Assignment

CASE of SANAYA

Intake Date: March 15, 2021

IDENTIFYING/DEMOGRAPHIC DATA:

Sanaya is 22 years old and the oldest child of two Pakistani parents. Her father owns a heating and air conditioning company and her mother is a stay at home mom. The family immigrated from Pakistan 7 years ago. Sanaya has one younger brother, aged 9, who has been diagnosed with attention deficit hyperactivity disorder (ADHD).

CHIEF COMPLAINT/PRESENTING PROBLEM:

Sanaya attended this session because her roommates finally insisted that she get some help, as she had gone from “slight” to “reed thin.” Sanaya stated that they are worried that she has an eating disorder. Sanaya denies any eating disorder, but she admitted that she often has no time for meals and at times has “no appetite.” Drinking still gets her bloated and she is just not hungry. She reports mild nausea often. Current weight was reported at 108 pounds.

HISTORY OF PRESENT ILLNESS:

As a freshman, she lived off campus with three other roommates. She has been waitressing in Tampa since freshman year at a bar/restaurant to supplement her spending. She had very good grades (B+ to A) in her first year of college.   The second year her grades started slipping and she began missing classes. She just could not concentrate. She reported not having interest in school at that time but wanted to graduate not to anger her parents.  She had to drop at least one course (and is retaking it now) due to nonattendance. “This is because I don’t get enough sleep,” Sanaya said, and she stated that she was simply unable to wake up in time for that course.  She struggled to get to sleep and woke up often.  She also reported being so tired during the day “it interfered with everything”.

Sanaya is now a junior. She still works long hours, and she recently took a course in bartending so she can serve drinks and “make more money.” She had managed to maintain a B grade point average while studying juvenile justice up until this year.

PAST PSYCHIATRIC HISTORY:

Sanaya denied any past psychiatric history. She does

SUBSTANCE USE HISTORY:

Sanaya rarely used alcohol in high school, due to her status as a varsity athlete which motivated her to limit her use. Sanaya began drinking with friends at the restaurant after closing 6 months ago. She started having a beer or two before going home. She now drinks every weekend with her college and “bar” friends. When she works the staff hang around in the restaurant having some drinks as well. She reported that over the last six months she has at times been “out all night partying, dancing, and drinking.” Sanaya reports beer bloats her so she now drinks several vodka and cranberry juice mixed drinks.

Sanaya does admit that she just can not make it to class very often because of her hangovers. Sanaya reported that she spent much of the last 2 months drinking at her workplace as well as at college parties. She used “hair of the dog” practices—e.g., a morning Bloody Mary—to feel better this past month, as she sometimes had mild hand tremors in the morning and was strongly nauseous. She admitted to being “foggy.” During these experiences, she claimed to have full memory (she denies blackouts) but reported that the hangovers make her “sound sensitive” with headaches. She said she “feels” normal by the end of the day most days, but she also stated that she has trouble sleeping several nights a week without an evening beer. She set some limits for herself, such as three cocktails per weekend evening, but she has often “not bothered” to maintain those limits for “other reasons.”

PAST MEDICAL HISTORY:

Sanaya appeared normally dressed and is 5’2” tall.

FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC:

Sanaya’s childhood was tumultuous. She was raised the first 5 years in Pakistan then the family moved to Saudi Arabia. They returned to Pakistan when she was 10 years old. Her father was jailed for political reasons and as soon as he was released they moved to London then the United States. She was raised Muslim and the entire family actively practice their religion. She reported that she has always worked hard at school and generally was an “A” student through high school. She ran track and was involved in many activities, socializing with boyfriends and her wide friendship circle. She had to keep secrets when dating since it was against her culture and religion to date.

CURRENT FAMILY ISSUES AND DYNAMICS:

She reported keeping many secrets from her parents. There were many fights over her decision to leave the state for college. After delaying admission for a year and working, Sanaya left her home in New Hampshire at 20 to attend college in Florida.

MENTAL STATUS EXAM:

Sanaya denies suicidal and homicidal ideation. She is oriented to time, place, and person. Her mood varies over the week, and she admitted to some anxiety and a tendency to get into “arguments” with her roommates when sober.