eating for example family gathering and or friends. For example, when Julia was at home, she lied to her mother that she was to meet with a coach for exercise and she would not be able to attend a family gathering.

This approach exactly meets the anorexia symptoms whereby the client or Julia avoids being involved in family meetings for fear of being forced to take a certain quantity of food. When Julia lost much weight, she even started wearing baggy clothes so that nobody could see her body; this suggests that she meet the Anorexia nervosa criteria symptoms. The client said to experience anorexia nervosa exclude specific food groups and make foods so that one can only take food that would not increase one's weight a habit that Julia has and usually uses. For example, Julia takes drinks such as Diet Coke or salads which are useful for reducing weight. The client may experience difficulty in studying. This symptom matches Julia’s signs of fear and stress in studying as she plans to attain her goals in education and exercising.

The contributing factor to this condition includes professional and careers that promote being thin and weight loss. For example, Julia to succeed in sports activities she needed to work on her body posture that led to anorexia nervosa disorders. The symptoms which match Julia’s signs include chronic restrictive eating, being significantly underweight and emaciated, and hiding food, failing to attend a family function or social gathering. Rebecca, a friend to Julia, indicated that Julia has thinning of hair on her head, dry and brittle hair which is one symptom of Anorexia Nervosa and experiences sleep problems because not any single day did Rebecca her roommate see Julia in the morning.

Diagnosis based on the patient’s symptoms and Criteria Based on Anorexia Disorder

According to DSM-5 criteria, a person with anorexia nervosa disorder might also make excuses or deny that there is a problem with being low body weight (Morrison, 2014). These symptoms are similar to the symptoms identified from the case study. Julia’s can be said to experience restrictive types of anorexia nervosa disorder. According to the DSM-5 diagnostic criteria, a patient with anorexia nervosa to qualify for diagnosis their weight should be 85 percent of ideal body weight excluding those suffering and have not yet lost any weight that would allow trained psychologist practitioner to conduct a test (Morrison, 2014). To conduct symptoms evaluation, the client is tested for any physical illness that might be contributing to the symptoms.

Some symptoms may be caused by a physical problem and not a mental problem, and therefore it is useful for a qualified physician to conduct laboratory test and psychological test to rule out whether the issues are mental or physical. The doctor or clinician trained for physical evaluations can perform a complete medical history and physical examination to ascertain if there is any other cause of the condition that might be contributing to the disorder (Zipfel, 2015). The diagnostic test applicable include a blood test that rules out physical illness that causes weight loss and evaluation of weight loss in the client's body; if the clinician or doctor can rule out that no physical disease then the client is referred to psychologist specially trained to diagnose and treat mental illnesses.

The psychologist uses many approaches to getting client symptom information. The psychologist may request for a longitudinal history of the client so that he can observe the client’s behavior from when she was young until when she started showcasing symptoms of anorexia nervosa. Through this approach, the psychiatrist can get information about environmental contribution towards the behavior and how the coach and parents played a role towards the disorder. To receive this information a psychiatrist needs to produce, clinical interviews and other assessments tools such as questionnaire are used. The parents of Julia may be requested to write about what they know about their daughter. Rebecca will write about what she observed from her friend while the coach will indicate training approaches and steps for Julia to take.

The following individuals are critical in ruling out the client’s symptoms, and it helps the psychologist be able to offer useful diagnostic based on presenting symptoms based on facts. Misdiagnosis or under diagnosis is done when psychiatric failed to use all methods to get facts about clients in our case Julia’s signs from people who live close to the client. The client is not aware of her condition, and therefore she will offer limited information, and it would take a lot of time before the psychiatrist can create a good relationship that would lead her to be open and be willing to talk about her lifestyle. For Julia to be diagnosed with Anorexia Nervosa according to DSM-5 criteria she must meet the following;- The client should have a habit of restrictive energy intake as it is a requirement for diagnosis (Birgegård, Norring, & Clinton, 2012). The pattern of restricting energy intake should significantly lead to low body weight in the context of age, sex, developmental course and physical health. The client should experience intense fear for gaining weight or becoming fat, even though underweight. The third requirement is that the client is heard denying the seriousness of the current low body weight. Restrictive types should indicate when the client participated in Binge eating or purging behavior to differentiate the disorder from Bulimia. In between a period of three months the client should have engaged in binge eating or not involved in binge eating. Other complications have to be evaluated to rule out client disorder for adequate diagnosis.

