Sandra Case Intake Date: July 2020 Presenting Problem ✓ Solved

CASE SANDRA INTAKE DATE: July 2020 PRESENTING PROBLEM

Patient was brought to counseling by her mother. Following an argument with her parents, she threatened to cut her wrist. Prior to this threat, Sandra’s mother says she started screaming and became very angry with her after discussing her eating habits.

PSYCHOLOGICAL DATA: Sandra is a 14-year-old white female who resides in Pennsylvania with her parents and older sister. She appears to be of average intelligence as she was able to respond to numerous questions in an articulate and intelligent manner. She was well versed about world history and current affairs. Her mother confirms that she has always done pretty well in school, maintaining a “B” average, although IQ testing indicates she could do better. She has always been somewhat of a perfectionist and likes to do well, and studies hard to get good results. Sandra participates in various school activities (e.g. chorus, school newspaper).

Sandra is quite shy and reserved in character but is generally well-liked by people. She started going out with a boy from her class and feels very happy. After a few weeks, her boyfriend dumped her and began going out with her best friend. Sandra feels an overwhelming sense of betrayal and hurt, and tried to talk to her family about it, who tells her “there are plenty more fish in the sea,” and not to worry about it. Sandra feels ashamed and embarrassed of her feelings and very alone. Not only has she lost her boyfriend but also her best friend, and no one around her seems to understand the severity of what she is going through.

To Sandra, whose life as a teenager revolves heavily around her friends, she feels she has lost everything. In order to cope and distract herself, she plunged herself into her studies, though her concentration is off. She began eating less since she loses her appetite quickly, and within a few weeks, people started commenting on how fantastic she looks with her weight loss. She went to a party one night in a tight fitted dress and received a large amount of attention from the boys. In a very difficult and painful time, Sandra finally finds she was praised for something, and began to more consciously restrict her food intake to ensure that she continues to lose weight and feel good about herself.

At times, Sandra finds herself eating more than she wants and goes into the bathroom and induces vomiting to rid herself of the extra calories. She has done this about 3 times over the past several months. MEDICAL HISTORY: Sandra had a complete physical by her doctor in June 2020. The doctor identified that Sandra was thin but remained in her weight range for her age. He also confirmed that she continued to have her menses. She denied any dieting or fasting to the doctor. More recently Sandra’s family began to worry about her, as she did not want to eat evening meals with them. Sandra’s friends also comment on how thin she is getting and jokingly put her on the scale. Sandra still maintained a weight within her height and body frame. Sandra sees this as a positive thing, believing it is praise and attention from others, but she has become completely obsessed with food.

She goes to bed at night counting the calories she has had in the day, and rigidly planning what she will eat the next day. SUBSTANCE ABUSE HISTORY: Sandra denies any drug or alcohol use. She states “I could do drugs if I wanted to. I don’t want to because it’s dumb.” PSYCHIATRIC HISTORY: Sandra denies any psychiatric history. MENTAL STATUS: Sandra was casually dressed. She was in a lively manner with good eye contact and the conversation flowed freely. Thought and speech patterns were clear. Affect was appropriate. She was oriented in three spheres. Sandra denies feeling depressed, anxious, or suicidal, although this was not a strong denial.

When questioned about her family’s concern of her eating habits, she suddenly became quiet, teary-eyed, lowered her head, and responded “you don’t understand it, I don’t want to hurt myself, there is nothing wrong.”

Paper For Above Instructions

### Introduction

The case of Sandra illustrates the intricate relationship between adolescents, their emotional well-being, and societal expectations, particularly concerning body image and eating habits. Through the examination of her psychological background, presenting issues, and the familial context, the present analysis aims to highlight the critical factors influencing Sandra's mental state and behavioral patterns.

