Reference no: EM133634695
Case 1: Not So Happy Vikki
Vikki, an 18-year-old Caucasian female, came to the university counseling center at the behest of her dormitory floor's residential adviser, who was concerned about Vikki's weight loss Vikki admitted that she was "not happy" about coming to the center, but she liked, the residential adviser and didn't want to "alienate" her. When she came to her initial session, Vikki appeared visibly emaciated and was wearing long, oversized sweater and baggy sweatpants. At the beginning of the interview, she was guarded and answered questions with only a few words. But when she realized that the social worker "was not going to tell me I needed to gain weight like everyone else," she began to open up, although she spoke in a flat, matter-of-fact tone, even about painful subjects.
Vikki said she had begun to lose weight the summer of her senior year of high school, though her concerns about her weight had begun at age 13. Before that time, she had been a "skinny kid," and that's how she wanted to stay. She admitted that she didn't want to grow up and thought that staying thin was a way to achieve this. She said she admired little girls' bodies (even girls as young as three and four) and thought they looked great.
During that summer, Vikki said that she was bored because there were no jobs for high school students in the midsized city where she lived. Losing weight gave her "something to do." Every day, she ate only two meals and jumped rope for 30 minutes. If she didn't exercise daily, she felt "fat" and "disgusted" with herself. Vikki said that before the summer, she didn't have the discipline to cut back on her food intake. At the same time, she said, she had exercised and weighed herself almost every day since he was 14 years old. At five feet, four inches, she has never weighed more than 105 pounds.
Vikki admitted with embarrassment that she lost control of her eating on occasion, usually with sweet food (ice cream, brownies, cake) but more recently with peanut butter; she could eat an entire jar at one sitting. She said that this happened "maybe once a month" and that she would atone for it by eating even less afterward. She denied using any methods of purging.
When asked how she was feeling during the summer after she finished high school, other than "bored" at the prospect of leaving for college, she seemed surprised by the question and answered, "How did I feel? I didn't feel anything."
Since entering college three and a half months ago, Vikki has eaten only two meals a day, subsisting on salad, yogurt, popcorn, and Diet Coke, and has lost an additional 10 pounds (she now weighs 85 pounds). She said that she doesn't feel hungry and that the weight loss has been easy. She has also stopped exercising.
Vikki admitted she hadn't menstruated in seven months and was losing her hair. She didn't mind the lack of menstruation because she had always hated her period, a clear marker that she was a woman. Her hair loss bothered her, however, and she showered only every other day because too much hair fell out when she washed it. She said that occasionally she felt her heart rate "slow down and then speed up." On one hand, this scared her; on the other hand, she would sometimes think, "Maybe I'll just die of a heart attack, and all this will be over." Despite these physical concerns, she had not been to a doctor.
Vikki said that in one sense she knew she was too thin and wore baggy clothes to disguise the fact, but she still felt "fat inside," recognizing that no amount of weight loss would help her feel different. Yet she didn't know anymore what normal eating was and became panicky when people pressured her about gaining weight. She denied having anorexia to anyone who pushed her about it, saying that she had read the criteria and she hadn't lost 15% of her body weight therefore, she couldn't have it. If she ever got fat she said, she would be totally worthless
1. What is your DSM 5-TR diagnosis and diagnostic code. Include diagnostic specifiers if present? Include medical conditions and all Z-Codes that may be applicable to the case.
2. What are the specific symptoms and how do they fulfill each criterion for the diagnosis?
3. Please provide at least one (1) potential DSM 5-TR differential diagnosis based on the DSM 5-TR and briefly explain why it was not selected.