Anxiety Disorders

Obsessive Compulsive Disorder and Eating Disorders

INTRODUCTION

Obsessive-Compulsive and Related Disorders

In this unit, you will learn about the obsessive-compulsive and related disorders including obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation disorder (skin-picking disorder) (American Psychiatric Association, 2013). Certain obsessive-compulsive and related disorders are characterized by excessive or repetitive behaviors (for example, hand washing, checking, or ordering) while others are categorized by recurrent body-focused repetitive behaviors (for example, hairpulling or skin-picking). Like anxiety disorders, the etiology of obsessive-compulsive and related disorders may be attributed to biological and environmental factors.

TOGGLE DRAWERHIDE FULL INTRODUCTION

Psychiatric medications, often called psychotropic medications, are used in a variety of contexts to treat diagnosed mental disorders. Some medications have been found to be effective in the treatment of a wide range of mental disorders, particularly when they are used in combination with counseling or psychotherapy, including anxiety, depression, and OCD. When used as prescribed, they may affect physiological as well as psychological changes that aid clients in feeling a remission of their primary symptomology. While no medication can cure a mental disorder, these medications may be effective in treating the various symptoms associated with the disorder itself.

Feeding and Eating Disorders

The second part of this unit focuses on Eating Disorders. In anorexia nervosa and bulimia nervosa, a person's evaluation of his or her own body weight or shape is distorted, and he or she engages in specific behaviors, including restricting intake of food and purging (Nolen-Hoeksema, 2020). It is important to recognize the influence of social and cultural factors on the ways in which a person defines physical attractiveness. The media, for example, present constant images of thin, young women in magazines, commercials, TV shows, and movies; these images impact the ways in which children, teens, and adults think about what is attractive or beautiful. Furthermore, a person's self-image is influenced by the ways in which his or her own family regards food, eating, exercise, and physical size and shape.

Click Unit 5: Theories of Psychopathology to see a video introduction for Unit 5.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Nolen-Hoeksema, S. (2020). Abnormal psychology (8th ed.). New York, NY: McGraw-Hill.

Readings

Use your Abnormal Psychology text to read the following:

· Chapter 5, "Trauma, Anxiety, Obsessive-Compulsive, and Related Disorders," pages 103–104 and 134–140.

. This reading will help you understand the range of disorders that are associated with trauma and stress.

· Chapter 12, “Eating Disorders,” pages 327–352.

Internet Resource

· American Psychiatric Association. (n.d.). Retrieved from https://www.psychiatry.org/

. Use the APA website to locate the ICD diagnostic codes. Enter “ICD” into the search field to locate the most up to date resources. You will use the codes in your assignment.

DSM-5 Review

Use the DSM-5 to read the following:​

· In Section II, "Relational Problems."

. Read these pages in the chapter "Other Conditions That May Be a Focus of Clinical Attention."

· From Section II, "Anxiety Disorders."

· From Section II, "Obsessive-Compulsive and Related Disorders."

· From Section II, "Feeding and Eating Disorders."

Multimedia

· Click The Case of Jenny to view the case study.

· Click The Case of Marisol to view the case study.

Optional – Readings

· Burton, A. L., Abbott, M. J., Modini, M., & Touyz, S. (2016). Psychometric evaluation of self‐report measures of binge‐eating symptoms and related psychopathology: A systematic review of the literature. International Journal of Eating Disorders, 49(2), 125–142.

· Sandberg, K., & Erford, B. T. (2013). Choosing assessment instruments for bulimia practice and outcome research. Journal of Counseling and Development: JCD, 91(3), 367–379.

· Sysko, R., Glasofer, D. R., Hildebrandt, T., Klimek, P., Mitchell, J. E., Berg, K. C., . . . Walsh, B. T. (2015). The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders. International Journal of Eating Disorders, 48(5), 452–463.

·

This activity will help you achieve the following learning components:

· Consider biological perspectives for presenting symptoms.

· Explore resources to aid in differential diagnosis.

· Explore assessment tools that collect information relevant to identifying systemic issues.

Diagnostic Skill Application I

For this assignment, you will work with two case studies (linked in the Resources):

· The Case of Jenny: Jenny is a 29-year-old single female who lives with her mother. She is bisexual, but is not currently dating. Jenny was recently in a relationship with a man, and they lived together briefly. They parted amicably when they just did not seem to be enjoying being together. Jenny moved back in with her mother, Barbara, to allow her boyfriend to take in a roommate to cover her share of the rent. She works as a bank teller and makes a modest income. She felt moving back home would allow her to provide some financial help to her mother. Jenny’s mother raised her as a single parent. Jenny and Barbara have shared many ups and downs over the years. Things were never easy, but they always made it through. Barbara is becoming increasingly concerned that Jenny is giving up on life and needs to snap out of it.

