BENCHMARK CASE PRESENTATION
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Basic Case Summary
Date of initial assessment: Thursday, February 15, 2024 Age: Twenty-two
Client’s Name: Beth Gender: Non-Binary
Employment Status: Employed Race/ Ethnicity: White
School Status: Not Currently Attending College Marital Status: Not Married
Reason for Referral/Presenting Concern
Beth, a 22-year-old individual assigned female at birth, has been experiencing a
significant increase in distress, affecting their daily life. They've been grappling with persistent
feelings of discomfort because of the breast they developed related to their assigned birth gender,
which have intensified over the past few months.
"I've been feeling really overwhelmed lately. It's like this constant weight on my chest
that just won't go away. Every time I look in the mirror, it's like I don't recognize the person
staring back at me. “I hate having boobs.” Lately it’s been going on for a while now, but it's
gotten so much worse recently. I can't even focus on work anymore because all I can think about
is how wrong my body feels."
Beth has been experiencing heightened anxiety and depression, feeling increasingly
isolated and disconnected from their surroundings. These feelings have led to difficulties in
maintaining relationships, both personal and professional.
"I used to be so outgoing, but now I just want to hide away from everyone. It kills me to
think someone is looking at my chest. "I haven't been sleeping well at all lately. I lie awake for
hours just tossing and turning, unable to shut off my brain.
Their distress has also manifested in physical symptoms, including disrupted sleep patterns and
changes in appetite.
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Overall, Beth's experience reflects a significant impairment in their daily functioning, as
they struggle to cope with the distress and discomfort associated with their gender identity. These
symptoms align with a possible diagnostic criterion for Gender Dysphoria in Adults outlined in
the DSM-5.
History
Family and Home/Religious Background
Beth grew up in a rural setting with the mother, Marland, and stepdad David. Emily, 48,
is a stay-at-home mom, while David, 58, is a retired coal miner. Beth has no siblings. The family
environment was generally supportive, until they divorced in 2015. However, Beth harbored
feelings of discomfort and confusion regarding gender identity from a young age, which Beth
struggled to discuss with the family due to fear of judgment.
Educational History
Beth excelled academically throughout the educational journey, consistently achieving
high grades. However, Beth dealt internally with feelings of dysphoria, occasionally impacting
the focus and motivation. Despite this, Beth maintained a positive attitude toward education,
viewing it as a means of achieving personal and professional growth.
Mental Health
Historically, Beth has experienced symptoms consistent with gender dysphoria, including
persistent distress and discomfort related to the assigned gender. Beth has also reported
symptoms of anxiety and depression, which have intensified over time. Formal mental health
assessments, including the DSM-5 cross-cutting symptom measure and Gender Dysphoria
Assessment, this assessment aims to evaluate the presence and severity of gender dysphoria
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symptoms. It typically includes questions about the individual's feelings of discomfort with their
assigned gender, desire to be of another gender, and experiences of gender-related distress.
Additionally, Beth experiences significant distress related to the breasts and desires their
removal, indicating a heightened level of dysphoria and dissatisfaction with the body.
Client’s Physical Health
Beth has a relatively stable physical health history, with no significant medical conditions
or chronic illnesses. Beth is not currently on any medications but has expressed a desire for
gender-affirming surgery to remove the breasts.
Occupational History
Beth has had a varied employment history, working in service, restaurant, and most
recently, a caretaker for Hilton hotels. While Beth has shown competence in work, feelings of
anxiety have occasionally impacted on occupational performance and satisfaction.
Sexual Adjustment
Beth identifies as non-binary and has experienced challenges in navigating sexual
orientation and gender identity within relationships. The distress related to the breasts may
impact comfort with the body during intimate situations and may influence preferences in
romantic partners. Additionally, the desire for gender-affirming surgery may be a significant
factor in sexual and romantic life.
Substance Use History
Beth reports occasional alcohol use but denies any patterns of substance abuse. Beth
states no drug use and does not engage in habitual substance use.
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Spiritual Assessment
While Beth does not adhere to any specific religious affiliation, spiritual and personal
beliefs about the universe and the place within it. Beth finds solace in nature and meditation
practices but does not attend formal religious services.
Cultural/Social Justice Factors
Beth faces cultural and social justice factors related to gender identity, including societal
discrimination and lack of understanding. These factors contribute to feelings of isolation and
may impact willingness to seek treatment.
Barriers to Treatment/Success
Personality factors, cultural influences, and the stage of change may present barriers to
Beth's success in treatment. Additionally, societal stigma surrounding gender dysphoria and
mental health could hinder progress.
Other Pertinent Data
Beth's distress regarding the breasts and the desire for surgery to remove them significantly
impact the quality of life and underscores the severity of an undiagnosed gender dysphoria. This
aspect of the experience is essential for understanding the treatment needs and motivations.
