Submit your diagnosis for the client in the case. Follow the guidelines below.

• The diagnosis should appear on one line in the following order. Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.

Code + Name + Specifier (appears on its own first line) Z code (appears on its own line next with its name written next to the code)

Then, in 1-2 pages, respond to the following:

• Explain how you support the diagnosis by specifically identifying the criteria from the case study.
  • Describe in detail how the client's symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
• Identify the differential diagnosis you considered.
• Explain why you excluded this diagnosis/diagnoses.
• 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.
  • Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months

IDENTIFYING/DEMOGRAPHIC DATA:Storm is a 62-year-old, single, Lesbian, African American female who receives Social Security income and is not currently employed. Storm is financially comfortable, the social security is decent, although her living expenses are always a concern to her. She lives alone in a subsidized apartment in the same building as her 72-year-old, unmarried sister so increasing the rent will not happen.

CHIEF COMPLAINT/PRESENTING PROBLEM: Storm seeks treatment for anxiety. She says she is very concerned and the anxiety has led to pulling her hair outand it has become noticeable on top of her head. She is taking to wearing hats and wigs to hide the bald spots. Storm reports thatgerms have been a regular concernof hers since adolescence, when she learned in health classes about the risks of serious diseases including sexual transmittable disease.Her sister encouraged her to seek treatment rather than "hiding her ways." She agreed to this session even though she is pessimistic about anything working.

HISTORY OF PRESENT ILLNESS:After Storm move to her own apartment and began pulling her hair out she reported feeling better but does not always notice how much she is pulling. She fears losing control of herself. Her sister learned of her hair pulling after Storm's wig slipped off one evening to reveal bald spots.She set up a schedule over the past few months with her sister to help stop the hair pulling. Sometimes it worked and sometimes it didn't. She is worried that she will be disappointing her sister by not sticking to the schedule to reduce her hair pulling. Stormfeels tired a lot tryingto keep up with the cleanlinessof the house especially with her lack of mobility andfinds herself napping often.This then interferes with a restful sleep at night.

PAST PSYCHIATRIC HISTORY: Storm worries about so many things, whichis not new to herand she finds that byscrubbing her home clean is her best therapy to ease her anxiety.

SUBSTANCE USE HISTORY: Storm denies any abusive use of alcohol and denies any drug use.

PAST MEDICAL HISTORY: Storm has arthritis in her spine and knees and uses a walker to help her manage mobility safely.With her physical disabilities it is challenging sometimesto scrub clean the house daily. Thisworries herin case she gets a visitor and the house is not in order as she would like. Luckily she is no longer workingso the amount of time it takes her to scrub the houseclean doesn't delay her daily scheduleas it used to.

FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC:Storm shared that when she was 2 years old her mother died from tuberculosis, and the following year her father, an army officer, died from colon cancer. After his death, Stormlived with her paternal aunt from whom she felt no love. Her older brother and sister were placed in an orphanage and Stormwas permitted to see them on Sundays. When it became apparent that the children were entitled to death benefits, Stormaunt agreed to take custody of all three siblings. The household then consisted of Stormpaternal aunt, her husband (who Stormdescribed as an alcoholic), their three children, Storm and her two older siblings. Storm was briefly married in her early 20s (4 years) but was disappointed and hurt by her husband's infidelity. She moved in with her sister at that time. Storm reported itasan "anxious" timebut denied hair pulling then. Storm also enrolled in a cosmetology school and liked her work. She had to stop working "for health reasons" when she was 58 years old.

CURRENT FAMILY ISSUES AND DYNAMICS: Storm shared an apartment for over 30 years with her sister, beginning when each of their marriages dissolved. Storm reported that when her sister began a romantic relationship5 years ago, Storm began to feel very anxiousand cried often. She continues to cry periodically for no known reason. Storm moved into an apartment down the hall in the building andbegan to pull the hair from her head, hiding her hair loss by wearing wigs. This behavior occurred at different times and resulted in scabbing. is reliant upon her sister for transportation and for a sense of social and emotional connection. Storm worriesabout bothering the sister due to her transportation needs andworriesif she doesn't have her sister what would she do. She knows she is edgy with her sister often andworriesthat might be fromlack of good sleep.The worrying has interfered with her concentration.

MENTAL STATUS EXAM: Storm presented with meticulous grooming, although the knees of her pants were noted as worn. She looks her stated age. Storm was collaborative during this assessment and engaged after a reluctant start. She denies suicidal and homicidal ideation. There was no evidence of hallucinations or delusions.