· The Case of Marisol: Marisol is a 40-year-old single female from a tight-knit Puerto Rican family. She is employed full time as a data analyst for a technology company. She has steadily progressed in her career by working for relatively small companies, where her role allowed her to work relatively independently. Unfortunately, working for small organizations was less stable financially, so she has been working for a larger company for the past four years. Interacting with a larger work group has challenged her comfort zone. She prefers to spend time with a network of close friends she has known most of her life, with whom she visits one-on-one. Her family lives in the area, and she sees them frequently. Her parents and older brother have always provided a support system and practical help. She enjoys quiet evenings alone or at the home of her brother and his family. Her friends and family privately wonder why she has never dated or wanted to travel.

Download Unit 5 Assignment Template. Use it to complete your assignment

Instructions

For each case study, you will complete a descriptive diagnosis using tools you select from the list of assessment tools provided later in the assignment. Each case requires the following information to be addressed:

· Identify presenting concerns from the client’s perspective as described in the video and accompanying narrative. Include relevant cultural and systemic considerations that frame the client's presentation.

· Describe what information has been provided in each case that helps to determine which disorders are appropriate for consideration (differential diagnoses) for a final diagnosis. Evaluate how at least one assessment tool, which is listed in the List of Assessment Tools resource, will aid in obtaining further information to back up your final diagnosis. The Differential Diagnosis Decision Tree may be helpful to guide this process.

· Present DSM-5 and ICD-10 codes, including relevant Z codes.

· Provide a descriptive rationale for the DSM diagnosis that best fits the information provided including relevant ICD codes. This should be written in a narrative form using complete sentences. Support your rationale with scholarly sources. Optional readings found in the course syllabus may be particularly relevant.

· Determine if a medication consultation is appropriate and provide a rationale with support from scholarly sources.

List of Assessment Tools and Supporting Resources

· Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory. Psyctests, doi:10.1037/t02025-000

. Bardhoshi, G., Duncan, K., & Erford, B. T. (2016). Psychometric meta‐analysis of the English version of the Beck Anxiety Inventory. Journal of Counseling & Development, 94(3), 356–373.

. Review this source to review how to interpret the Beck Anxiety Inventory.

· Derogatis, L. R. (1977). Symptom checklist-90–revised. Psyctests, doi:10.1037/t01210-000

· Grande, T. L., Newmeyer, M. D., Underwood, L. A., & Williams, C. R. (2014). Path analysis of the SCL-90-R: Exploring use in outpatient assessment. Measurement and Evaluation in Counseling and Development, 47(4), 271–290.

. Review this source to review how to interpret the SCL-90-R.

· Prevatt, F., Dehili, V., Taylor, N., & Marshall, D. (2015). Anxiety Symptom Checklist. Psyctests, doi:10.1037/t39906-000

· Beck Depression Inventory–II

· Erford, B. T., Johnson, E., & Bardoshi, G. (2016). Meta-analysis of the English version of the Beck Depression Inventory–Second edition. Measurement and Evaluation in Counseling and Development, 49(1), 3–33.

. This resource will help you use the Beck Depression Inventory-II if you access that assessment tool.

Submission Requirements

· Written communication: Written communication must be grammatically correct and free of errors that detract from the overall message. Writing should be consistent with graduate level scholarship.

· APA formatting: Title page, main body, and references should be formatted according to the current APA style and formatting.

· Number of resources: Minimum of six scholarly resources. Distinguished submissions typically exceed this minimum.

· Length of paper: 5–7 typed double-spaced pages. Abstract and Table of Content pages are not necessary.

· Font: Times New Roman, 12 point.

THE CASE OF JENNY

Jenny: It's just been happening for a long time. It seems like it's been forever, but I guess it's been at least the last several months. I feel like my mom has been hounding me about stuff for a long time, so maybe it's been longer. I don't know, but I really try to go ... I really try, I felt like I tried to do so many different things to feel better, and I just can't feel better. It's just this dark cloud constantly follows me around, and no matter what I do, everything goes wrong. My mom thinks it's just so easy. Go out with your friends, or go out on a date, or you just need to be out around people, but I don't even know what I would say to people, because I just have no motivation to even be around them, so when you don't have motivation to be around people, what do you say? Sometimes I'm just too tired because I don't know how this is possible, but I'm in bed a lot. When I get home from work, I take a nap. It's, I don't know, usually until like eight o'clock.

Then I'll get up, and I'll try to eat a little something, but I never really feel all that hungry, and then what else is there to do? I just go back to sleep, but I still feel tired all the time, and it's really tough for me to make it through the day. It seems like everything I try to do just doesn't work out, and everybody just tells me to, why don't you just go shopping, or why don't you do this, or you need to eat better, or you got to get out of bed, or you got to find something you enjoy doing, but I'm just not ... I just have no energy, and that's what they don't get. I just have no energy. It seems like a long time ago, I loved doing some things, and I loved going outdoors, and take walks, and I liked going out with my friends, but now, nothing. It seems like nothing's interesting, nothing's ... It just seems like things are hopeless, and the more effort I make, the worse things get.

