Lorraine
is an 18-year-old first-year college student who, since leaving home to go to
school, has been losing weight steadily.
Initially, Lorraine wanted to lose a few pounds, thinking this would
make her look sexier. She stopped
eating at the cafeteria, because they served too many starchy foods, choosing
instead to prepare her own low-calorie meals.
Within 2 months, she became obsessed with dieting and exercise and with
a fear that she might gain weight and become fat. She stopped menstruating, and her weight dropped from 110 to 80
pounds. Regardless of repeated
expressions of concern by her friends that she appeared emaciated, Lorraine
insisted that she was fat. When Lorraine
went home for Thanksgiving break, her parents were so alarmed that they insisted
she go for professional help.
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):
Jonathan
is a 37-year-old construction worker whose wife took him to a psychiatric
facility. Although Jonathan has been functioning normally for the past several
years, he suddenly became severely disturbed.
At the time of admission, Jonathan was agitated, dysphoric, and
suicidal, even going as far to purchase a gun to kill himself. He had lost his appetite and had developed
insomnia during the preceding three weeks.
As each day went by, he found himself feeling more and more exhausted,
less able to think clearly or to concentrate, and uninterested in anything or
anyone. He had become hypersensitive in
his dealings with neighbors, co-workers, and family, insisting that others were
being too critical of him. This was the
second time in his life that Jonathan experienced this pattern of symptoms; the
first time occurred 5 years earlier, following the loss of his job due to a
massive layoff in his business.
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):
Larry
is a 32-year-old bank cashier who has sought treatment for his mood variations,
which date back to the age of 26. For
several years, co-workers, family, and friends have repeatedly told him that he
is very “moody.” He acknowledges that
his mood never feels quite stable, although at times others tell him he seems
more calm and pleasant than usual.
Unfortunately, these intervals are quite brief, lasting for a few weeks
and usually ending abruptly. Without
warning, he may experience either a depressed mood or a period of elation. When his mood is depressed, his confidence,
energy, and motivation are also very low.
During the periods of elation, he willingly volunteers to extend his
workday and to undertake unrealistic challenges at work. On weekends, he acts in promiscuous and
provocative ways, often sitting outside his apartment building, making
seductive comments and gestures to women walking by. Larry disregards the urging of his family members to get
professional help, insisting that it is his nature to be a bit
unpredictable. He also states that he
doesn’t want some “shrink” to steal away the periods during which he feels
“fantastic.”
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):
Cynthia
is a 26-year-old dance teacher who has struggled with her weight since
adolescence. A particular problem for
Cynthia has been her love of high-calorie carbohydrates. She regularly binges on a variety of sweets
and then forces herself to vomit. Over
the years, Cynthia has developed a number of physical problems from the
frequent cycles of binging and purging.
She recently went to her physician, complaining of severe stomach cramps
that had bothered her for several weeks.
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):
Miriam
is a 34-year-old community college instructor who, for the past 3 years, has
had persistent feelings of depressed mood, inferiority, and pessimism. She realizes that, since her graduation from
college, she has never felt really happy and that, in recent years, her
thoughts and feelings have been characterized as especially depressed. Her appetite is low, and she struggles with
insomnia. During waking hours, she
lacks energy and finds it very difficult to do her work. She often finds herself staring out the
window of her office, consumed by thoughts of how inadequate she is. She fails to fulfill many of her
responsibilities and, for the past 3 years, has received consistently poor
teacher evaluations. Getting along with
her colleagues has become increasingly difficult; consequently, she spends most
of her free time alone in her office.
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):
Isabel
is a 38-year-old realtor who, for the past week, has shown signs of
uncharacteristically outlandish behavior.
This behavior began with Isabel’s development of an unrealistic plan to
create her own real estate “empire.” She
went without sleep or food for 3 days, spending most of her time at her computer
developing far-fetched financial plans.
Within 3 days she put deposits on 7 houses, together valued at more than
$3 million, although she has no financial resources to finance even one of
them. She made several visits to local
banks, where she was known and respected, and “made a scene” with each loan
officer who expressed skepticism about her plan. In one instance, she angrily pushed over the banker’s desk,
yanked his phone from the wall, and screamed at the top of her lungs that the
bank was keeping her from earning a multimillion dollar profit. The police were summoned, and they brought
her to the psychiatric emergency room, from which she was transferred for
intensive evaluation and treatment.
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):
Sylvia,
a 30-year-old administrative assistant, started to complain to her husband
about their neighbors. She reported
that a woman who lived on the floor beneath them was knocking on the wall to
irritate her. According to the husband,
this woman had really knocked on the wall a few times; he had heard the
noises. However, Sylvia became more and
more concerned about it. She would wake
up in the middle of the night under the impression that she was hearing noises
from the apartment downstairs. She
would become upset and angry at the neighbors, and eventually came to believe
that the neighbors were now recording everything she said. She thought they had hidden wires in her
apartment. She started to feel “funny”
sensations. There were many strange
things happening, which she did not know how to explain: people were looking at
her in a funny way in the street; in the butcher shop, the butcher had
purposely served her last, although she was in the middle of the line. She began to feel that people were planning
to harm her or her husband. Sylvia also
began to believe that the people she saw on television at night were just
repeating ideas she had thought, and that the programs referred to her life. She wanted to go to the police and report
them for stealing her ideas.
DIAGNOSIS:
JUSTIFICATION
(e.g., symptoms present):