Question

Review the case study of Ellen. Come up with a DSM diagnosis based on the information provided, as well as a treatment plan to touch on all of the issues this client expressed. Use the following webpage link to access DSM diagnostic categories and their criteria.

Case Study: Ellen Smalls

Ellen Water’s psychotherapist referred her for a medication consultation because of her continuing depressed mood and panic attacks. She is a 37-year-old part-time graduate student who lives alone and supports herself by working as a home health aide. She completed the course work for a Ph.D. in psychology 3 years ago, but has not yet begun her dissertation.

            Ellen is indeed an unhappy-looking woman and describes being unhappy through much of her life, with no long periods of feeling really good. Her father had a history of alcohol problems, and there was always a great deal of strife in her parents’ marriage. She denies sexual or physical abuse, but feels that her parents were “emotionally abusive” to her. She was first referred for treatment after she made a suicide attempt at age 14, and there have been many times over the years during which her usual low-level depression has become considerably worse, but she has not sought treatment.

            Two years ago, when she had been seeing her current boyfriend for about 4 years, it finally became clear that he was unwilling to marry her or live with her. She began to get more depressed and to experience acute panic attacks, and it was at that time that she entered psychotherapy.

            In the month before consultation, she says she was depressed most of the time. She gained about 10 pounds because she was constantly nibbling on chips or cookies or making herself peanut butter sandwiches. She often awakened in the middle of the night, was unable to go back to sleep for hours, and then overslept the following day, often sleeping up to 18 hours. She says she feels like dead weight, her legs and arms are heavy, and she is always tired. She ruminates about her own failures and cannot concentrate on any serious reading. Although she often wishes to be dead, she has not made any recent suicide attempts.

            Ellen’s academic and vocational history have been erratic. She has a master’s degree in psychology and worked as a counselor for a while, but found this too upsetting. She then began a Ph.D.program in psychology, completed her course work, but interrupted this to train in physical therapy. She has never worked in one job for more than a few years and has sent much of her adult life as a student.

Her current romance is the longest she has sustained. She lived with a man once previously, but this was a brief and tumultuous relationship. Boyfriends have described her as “needy and clinging.”And it appears her current boyfriend fears her neediness.

            Although Ellen reports chronic depression, when she is asked about “high” periods, she describes many episodes of abnormally elevated mood that have lasted for several months. During these times she would function on 4 or 5 hours of sleep a night, run up huge telephone bills, and feel that her thoughts were racing. She was able to get a lot done, but her friends were obviously concerned about the change in her behavior, urging her to “slow down” and “calm down.” She has never gotten into any real trouble during these episodes.