Explain how you support the diagnosis by specifically identifying the criteria from the case study.

Identify the differential diagnosis you considered and why you excluded this diagnosis.

Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.

Explain why you chose the Z codes you have for this client.

The Case of Shannel

Intake Date: August xxxx

DEMOGRAPHIC DATA: This was a voluntary intake for this 28-year-old single African American female. Shannel lives with a 24-year-old female roommate in New York City. She has a bachelor's degree in Art History and is employed by a major New York museum. Shannel was born and raised in Virginia and moved to New York 4 years ago for employment.

CHIEF COMPLAINT: "My roommate suggested I go to therapy. I do not agree. I can handle my life, but she threatened to move out and I cannot afford the apartment by myself."

HISTORY OF PRESENT ILLNESS: Shannel admitted to purging and frequent use of laxatives to try and keep her weight down. Shannel reported her weight was being monitored by a nutritionist and she had lab work done to be sure she remained healthy. Shannel reports that she was much heavier as a teenager and wants to confirm she doesn't get like that again.

Shannel reported that she has a very stressful job. She stated that approximately one month ago she started to have difficulty concentrating at work. She had several altercations with coworkers as well. Several weeks ago Shannel reported that a coworker "said something nasty and I lost it." Shannel reported that she was angry and "hit everything I knew I couldbut that did not help." Shannel also reported being under stress due to applying for her master's degree in art history and difficulties with her boyfriend.

Shannel complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. This was another reason her roommate wanted her to seek treatment. Shannel reported she was emotionally abused as a child and suffered from post-traumatic stress disorder, but she denied a history of flashbacks or nightmares or any avoidance of the person who she says emotionally abused her..

Shannel noted that at times over the past year she has very strange experiences of being overwhelmed with fear. At these times she begins sweating, has chest pains and chills, and thinks she is going crazy. It concerns her terribly that these may happen at inappropriate times. Reluctantly, Shannel admitted to bingeing several times per month since she was 17-years-old.

PAST PSYCHIATRIC HISTORY: Shannel denies any history of psychiatric problems in the past. Shannel admits to using alcohol periodically but rarely to excess.

MEDICAL HISTORY: Shannel is allergic to penicillin and has a lactose intolerance. She wears glasses for reading.

PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Shannel's parents were married when her mother was 19-years-old, and Shannel was born the following year. Two years later, Shannel's sister was born. Shannel reports her mother stated Shannel's personality changed; she became stubborn and difficult. Shannel's mother said that Shannel began biting, having temper tantrums, and has been moody since then. Shannel states she "adores her father" because he was never the disciplinarian. When Shannel was 12-years-old, her parents separated for 2 weeks. Shannel reported her mother quit college after Shannel's birth and returned to college after her sister's birth. She said her father worked all the time, and there was a housekeeper who cared for the children.

Shannel reports that when she was in high school, her maternal aunt, who was dying of cancer, came to live with the family and this was very stressful for the family. During those years, Shannel told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Shannel had a temper tantrum and there was no further investigation.

Currently, Shannel is friendly with her roommate but does not have many other friends. "I don't trust anybody." Shannel states that when she lived in Connecticut during college, she had many friends.

Shannel worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, Shannel has been employed by a museum. Shannel reports she currently has financial problems due to living in New York.

MENTAL STATUS EXAMINATION: Shannel presented as a slightly overweight, somewhat disheveled, African-American female. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Shannel's speech was pressured, and she spoke in a loud voice. At times, her thinking was logical; and at other times, it was illogical. Shannel denied hallucinations but complained of hearing policemen outside her door sometimes. She denied homicidal ideation. She initially admitted to suicidal ideation but then denied it.

Shannel was oriented to person, place, and time. Her fund of knowledge was excellent. Shannel was able to calculate serial sevens easily and accurately. Shannel repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Shannel was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate. Shannel's three wishes were: "To be skinny, to have a big house where I can take in all the stray cats, and for a million more wishes." When asked how she sees herself in 5 years, Shannel replied, "Hopefully graduating from graduate school." If Shannel could change something about herself, she would "make myself thin."