Sally Bbd Case Study

Clinical Diagnosis Homework Assignment #1
Diagnosis
After theoretically discussing with Sally how she's been feeling and conducting a clinical interview, my partners and I have come to the conclusion that Sally is exhibiting the symptoms of Body Dysmorphic Disorder (BDD) and Social Anxiety Disorder. Since her teenage years, Sally has been picking at her skin daily. The concern Sally has about her minor skin anomaly is one of the main symptoms of BDD. Impairment in her social and occupational areas of functioning are additional symptoms that she strongly shows. The picking started on her face when she noticed red spots, but as she got older she began picking at other areas of her body, such as her chest and her back because of the overanalyzing
and anxiety that accompany BDD.
We believe Sally’s increased BDD habits has cause symptoms of Social Phobia Disorder to surface. Sally grew up in a home based on physical expectations. She was pressured about her weight as a child, so she grew up with the mindset of approval from others. These societal expectations followed her throughout her life and her discomfort continues to increase and expand to the point of avoidance of social situations, due to fear. Sally intentionally avoids presentations on her job because she doesn’t want to be judged or rejected by her peers due to any flaws on her skin. She truly feels like the scars and scabs on her skin make her ugly. She believes that any flaw is unacceptable to society, which causes her to avoid society more and more as time passes.
Origins/Expected Prognosis
Sally’s BDD and Social Phobia can be explained by her family background and history of teasing at school. Her sister having been treated for bulimia nervosa and her father having obsessive-compulsive disorder along with depression makes Sally susceptible to having a disorder of her own. Body Dysmorphic Disorder and Bulimia Nervosa have similar symptoms in terms of viewing oneself as ugly or unfit although there is nothing wrong. Over-compulsive behavior also relates to Sally’s disorder because of the obsession with obtaining a perfect appearance and her rituals of skin picking and distress if she does not engage in these rituals.
Another factor to consider is Sally’s experience with bullying when she attended grade school. Bullying would have a negative effect on Sally’s confidence and would make her want to alter her appearance to match society’s standards for attractiveness. Even after losing weight and improving her appearance, she would still not feel beautiful enough despite praise and reassurance from her family and her peers. Along with the body dysmorphic disorder, Sally’s social phobia arises also because of teasing by her peers during adolescent years. The familial history along with a history of being bullied makes Sally vulnerable to obtaining a disorder because of the diathesis stress model, the diathesis or biological component from her family history and stress from social obligations as an adolescent. Unfortunately, Sally’s BDD and social phobia are chronic disorders and accompanied with depression, substance use, self-inflicted harm, and suicide. Fortunately, there are treatment strategies to help Sally with these disorders.
Therapy
In Sally’s case there are many different options a psychologist/psychiatrist can suggest for treatment.
The option that tends to have a higher rate of effectiveness is cognitive-behavior therapy. Since Sally has a dual diagnosis of Body Dysmorphic Disorder (BDD) and Social Phobia, starting off with techniques like, exposure, cognitive restricting, rehearsal or role-play can be extremely beneficial for her. Especially in her case, since her social phobia is impairing her performance in the work place and her social life. If she was able to develop coping strategies with CBT, she could lessen her skin picking episodes, which could in turn, lessen her anxiety from her social phobia. Research has suggested that CBT was proven 82% effective for patients with BDD, and was also found to be 84% effective when used for treating Social Phobia. Sally should respond well to the CBT, but could experience discomfort when she initially experiences the exposure technique of CBT. Experiencing situations that trigger her onset of picking could create anxiety/fear, but would decrease once the psychologist successfully teaches her the right strategies. Another options Sally might consider when seeking treatment is taking a SSRI (selective serotonin reuptake inhibitor) along with her CBT. Both Social Phobia and BDD can be treated with SSRIs, and have a high efficiency rate, especially when accompanied with CBT. Some options of SSRI sally could take would be Anafranil or Luvox. These SSRI are used when treating patients with BDD, and in Sally’s case it would be recommended for her to take a SSRI that is primarily used to treat BDD, instead of Social Phobia. The reason being that her initial diagnosis was BDD, and the development of Social Phobia after the fact, so it would be more imperative to focus of the first diagnosis. A treatment that Sally should never seek out is plastic surgery. Twenty-five percent of people seeking plastic surgery have BDD, and it often worsens the symptoms of
the disorder. From Sally case history it stated that when her parent attempted to purchase makeup for her “blemishes” her anxiety seemed to increase instead of decrease. These reasons are a good example to show how artificial enhancement, like plastic surgery, could increase her symptoms. If Sally sticks to her CBT and SSRI treatment she has a high chance of seeing improvement in her quality of daily life.