Reference no: EM133226082

Read the vignette and Consider what comorbid disorders may exist and what additional information may you need to confirm diagnostic criteria.

Discuss legal, ethical and cultural considerations related to the diagnostic and treatment.

Sam is a 22 year old man. he presents as markedly underweight, with significant agitation. His mother is an attractive Japanese woman of slight build. HIs father is a Latino who appears deeply concerned about his son. Sam is their only child.

The parents report that when Sam was 5-years old, he was sexually abused by an older cousin. While this cousin has not been part of Sam's life since, this remains a family secret and no legal action was ever taken due to the cousin's mental illness.

Reportedly, Sam has been erratic, impulsive and self-destructive throughout much of his life. his parents report that sam suffers from mood swings, angry outbursts and has alienated most of his friends. he has a history of self-abuse and suicidal ideation. While Sam has reportedly never made an attempt on his life, his parents have always been cautious and concerned. Sam has a history of cutting his wrists, but the parents report this was superficial and did not require medical attention.

Sam has also been struggling with anorexia and bulimia since age 15. They have taken him to doctors and therapists with no success. In the past few months, Sam has lost a significant amount of weight, is not sleeping and is "talking crazy". The parents often find Sam up all night having conversations with himself that make no sense. Sam's mother begins to cry as she expresses a fear that her son is using drugs and worries that he will overdose and die. At this point, Sam starts wringing her hands and looking around the room and asks if she can be excused to use the restroom.