Case study
Instructions: Provide a multiaxial diagnosis based on the DSM-IV-TR criteria for the case study presented below. Use the format that follows the case study and give a multiaxial diagnosis. Give a brief explanation for your decision on the different axes in 1-3 sentences in the respective boxes. You must provide information for each of the five axes. The diagnostic codes should be included with the diagnostic labels for Axis I and Axis II.
Charlene (a pseudonym) is an African American female from an impoverished native family in New Orleans. At the age of 20, she was first admitted to the inpatient internal medicine unit of a public hospital for evaluation of weight loss. She was 5’2’’ in height and weighed 79 lbs (25 percent below her minimal body weight). Her past medical history was significant only for hyperthyroidism. Her medical workup was essentially within normal limits, including her thyroid function. During the medical evaluation, it was discovered that the patient was not eating. She was forced fed by tube for the duration of her medical workup and then transferred to psychiatric services after 22 days. Her desire to lose weight was the most prominent feature of her initial psychiatric evaluation. She felt fat, stating that her ideal weight was 95 lbs; she acknowledged, however, that she would likely want to lose additional weight after reaching that goal in order to ‘feel satisfied’. She denied feeling hungry and denied any history of alcohol or drug abuse. At the time of evaluation, there was no evidence of thought disorder except for the delusion that her sister, who had died two years previously of pneumonia and rhabdomyolosis (likely secondary to alcohol dependence), was on a trip and would return. The patient appeared mildly depressed and anxious; her sleep, memory, and concentration were within normal limits. There was no suicidal ideation and she denied any history of physical or sexual abuse.
AXIS I Anorexia Nervosa
Charlene (a pseudonym) is an African American female from an impoverished native family in New Orleans. At the age of 20, she was first admitted to the inpatient internal medicine unit of a public hospital for evaluation of weight loss. She was 5’2’’ in height and weighed 79 lbs (25 percent below her minimal body weight). Her past medical history was significant only for hyperthyroidism. Her medical workup was essentially within normal limits, including her thyroid function. During the medical evaluation, it was discovered that the patient was not eating. She was forced fed by tube for the duration of her medical workup and then transferred to psychiatric services after 22 days. Her desire to lose weight was the most prominent feature of her initial psychiatric evaluation. She felt fat, stating that her ideal weight was 95 lbs; she acknowledged, however, that she would likely want to lose additional weight after reaching that goal in order to ‘feel satisfied’. She denied feeling hungry and denied any history of alcohol or drug abuse. At the time of evaluation, there was no evidence of thought disorder except for the delusion that her sister, who had died two years previously of pneumonia and rhabdomyolosis (likely secondary to alcohol dependence), was on a trip and would return. The patient appeared mildly depressed and anxious; her sleep, memory, and concentration were within normal limits. There was no suicidal ideation and she denied any history of physical or sexual abuse.
AXIS I Anorexia Nervosa