### Psychological Background

Sandra, a 14-year-old girl, exhibits symptoms commonly associated with adolescent emotional distress and eating disorders. The triggering events leading to her behavioral changes, particularly the breakup with her boyfriend and the loss of her best friend, shed light on the emotional turmoil she is facing. At this developmental stage, friendships and romantic relationships are vital to identity formation and self-esteem (Arnett, 2014). Sandra's sense of betrayal and isolation exacerbates her existing perfectionist tendencies, pushing her towards unhealthy coping mechanisms like self-induced vomiting.

Her psychological profile indicates that she is intelligent and articulate, which further complicates her struggle. High achievers often experience heightened pressure to succeed, both academically and socially (Dunkley et al., 2017). Sandra's attempt to attain an idealized version of herself—garnered from societal standards—leads her to perceive weight loss as a form of success, thus skewing her self-image and self-worth.

### Familial Factors

The familial context presents another layer to Sandra's struggle. Her parents, though well-intentioned, minimize her emotional distress through clichéd phrases like “there are plenty more fish in the sea.” Such responses fail to validate her feelings, leaving her feeling misunderstood and alone (Dixon & Gibbons, 2018). The family's avoidance of deeper conversations regarding Sandra's eating habits further indicates a disconnect, potentially exacerbating her issue. Emotional support is crucial at this stage of development, and the lack thereof can lead to increased feelings of shame and isolation (Harter, 2012).

Furthermore, Sandra's experience with food and body image highlights the role of peer pressure and societal norms. The compliments she receives regarding her weight loss, while seemingly positive, reinforce her maladaptive behavior and obsession with food. This societal reinforcement can lead to a pathological relationship with food, as seen in cases of anorexia nervosa and bulimia nervosa (Treasure et al., 2015). Sandra's attempt to control her eating habits signifies a broader narrative often prevalent in adolescent girls, where weight becomes a measure of worth and acceptance.

### Coping Strategies

In light of her challenges, it is crucial to implement effective coping strategies for Sandra. Addressing her self-image and exploring healthier methods of self-expression is necessary, adequately supported by familial involvement. Cognitive Behavioral Therapy (CBT) has proven effective in restructuring harmful thought patterns associated with body image and disordered eating behaviors (Fairburn et al., 2015). Through understanding the cognitive distortions that Sandra may engage in, therapists can work with her to develop a more balanced and healthy perspective towards food and self-worth.

Additionally, involving her family in therapy sessions may enhance communication and provide a supportive environment where Sandra feels heard and understood. This family-based approach encourages shared experiences and teaches family members how to better support Sandra in her recovery journey (Le Grange et al., 2016).

### Conclusion

Sandra's case showcases a complex interplay between emotional distress, familial dynamics, societal influences, and personal coping mechanisms. A comprehensive approach addressing these multifaceted issues is paramount for her recovery. By fostering open communication, validating her feelings, and utilizing effective therapeutic interventions, Sandra can work towards developing a healthier relationship with food and herself. It is essential to remember that adolescent mental health is a critical aspect of overall well-being, and the support of family and professionals plays a significant role in navigating this tumultuous period.

References

  • Arnett, J. J. (2014). Adolescent development and the transition to adulthood. In J. W. Stedman (Ed.), Handbook of adolescent psychology.
  • Dixon, A. R., & Gibbons, F. X. (2018). Adolescent reactivity to peer evaluations: The role of social comparison. Journal of Youth and Adolescence, 47(8), 1597-1613.
  • Dunkley, D. M., et al. (2017). Perfectionism and eating disorders: The mediating role of self-criticism. International Journal of Eating Disorders, 50(5), 487-490.
  • Fairburn, C.G., et al. (2015). Cognitive behavior therapy for eating disorders. Guilford Press.
  • Harter, S. (2012). Self-Development throughout the Life Span.
  • Le Grange, D., et al. (2016). Family-based treatment for adolescents with anorexia nervosa: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 55(2), 110-118.
  • Treasure, J., et al. (2015). Anorexia nervosa and bulimia nervosa. Cambridge University Press.

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