USE THIS CASE STUDY FOR THE QUESTION

Ellen Farber, a 35-year-old, single, insurance company executive, came to a psychiatric emergency room of a university hospital with complaints of depression and the thought of driving her car off a cliff. An articulate, moderately overweight, sophisticated woman, Ms. Farber appeared to be in considerable distress. She reported a 6-month period of increasingly persistent dysphoria and lack of energy and pleasure. Feeling as if she were "made of lead," Ms. Farber had recently been spending 15-20 hours a day in her bed. She also reported daily episodes of binge eating, when she would consume "anything I can find," including entire chocolate cakes or boxes of cookies. She reported problems with intermittent binge eating since adolescence, but these had recently increased in frequency, resulting in a 20-pound weight gain over the last few months.

She attributed her increasing symptoms to financial difficulties. She had been fired from her previous two jobs before comng into the emergency room. She said she owed "a small amount of money." When asked to be more specific, she reoprted owing $150,000 to her former employees and $100,000 to various local banks due to spending sprees.

In addition to lifelong emptiness, Ms. Farber described chronic uncertainty about what she wanted to do in life and whom she wanted to be friends with. She had many brief, intense relationships with both men and women, but her quick temper led to frequent arguments and even physical fights. Although she had always thought of her childhood as happy and carefree, when she became depressed, she began to recall episodes of abuse by her mother. Initially, she said she had dreamt that her mother had pushed her down the stairs when she was only 6, but she then began to report previously unrecognized memories of beatings or verbal assaults by her mother.

1. Use the case study to answer part a, b, c, d
   1. a. What diagnosis would you give Ms. Farber? Why?
   2. b. Please provide ONE factor that makes diagnosis difficult based upon Ms. Farber's history and symptom presentation
   3. c. Please describe ONE treatment approach you would use to treat Ms. Farber (e.g. behavioural, cognitive, family systems, psychoanalytic). Why would you use this approach?
   4. d. What treatment approach do you think would be least effective in treating Ms. Farber? Why?