Explanation on how the client meets the criteria for the disorder

The first criteria(A) according to DSM-5 indicates that the client should showcase restrictive of energy intake relative to a requirement which leads to significant low body weight in the context of age sex, developmental trajectory, and physical health. Julia meets these criteria because she has a habit of restrictive energy intake and through that habit; she had a low weight to the standard requirement. The second criteria (B) include an intense fear of gaining weight or becoming fat (Birgegård, Norring, & Clinton, 2012). Still, Julia meets these criteria because she has an intense fear of gaining weight or becoming fat and she tries all approaches to ensure she loses weight. The third criteria(C) suggest that a client should experience a disturbance in the way in which one’s body weight.

The client should experience a persistent lack of recognition of the seriousness of the current low body weights. Julia also meets these criteria because she does not recognize that she is underweight or when she had added weight. Julia has that urge of reducing her body weight even when her weight is below the average required weight. The other specification includes three months by which a client has engaged in binge eating or purging behavior or not participate in binge eating or purging as it helps in ruling out Bulimia nervosa. Julia has not engaged in binge eating even when she is at home during a family gathering she avoids the group because she does not want to eat fatty food. Therefore, it is clear that Julia fits the diagnostic criteria for anorexia nervosa disorder.

Reason for Using DSM-5 Manual for Diagnosis Client disorder

The DSM is an updated manual which is approved by mental professionals to be used by a mental psychologist in evaluating clients based on presenting symptoms. The DSM manual provides common languages and standard criteria for the classification of mental disorder, and it is recommencement guide in the United States and other countries. The DSM-5 is a revised diagnostic manual for anorexia nervosa and bulimia nervosa and other eating disorder. The recent diagnostic manual that DSM-IV-TR was not applicable uniformly because only limited individual meets DSM-IV categories. For example criteria (D) of the DSM-IV indicated that the client should miss the menstrual cycle three times before qualifying to be diagnosed which is an option deleted in DSM-5 because it was not applicable to men. The DSM-IV-TR majors on women and not men, therefore, DSM-5 is a better option for diagnosis. (Birgegård, Norring, & mentioned that the low weight criterion was revised to allow more subjectivity and clinical judgment.

Summary of Diagnosis from theoretical orientation and historical perspective

The psychodynamic theory of therapy can be applied for diagnosis whereby the patient is viewed within a model of illness or what is lacking an individual is said to be made up from a dynamic that begins in early childhood and progresses through life. The theory indicated that all adult problems could be traced back from their childhood life. Psychologists who apply this theory look at the individual as a composite of their parental upbringing and how a conflict between parents altered the patient behavior. Proper interpretation of the client using the psychodynamic theory of therapy helps to bring clear insight of the client’s condition. According to the case, Julia’s behavior can be traced back to her childhood and how her parents contributed to the current behavior.

The parental upbringing requiring Julia to engage in sports challenged Julia and it also influenced the current behavior. If there is a proper interpretation of Julia’s behavior through psychodynamic theory, the client may gain some insight about her condition. Cognitive –behavioral approach emphasizes the cognitive or through a person has as an explanation as to how people develop and how sometimes they get the mental disorder. The cognitive behaviorist theory focuses on social learning in child development. Julia’s parents according to cognitive behavioral theory might have played a critical role in influencing Julia’s behavior of not recognizing if she is losing weight and adding weight because children grow through learning from an environment.

