Miriam cries herself to sleep every night. She is certain that the future holds nothing but misery. Indeed, this is the only thing she does feel certain about. "I'm going to die and my daughters are going to die.We're doomed. The world is ugly. I detest every moment of this life." She has great trouble sleeping. She is afraid to close her eyes, afraid that she will never wake up, and what will happen to her daughters then? When she does drift off to sleep, her dreams are nightmares filled with blood, dismembered bodies, thunder, decay, death, destruction.

One morning Miriam has trouble getting out of bed. The thought of facing another day overwhelms her. Again she wishes she were dead, and she wishes her daughters were dead. "We'd all be better off." She feels paralyzed, too tired to move and too afraid to leave her house. She decides once again to stay home and to keep her daughters with her. She makes sure that all the shades are drawn and that every conceivable entrance to the house is secured. She is afraid of the world and afraid of life. Every day is the same, filled with fear, immobility, and withdrawal. Every day is a nightmare.

For each of the four standards below, rate Miriam's behavior and explain WHY you rated her behavior the way you did using concrete examples from the case study above.

1. Atypical Behavior: Miriam's persistent crying, overwhelming fear of the future, and the belief that death is imminent indicate a level of distress and hopelessness that deviates from typical, healthy functioning. Her nightly nightmares filled with disturbing imagery, dismembered bodies, and thoughts of death further contribute to the atypical nature of her emotional and psychological state. The desire for her own death and the death of her daughters is a concerning deviation from normal thoughts and emotions.

2. Distressful to Self or Others:

3. Dysfunctional:

4. Danger to Self or Others: