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Psychology

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May 7, 2024

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Case Conceptualization Devon, a 24-year-old biracial, gay male, presents with a history of disordered eating behaviors and recent relational distress following a breakup with his boyfriend of three years, Marcus. Devon self-refers for counseling, expressing feelings of anxiety and sadness related to the breakup and his struggles with disordered eating. His disordered eating patterns, characterized by binge eating followed by purging behaviors, have intensified since the breakup with Marcus. He reports using food as a coping mechanism to manage stress and negative emotions, particularly during periods of emotional distress. Devon describes feeling out of control during binge-eating episodes and uses purging behaviors to alleviate feelings of guilt and self-hate. Observations of Devon reveal emotional distress, evidenced by feelings of sadness, anxiety, and self-hate. He demonstrates insight into his behaviors and expresses a desire to seek help for his struggles. Devon appears introspective and willing to engage in therapy, demonstrating a motivation for change. However, he also exhibits ambivalence about seeking help, as indicated by his previous counseling experience for eating issues and his current struggles with disordered eating. Several factors contribute to and reinforce Devon's disordered eating patterns, including the trauma of infidelity in his relationship with Marcus, underlying feelings of inadequacy and self- hate, and societal pressures related to body image and attractiveness. Devon's disordered eating serves a dual purpose of coping with emotional distress and attempting to maintain control over his body and weight. Themes of shame, guilt, and fear of rejection emerge in Devon's narrative, reflecting his internal struggles and emotional turmoil. Barriers to growth and coping for Devon include entrenched patterns of disordered eating, fear of judgment or stigma associated with seeking help for mental health concerns, and challenges in identifying and addressing underlying emotional needs. Despite these barriers, Devon exhibits strengths and resilience, such as insight into his behaviors, willingness to engage in therapy, and capacity for self-reflection and introspection. Overall, Devon's case highlights the complex interplay between relational distress, disordered eating behaviors, and underlying emotional issues. Addressing these concerns requires a holistic approach that considers Devon's unique experiences, cultural background, and individual strengths and challenges. Diagnostic impressions- DSM-5-TR diagnosis In formulating diagnostic impressions for Devon, it is essential to approach the process with ethical sensitivity and cultural competence. Considering Devon's presentation, a potential DSM-5 diagnosis could include Bulimia Nervosa (ICD-10 code: F50.2), characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain, such as purging. Specifiers may include mild, moderate, severe, or extreme based on the frequency and severity of his symptoms. Additionally, relevant Z codes may include Z63.0 (Problems in relationship with spouse or partner) to address the relational distress following his breakup with Marcus and Z55.9 (Problems related to education and literacy) to acknowledge his previous counseling experience and ongoing struggles with disordered eating. By incorporating cultural components and contextual factors into the diagnostic formulation, clinicians can ensure a more comprehensive understanding of Devon's concerns and tailor interventions to address his unique needs and experiences.

Rational For Diagnosis Impressions The rationale for diagnosing Devon with Bulimia Nervosa is grounded in a careful examination of his symptoms and behaviors, as disclosed during the counseling session. Devon's description of recurrent binge eating episodes, coupled with subsequent purging behaviors, aligns closely with the diagnostic criteria outlined in the DSM-5. Specifically, his sense of loss of control during binge eating episodes, followed by attempts to compensate for caloric intake through vomiting, mirrors the characteristic features of Bulimia Nervosa. Furthermore, Devon's revelation that these behaviors have escalated in response to the breakup with Marcus underscores the significant impact of psychosocial stressors on his disordered eating patterns, highlighting the need for a comprehensive diagnostic approach that considers both individual symptoms and contextual factors. Addressing all necessary diagnostic characteristics, Devon exhibits the core symptoms associated with Bulimia Nervosa, including recurrent binge eating episodes, a sense of lack of control during these episodes, and compensatory behaviors aimed at preventing weight gain. Additionally, his preoccupation with body shape and weight, as evidenced by his statements about fearing becoming "fat and unlovable," further supports the diagnosis. Furthermore, Devon's disclosure of using purging as a maladaptive coping mechanism to alleviate negative emotions underscores the functional impairment associated with the disorder. Integrating insights from the course and literature on eating disorders, Devon's case highlights the multifaceted nature of Bulimia Nervosa, influenced by biological, psychological, and sociocultural factors. By considering these factors in the diagnostic process, counselors can ensure a comprehensive understanding of Devon's condition and tailor interventions effectively to address his unique needs and experiences. Differential Diagnostic considerations While considering differential diagnoses for Devon, several other possibilities may arise but could be ruled out based on the information provided. One potential diagnosis could be binge eating disorder (BED), characterized by recurrent episodes of binge eating without compensatory purging behaviors. However, Devon's reported use of purging methods such as vomiting indicates behaviors consistent with bulimia nervosa rather than BED. Another consideration might be major depressive disorder (MDD), given Devon's feelings of sadness and self-hate following his breakup. However, the primary focus of Devon's distress appears to be related to his disordered eating behaviors rather than being solely indicative of a depressive disorder. Additionally, generalized anxiety disorder (GAD) could be considered due to Devon's reported feelings of anxiety, but the onset and intensity of his symptoms seem more closely tied to his relationship breakup and disordered eating patterns rather than generalized worry or anxiety. Therefore, while these alternative diagnoses may initially seem plausible, a careful examination of Devon's symptoms suggests that bulimia nervosa is the most appropriate diagnosis based on the available information. Cultural Considerations

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