Humanistic theory and therapy state that what motivates an individual to achieve self-actualization is the desire to achieve a particular goal leads to an individual to make an individual decision that would help the individual in meeting those goals. Julia’s condition might be said to be self-actualization decision which she made so that she can maintain athletic psychical body and as well to ensure she will be able to succeed in her studies. The disorders that can be linked to the client include depression whereby the client is stressful for her education. The symptoms of depression closely relate to anorexia nervosa, and therefore Julia might be having depression and at the same time have anorexia nervosa. Depression symptoms might be observed, but it is evident that she is stressed by the way her parents are snooping on her life and the way her friend is talking behind her back. The best approach of diagnosis includes differential diagnosis.

Evaluation of Symptoms in the context of theoretical orientation:

Biological perspective is necessarily a way of looking at human problem and action and how association shapes the behavior, reinforcement and how social perspective contributes to such behavior. According to some scientist, the multiple genes may interact with environmental and other factors to increase the risk for developing the condition (Köster, & Mojet, 2015). Biological perspective and social perspective can be used to explain Julia’s situation. For example, Julia never engaged in binge eating but if she eats fast food her weight increases. Therefore her behavior to avoid eating fatty foods is one approach to avoid gaining more weight. Julia’s condition develops due to social pressure and training requirements.

The social pressure, in this case, develops when the coach gave her suggestions that would help her burn some fat and put pressure on her. The training requirement is linked to environmental influence also contributed to Julia’s condition. The behavioral psychologist believes that some behavior is learned or acquired through conditioning (Köster, & Mojet, 2015). The behaviorists believe that our response to environmental stimuli shapes our action. Julia’s behavior is widely influenced by trainer requirement. Social psychology theory is centered on group behavior, prosocial behavior, and social influence. The habit of Julia to avoid friends and other social gatherings, especially which involve social psychology theory can better explain family members.

Assessing valid of diagnosis based on the condition

The article authored by Zipfel, Gile, Hay, and Schmidt (2015) describes a variable method for diagnosing clients whereby the article recommends DSM-5 diagnostic criteria for diagnosis client. The report indicated that the client around their teen and adolescence age are more likely to be diagnosed with Anorexia nervosa disorder. The article also suggested that the client can be diagnosed using ICD-11 which entails observing significant low body weight for the clients, age, and development. The healthy body weight is approximate 18.5 kg/m. The loss of food is accompanied by a persistent pattern of behavior to prevent a restoration of standard weights which may include behavior aimed at reducing energy (Zipfel, 2015). Low body weight is central for evaluation. Women are more likely to be diagnosed because the effects of body weight are influenced by changes in society lifestyles and due to environmental influence.

Risk factors (i.e., biological, psychological, and social) for the diagnosis

The risk factor includes genetic factor whereby researcher indicated that nervous is strongly influence family and heritability. There is a direct correlation between anorexia nervosa and BMS and a significant positive genetic correlation between anorexia and nervosa. Neurological factors for example abnormalities might result from state-related consequences of malnourishment (Zipfel, 2015). Developmental factors increase the prevalence of anorexia nervosa, for example, perinatal, and neonatal events. The puberty and adolescence are characterized by profound changes, vulnerabilities and the transition to adulthood. Environmental factor indicates that cultural shifts are associated with industrialization, urbanization and globalization is related to environmental risk constellation for the development of anorexia nervosa.

Compare evidence-based and non-evidence-based treatment options for the diagnosis.

The evidence-based approach is widely used for the treatment of an adolescent with anorexia nervosa. Example of evidence-based therapy includes family treatment in adolescence that has indicated some efficacy as compared to individually based approach (Zipfel, 2015). The family-based focus on eating disorder behavior and weight gain as opposed to the more general family process. Various trials made on the approach indicate that adult patients with anorexia nervosa have reported substantial weight gain and definite improvement in eating disorder.

Evaluate well-established treatments for the diagnosis, and describe the likelihood of success or possible outcomes for each treatment.