I don't work on the weekend, so I end up sleeping a lot, and a lot of times I just think, "What's the point? Why even bother?" I don't know what I can do. I don't know, so I just think, why bother? I don't like when I think that, but I just can't help it, and I try to talk to my mom, but she just doesn't want to hear it, and she just thinks I'm ... I think the word lazy has come out of her mouth at least 50 times just this past week, so I just don't know what to do from here.

THE CASE OF MARISOL

Marisol: I don't know why it happens to me but anytime I go out with friends or do something related to work, I get so panicky and I get so anxious. I can't think. It's ridiculous. I know it's irrational. I know that, I don't know, maybe I don't know. I get all excited, I get panicky, I don't want to see people. I think they're all looking at me. I go to a function, I walk in and as soon as I walk in, I'm walking out the door. I get all flustered. I mean, it's hard to be like this. I don't want to be this way. I fear what people are gonna say about me, to me. It's something like I could walk out of a restaurant and the toilet paper is in my skirt or something and I got spinach in my teeth.

Now, does that happen? I'm always looking to check that nothing's there. Like now, coming to talk to you, I couldn't even get out of my car because I knew that they had so many people in the lobby. I want to be different. It's affected me so badly, I was up for a promotion and I couldn't even take it because it required me to talk to everyone and what were they gonna say about me? I don't know. What were they gonna say?

Diagnostic Skill Application I Scoring Guide

Due Date: End of Unit 5 Percentage of Course Grade: 15%.

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Identify the main symptoms observed in case studies including impact of biological and neurological mechanisms.  16%	Does not identify the symptoms observed in case studies.	Identifies the symptoms observed in case studies, but with errors or omissions.	Identifies the symptoms observed in case studies including impact of biological and neurological mechanisms.	Identifies the symptoms observed in case studies including impact of biological and neurological mechanisms with scholarly support.
Identify the methods used for differential diagnosis in case studies. 14%	Does not identify methods used for differential diagnosis of clients.	Identifies the methods used for differential diagnosis in case studies, but with errors or omissions.	Identifies the methods used for differential diagnosis in case studies.	Identifies the methods used for differential diagnosis in case studies; includes the application of a DSM decision tree.
Describe the application of specific symptom checklists appropriate to each case. 14%	Does not describe the application of specific symptom checklists appropriate to each case.	Describes incorrectly or incompletely the application of specific symptom checklists appropriate to each case.	Describes the application of specific symptom checklists appropriate to each case.	Describes the application of specific symptom checklists appropriate to each case with clear connection to the differential diagnosis.
Describe the application of specific assessments relevant to marriage, couple, and family counseling appropriate to each case. 14%	Does not describe the application of specific assessments relevant to marriage, couple, and family counseling appropriate to each case.	Describes incorrectly or incompletely the application of specific assessments relevant to marriage, couple, and family counseling appropriate to each case.	Describes the application of specific assessments relevant to marriage, couple, and family counseling appropriate to each case.	Describe the application of specific assessments relevant to marriage, couple, and family counseling appropriate to each case supported by scholarly literature.
Apply the current DSM and ICD to the diagnosis of a client seen in family counseling, providing support for diagnostic choices. 14%	Does not apply the DSM-5 and ICD system to the diagnosis of a client seen in family counseling.	Applies some aspects of the DSM and ICD to the diagnosis of a client seen in family counseling but does not provide support for diagnostic choices.	Applies the current DSM and ICD to the diagnosis of a client seen in family counseling, providing support for diagnostic choices.	Applies the current DSM and ICD to the diagnosis of a focus client seen in family counseling and an additional family member, and providing support for diagnostic choices.
Describe the rationale for appropriate medical referral and consultation. 14%	Does not describe the role of psychopharmacological medications for appropriate medical referral and consultation.	Only generally describes the rationale for appropriate medical referral and consultation.	Describes the rationale for appropriate medical referral and consultation.	Describes the role of psychopharmacological medications for appropriate medical referral and consultation and incorporates relevant examples.
Communicate effectively through the consistent use of APA guidelines for grammar, punctuation, and mechanics expected of a counseling professional. 14%	Does not use APA guidelines for grammar, punctuation, and mechanics.	Uses APA guidelines for grammar, punctuation, and mechanics inconsistently.	Communicates effectively through the consistent use of APA guidelines for grammar, punctuation, and mechanics expected of a counseling professional.	Communicates clearly and effectively through the consistent and correct use of APA guidelines for grammar, punctuation, and mechanics expected of a counseling professional.