What is the principal DSM-5TR diagnosis as well as other diagnoses as appropriate based on the following case study? This could include a comorbid disorder and/or an appropriate Z-code.

Juno MacGuff, a 16-year-old junior at Dancing Elk High School, is the central character in the Academy Award-winning film Juno (Reitman, 2007) about a Minnesota teenager and the poignant, occasionally humorous challenges she confronts over the course of her unplanned and unwanted pregnancy. Lauded by some

critics as a feminist anthem and described by others as a powerful forum for the prolife/prochoice debate, Juno clearly stirred the hearts of millions and won box-office acclaim. Perhaps the sentiments of the film writer,

Diablo Cody, best capture her creation. She noted, "You can look at it as a film that celebrates life and celebrates childbirth, or you can look at it as a film about a liberated young girl who makes a choice to continue

being liberated . .. or you can look it as some kind of twisted love story, you know, a meditation on maturity." Our professional counseling view of Juno's character, including some of our own conjectures about her early

years, is described in the following basic case summary and diagnostic impressions.

Basic Case Summary

Identifying Information. At the time of her first interview 7 months ago, Juno MacGuff was a 16-year-old white female who resides with her father and stepmother in Minnetonka, Minnesota, and is a junior at Dancing Elk High School. She appeared healthy, appropriately dressed for her age and context, and is of modest height, fair-skinned, and sandy-haired. She very recently revealed to her parents that she was about 2 months pregnant, but

to date shows no obvious physical signs that she is pregnant.

Presenting Concern. Upon learning of their daughter's pregnancy 7 months ago, Mr. and Mrs. MacGuff immediately made an appointment for their daughter at the Minnetonka Family Services Center in order to help her decide on the best course of action as well as to provide her with a therapeutic outlet that they believed would be necessary over the coming months. The parents appeared very concerned for and supportive of Juno,

but they also appeared notably distressed regarding their circumstance and, according to her mother, "the

devastating effect that this pregnancy is going to have on all of us." Although Juno sat relatively quietly

throughout this meeting, she asserted that "I think I'm old enough to make an important decision affecting my own life."

Background, Family Information, and Relevant History. Juno was born in Minnetonka, Minnesota, the only child of the MacGuffs. At birth and throughout early childhood, Juno experienced health problems, including

cardiac and respiratory difficulties that resulted in numerous hospitalizations. According to her father's report, Juno's parents often quarreled about their daughter's care and the resulting tension led to irretrievable marital stress and a divorce that occurred when Juno was 5 years old. By that time, Juno's father had initiated a

relationship with one of his daughter's nurses at Minnetonka Regional Hospital. The couple married soon after his divorce was final. Juno's mother left town and has had only sporadic contact with the family for years (such

as sending her daughter an annual "Valentine's Day cactus" in February). By the time Juno entered third grade, her health had stabilized and she experienced normally expected,

successful psychosocial development. Early written reports describe her at this time as a "vibrant, self-assured, and sociable child" who seemed to have grown immeasurably from the medical adversities that marked her

earlier years. She was voted "most popular" by her elementary school peers and, by her report, eagerly moved on to Minnetonka Middle School. There, Juno's social integration was very positive and the older students regarded her as considerably more mature than her peers. She was invited to be involved in the student

government and helped to establish charity efforts for the disenfranchised American Indians in the community. Juno was also described as a "fierce defender" of those whom she believed were being unfairly treated within the school and led Minnetonka Middle School's first-ever rally against bullying. Throughout her middle school

years, Juno enjoyed a very close relationship with her father and moderately close relationship with her stepmother, Bren, who she regarded as "an adult who I could usually relate to." Near the end of middle school, Juno applied for a competitive slot at Dancing Elk High School, which had a Social Justice program that was very attractive to her. By her description, much to her surprise, although

not surprising to her parents, Juno was accepted after the first round. Juno described her first 2 years of high school as "the best in my life." She had a satisfying number of friends, was active on the school newspaper, and

participated in several community-awareness drives. She was described in an interview with a Twin City Gazette reporter as "a promising, highly intelligent, funny, and extraordinarily wise young woman who is a leader in her school community." As she describes the experience, on the night of the release of the interview in

the newspaper, Juno and a few of her friends gathered at the gymnasium to celebrate. After the event, she and her best friend and confidant, Paulie Bleeker, had their own private celebration and in recounting that night, Juno noted, "One thing led to another and got out of hand, and before I knew it, we had had sex." Three weeks later, Juno was pregnant.

Juno reported that during the initial 2 months of pregnancy, she confided only in a few close peers. At 2 months, Juno sought the support of her parents, attended a family session here at the Minnetonka Family Services Center, and consulted her pastor. She also attempted to visit her biological mother; however, she was

unsuccessful in locating her. Although not inclined to return to counseling, Juno did so for two additional meetings at the request of her parents but held firmly that "I'm really doing okay, it's just a real big decision, and I'm not sure what the right thing to do is."

The outcome was that Juno made a determination to continue her pregnancy and pursue placing the baby for adoption. As she describes it, upon recommendation of her best friend, Juno put an ad in the local Penny

Saver to see if anyone would be interested in adopting her child should she decide to carry to term. She was fortunate to find a young couple, the Lorings, who were very interested in pursuing adoption. However, shortly

before the birth of Juno's child, Mr. Loring left his wife in order to pursue his music career. Three days after her 17th birthday, Juno gave birth to a healthy boy and immediately placed him in the hands of Mrs. Loring who, along with her parents and Paulie, had been in the hospital throughout her labor and delivery.