Posted: March 9th, 2016

Taking into account the genetic, neurobiological, sociocultural, familial and environmental factors of assessment and diagnosis, what are your diagnostic thoughts for Jackie?

Jackie is a 35 year old European American woman who is referred to you by her primary care physician. Her husband George, a 45 year old man of Native-American descent, is present for this first session. Jackie tells you that her doctor is overreacting. “Just because I lost 10 more pounds, he thinks I have an eating disorder. He’s ridiculous. Don’t I look a bit pudgy to you?” You notice Jackie is dressed in loose fitting clothes, looking painfully thin. Jackie tells you, “I gained a lot of weight as a kid hoping to keep my old man off of me. It didn’t work, so I started cutting to stop the rage. A lot of my friends were cutting back then. And making yourself throw up was the norm in high school. Sure was a quick way to knock off those pounds! Jackie and George have been married for 5 years. The couple has a 4 year old daughter. Prior to George, Jackie admits to being in several “mutually-abuse” relationships. She describes George as, “ a passive softie. He hates conflict. Sometimes he’s so boring, but he loves me no matter what.” George is reluctant to comment on his wife’s behavior. He does tell you, “I worry about our little girl. She looks so scared sometimes when Jackie is having one of her episodes. When Jackie doesn’t get her way, things start flying across the room.”

Consider Eating and Personality Disorders

1. Taking into account the genetic, neurobiological, sociocultural, familial and environmental factors of assessment and diagnosis, what are your diagnostic thoughts for Jackie? What might be going on with George? Use the DSM-5 criteria to formulate your diagnostic impressions for Jackie and possibly for George, supporting what you see in the vignette that supports your diagnostic impressions.

2. Using the psychotherapeutic and pharmacological interventions discussed in the text, describe an initial treatment plan for Jackie and George. Remember to treat the persons in the vignette, and not the diagnosis. Also remember to consider culture and legal/ethical issues.