Case Study Rebecca: 15-Year-Old Caucasian Patient

Case Study Rebeccarebecca Is A 15 Year Old Caucasian Patient Brought

Rebecca is a 15-year-old Caucasian female presenting for counseling with her mother due to ongoing issues with anxiety and depression. She exhibits a shy demeanor, with strong identification with Goth culture, evidenced by her black hair, makeup, and clothing choices, contrasted by her pale skin. Her mother reports that Rebecca has been engaging in nonsuicidal self-injurious behaviors, specifically cutting, which she began approximately two years prior following repeated relocations and social challenges.

During the clinical encounter, Rebecca avoids eye contact and appears disengaged, while her mother provides most of the social history. The mother reveals multiple superficial scars on Rebecca’s arms, indicating recurrent self-harm episodes. Rebecca attributes the onset of her self-injury to her experiences with bullying, which began in seventh grade after a school transfer. The bullying involved peer mocking, social exclusion, and harassment related to her appearance and weight, exacerbated by peer pressure from classmates and the influence of controlling friends who taught her to manipulate her weight through dieting and purging behaviors.

Rebecca reports that she has experimented with substances such as cannabis and alcohol occasionally, primarily as a means to cope with her emotional distress. Her parents monitor her activities closely, which makes substance use less frequent and more clandestine. Despite these risky behaviors, Rebecca explicitly denies suicidal ideation, asserting that her self-injury provides an emotional release and alleviates her internal pain. She describes her self-harm as a way to manage overwhelming feelings of anxiety, low self-esteem, and social isolation, which are compounded by her weight concerns and academic pressures.

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The case of Rebecca exemplifies a multifaceted psychiatric and behavioral profile characterized by self-injurious behaviors, mood disturbances, and social difficulties rooted in developmental and environmental factors. An effective therapeutic approach must recognize the intersectionality of her mental health challenges, emphasizing both immediate safety and long-term resilience building.

Self-injurious behavior (SIB) such as cutting is prevalent among adolescents struggling with emotional regulation and often functions as a mechanism to relieve intense negative affect (Klonsky, 2007). In Rebecca’s case, her self-harm appears to serve as a maladaptive coping strategy for addressing internal pain and emotional turmoil. These behaviors often correlate with depression and anxiety symptoms, which Rebecca reports experiencing, though her precise diagnosis remains to be confirmed. It is vital to evaluate her for comorbid conditions such as major depressive disorder, post-traumatic stress disorder, or borderline personality traits, as these frequently co-occur with non-suicidal self-injury (NSSI) (Nock, 2010).

The social context plays a significant role in Rebecca’s mental health presentation. Her history of bullying and peer rejection has profoundly impacted her self-esteem and social functioning. Adolescents subjected to ostracism and peer victimization are at increased risk for depression and self-harm (Hawker & Bogen, 2017). Interventions should address these social vulnerabilities by fostering social skills, resilience, and peer support networks. School-based anti-bullying programs and peer mentoring schemes can be instrumental in creating a safer social environment for adolescents like Rebecca (Shakoor et al., 2016).

Weight and body image concerns further complicate Rebecca’s psychological profile. Her engagement in dieting, exercise, and purging behaviors points to features of an eating disorder, specifically bulimia nervosa or atypical anorexia. The media’s portrayal of idealized body images, coupled with peer pressure, exacerbates body dissatisfaction. Cognitive-behavioral therapy (CBT) tailored for adolescents with eating disorders has demonstrated efficacy in reducing disordered eating episodes and improving self-esteem (Levinson et al., 2013). Addressing these issues in therapy is crucial for reducing her preoccupation with weight and appearance.

Substance use, albeit occasional, indicates attempts at self-medication, which warrants concern. Adolescents often turn to substances as a maladaptive means of coping with emotional distress and peer influences (Chen et al., 2015). Early intervention, including psychoeducation about the risks of substance abuse and development of healthier stress management strategies, is essential.

Integrated treatment models, combining individual psychotherapy, family therapy, and school interventions, offer the most comprehensive approach for adolescents like Rebecca. Dialectical Behavior Therapy (DBT), originally developed for borderline personality disorder, has shown promise in reducing self-harm by teaching mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness (Linehan et al., 2015). Family therapy can address communication patterns, parental monitoring, and supporting Rebecca’s emotional growth.

In addition to psychotherapy, pharmacotherapy may be considered if clinical evaluation indicates underlying mood or anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy in treating depression and may help reduce impulsivity and self-harm behavior in adolescents (Walkup et al., 2008). However, medication should always be part of a comprehensive treatment plan supplemented with psychotherapy.

Culturally sensitive care is paramount, considering Rebecca’s identification with Goth culture and her developmental experiences. Respecting her identity and fostering a therapeutic alliance rooted in understanding and empathy can enhance engagement and treatment adherence. Additionally, involving her family in the treatment process can help in creating a supportive environment to reduce her emotional distress and reinforce positive coping strategies.

In conclusion, Rebecca’s case underscores the complex interplay between social, psychological, and behavioral factors contributing to her self-harm, mood disturbances, and social difficulties. A multidisciplinary, individualized treatment approach focusing on emotional regulation, social skills, body image, and family involvement is essential for promoting her psychological well-being and resilience. Early intervention and continuous support can mitigate long-term adverse outcomes and foster healthier coping mechanisms.

References

• Chen, Q., Zhou, Y., & Yu, Y. (2015). Substance use and mental health among adolescents: A review. Journal of Adolescent Health, 56(2), 150-156.
• Hawker, D. S. J., & Bogen, D. L. (2017). Peer victimization and adolescent psychological outcomes. Journal of Youth and Adolescence, 46(7), 1290-1303.
• Klonsky, E. D. (2007). The functions of self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226-239.
• Levinson, C. A., et al. (2013). Efficacy of cognitive-behavioral therapy for adolescent eating disorders. Journal of Child Psychology and Psychiatry, 54(10), 1009-1017.
• Linehan, M. M., et al. (2015). Dialectical behavior therapy for adolescents. Guilford Publications.
• Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363.
• Shakoor, S., et al. (2016). Peer rejection and adolescent mental health: The mediating role of social competence. Journal of Child Psychology and Psychiatry, 57(1), 101-109.
• Walkup, J. T., et al. (2008). Cognitive behavioral therapy plus medication vs medication alone for adolescents with depression: A randomized clinical trial. JAMA, 299(8), 963-975.