`There following therapies can be applied to treat Julia. The treatments methods include pharmacological therapies. The antidepressants are used to improve weight gain. The drug does not reduce eating disorder, but they work by post weight restoration. Olanzapine and typical antipsychotics have been proved for lowering illness preoccupation and anxiety during refeeding. Nutritional treatment is also applied. The patient may undergo nutritional counseling in addition to being admitted to a specialist inpatient or day –patient for eating disorder for combined Programs of supervised refeeding and anorexia nervosa related psychotherapy. Evidence of the same indicates that substantial weight gain can be best achieved in an inpatient setting. Psychological treatments therapy for anorexia nervosa target neuropsychological inefficiencies in executing functioning and central coherence. Treatments through this approach found more significant improvement in the quality of life on eating disorder.

Each section covered Julia’s case and her disorder, it explained in-depth overview of the disorder within diagnosis, treatment options for the diagnosis and sound rationale that explains why a determination was made. The determination was made because if Julia kept traveling down this road of anorexia nervosa she could wind up dead.

Annotated Bibliography

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry, 68(7), 724-731. This article discusses the impact of the disorder on the society, and it gives figure or facts about people who losses their life due to the condition. These suggest that the condition is lethal. The article is used to prove how the disorder contributes to deaths.

Birgegård, A., Norring, C., & Clinton, D. (2012). DSM‐IV versus DSM‐5: Implementation of proposed DSM‐5 criteria in a large naturalistic database. International Journal of Eating Disorders, 45(3), 353-361. The article explains various changes made in the DSM-IV diagnostic criteria and how the changes led reduction in mental variance. The old section which was discriminatory because covered women were removed therefore it can be applied across all gender. This article gives information about the diagnostic criteria method for an individual with an eating disorder. The article articulates the diagnostic criteria for DSM-iv and DSM-V.

Courty, A., Godart, N., Lalanne, C., & Berthoz, S. (2015). Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa. Comprehensive Psychiatry, 56, 217-228. The articles explore the links between alexithymia and two other types of difficulties in eating symptoms and social avoidance. The report also includes a scientific study that helps to identify various symptoms of eating disorder. The article is essential in my discussion as it helps in ruling out any association between alexithymia and social avoidance and anxiety.

Fitzsimmons-Craft, E. E. (2011). Social psychological theories of disordered eating in college women: Review and integration. Clinical psychology review, 31(7), 1224-1237. The article discusses three theories of disorder eating in college’s women. The article presents comprehensive understanding of the social psychological mechanism that plays crucial roles in development especially in women. This article also discuss factor that contributes to disorder easting and implication for treatments and prevention. The article contains important information that is critical in this assignment.

Köster, E. P., & Mojet, J. (2015). From mood to food and from food to mood: A psychological perspective on the measurement of food-related emotions in consumer research. Food Research International, 76, 180-191. The article indicated that Bi-directional influences between emotion and food consumption and other emotional factors that play a critical role towards determining how much an individual consume. This article is important in this research as it gives information about various factors that influence client behavior and what made some student behave how they behave.

Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B. (2010). A randomized clinical trial is comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of general psychiatry, 67(10), 1025-1032. The article evaluates evidence-based treatment trials for an adolescent with anorexia nervosa. The report also gives the efficacy of the treatments outlined in the article. It conducted trail for treatments for over 12 months of FBT or AFT. Family evidence treatment approach was more effective in treating a client than any other method. The article is important as it gives various methods that can be used to treat patient said to experience anorexia nervosa

Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: etiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111. The article discusses anorexia disorder and the approach of diagnosing the anorexia disorder using the ICD OR through DSM-5. The article also explains why DSM-IV is not preferred while diagnosing client. The article is essential in my discussion as it provides a remedy for handling some of the question relating to the case study and also it included potential treatments methods for a client under discussion.

References

Courty, A., Godart, N., Lalanne, C., & Berthoz, S. (2015). Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa. Comprehensive Psychiatry, 56, 217-228.

Fitzsimmons-Craft, E. E. (2011). Social psychological theories of disordered eating in college women: Review and integration. Clinical psychology review, 31(7), 1224-1237.

Gorenstein, E., & Comer, J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers. ISBN: 9780716772736

Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The Guilford Press.

Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: etiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111.