Abnormal (PSYC 356)

Abnormal psychology is a course that dives into the depths of each abnormal disorder. These disorder range from Bipolar disorder to body dysmorphia. This was one of my favorite classes because we were able to work on cases that were based off of real life cases. Also, a vital part of the class was talking about how media perceptions of the mentally ill have a negative connotation, thus giving the population a skewed view. This class worked on reducing stigma and how to spread correct educational incite.

This is one Case Conceptualization:

Case Conceptualization Project 2

Due: Monday, December 3rd


This case conceptualization project will be worth 150 points (out of the 1,000 total course points; 15% of the overall course grade). This project replaces a traditional final exam and is designed to be a final synthesis and application of information, concepts, and skills you have learned. You are encouraged to use your notes, your textbook, and the internet to help you complete these projects. You are also encouraged to email Dr. Ritzert or come to his office to ask questions. These projects, however, must be completed individually and must feature your own independent work. If your answers are based on the work of other or previous students, you will receive a zero.

Grading for this project will be based on both accuracy and the degree to which you demonstrate the critical thinking skills we have been practicing. For example, in the diagnosis section, a significant portion of the grading will be based on the rationale you present for the diagnosis and if you adequately communicate the connection between the diagnostic criteria and relevant pieces from the case example.

The case example presented in this project is based on a combination of several clients. Details of the case have been altered to maintain confidentiality and comply with APA ethical guidelines.


To complete this project, read the case example on the next page and then answer the questions that follow. Provide sufficient detail so as to comprehensively answer the questions. For example, when you suggest a treatment, not only define the treatment, but also explain how that treatment would be carried out. Please note that more detail will be needed on this case conceptualization project than was needed on the first. To ensure that you provide the necessary level of detail, make sure you address the questions within each section in a comprehensive manner. Because this project is worth 150 points, it is expected that each section will include a thoughtful, well-articulated, well-written answer that satisfactorily addresses each question and communicates your ideas well.

There are two options for turning in this project. You may either submit your project through Canvas by the deadline stated below (preferred) or turn in a paper copy to Dr. Ritzert. If you choose the latter option, Dr. Ritzert will be available in his office (Ruffner 303) during the final exam window. The deadline for turning in this project is December 3rd at 10:30 AM. Note that projects turned in one calendar day late (i.e., by December 4th at 11:59 PM) will not be penalized. Projects turned in on 12/5 will be eligible for 75% of the possible points, projects turned in on 12/6 will be eligible for 50% of the possible points, projects turned in on 12/7 will be eligible for 25% of the possible points, and those turned in after 12/7 will be eligible for zero points.

Case example:

You are a mental healthcare provider in the Eating Disorders Clinic. Your new client, Carmen, is an 18-year-old single woman. She recently graduated high school and lives with her mom. She was referred to the clinic by her primary care physician, who was concerned about Carmen’s eating behavior and the consequences of this behavior. The physician reports that Carmen is not experiencing any underlying medical disease, but that she is experiencing an electrolyte imbalance and early signs of tooth decay. Carmen first provided a brief history. She is an intelligent teenager and will be attending college soon. She is particularly talented in science and math and will be going into engineering. She has developed a small, close group of friends with whom she spends time, but describes herself as generally shy and introverted. Carmen is currently working a summer job at a movie theater.

In high school Carmen had a BMI (body mass index) in the low to mid 20s, which is in the “normal” range. During her freshman year, Carmen, like many high school students, struggled to fit in. She rarely interacted with other students. A few times during her freshman year, fellow students teased Carmen about her appearance, focusing on her body shape. Carmen developed a negative self-image, mostly focused on her body size and shape. She felt that she “would never fit in,” that she would never look or be good enough to be accepted by the other students, and that her body would not match the ideal that she felt pressure to match – despite the fact that others around her reassured her about her appearance.

Carmen displayed resiliency in the face of this emotional distress – she reported that she began to interact with her peers, make friends, and develop an active social life. Yet, on the inside, Carmen still felt sad. She believed that other people didn’t really like her, and only spent time with Carmen because she asked them to – even though her friends told Carmen that they valued having her as a friend. “Eventually, I started to believe that I was worthless or that something was wrong with me and that others wouldn’t ever really accept me,” she explained. Carmen began to focus more on her shape and weight, and reported that her self-esteem began to drop, as she felt that other people were more attractive. She reported that she began to lose interest in things she once enjoyed and that she found it difficult to find the energy to get going.

Eventually, Carmen found herself eating less – often skipping breakfast, eating a small lunch, and eating a normal-sized dinner. However, because she was eating less during the day, Carmen found that, by dinner time, she was, naturally, quite hungry. As a result, several times a week, Carmen began to eat meals that were far larger than normal, by several thousand calories, such that, in general, her total caloric intake was typical of someone her age. She would eat these meals by herself, quickly, and end up eating until she felt unconformable – feeling like she could not stop. Feeling a mix of guilt about these episodes and concern about her body shape, Carmen tried to “make-up” for eating the big dinners, sometimes by making herself throw up, and other times by engaging in large amounts of aerobic exercise the next morning, sometimes spending hours at the gym. Despite these behaviors, Carmen’s weight and BMI remained relatively stable.

Carmen explained that these experiences, including her low mood, feelings of worthlessness, beliefs about her body and low self-esteem, and eating behavior patterns continued over the next few years, up until now. Indeed, she says life right now is especially stressful because her parents recently divorced and because she will soon be going to college and moving away from her family and friends. Carmen reported that she has tried her hardest to make changes but feels like she needs assistance. She explained that she feels hope, is committed to working hard, and is ready to make changes in order to ultimately reach her long-term goals related to college and her career.

  1. Problem list: Identify the 3-5 most important problems ordered by importance.
  2. Food restriction – skipping breakfast, eating small lunches, and then eating a normal sized dinner
  3. Recurrent binge eating (several times a week)- because she has been restricting her food intake her body naturally made her more hungry by dinner, so she began eating meals that were larger than normal (by several thousand calories)
  4. Compensatory Behaviors- self induced vomiting (purging behavior),  spending hours at the gym after binge eating (non-purging)
  5. Negative self image of body weight and shape- started with teasing from other students, developed into her own thoughts that she would never be good enough or attractive enough for people to accept her
  6. Feelings of worthlessness- feels like something is wrong with her, that people would never accept her, loss of interest in things she once enjoyed, low energy
  • Diagnosis: Indicate the diagnoses for which the client meets diagnostic category. Explain how the client meets criteria for the indicated disorder(s). If the client meets criteria for multiple diagnoses, indicate which diagnosis is the primary diagnosis and explain why you made that determination.
  • Bulimia Nervosa- criteria
    • She started off with thoughts that her body weight and shape having a large negative influence on her self evaluation.
    • She started to have recurrent binge eating after dinner, about several thousand calories more than most individuals consume under similar circumstances. (lack of control (cannot stop eating), eats until feels uncomfortable, she quickly eats these meals by herself)
    • She self induces vomiting after consuming large amounts of food (purging compensatory behavior), and goes to the gym for hours after consuming large amounts of food (non-purging compensatory behaviors)

– After the episode she has feelings of guilt and concern about her body shape, then tries to “make up” for eating that much by doing compensatory behaviors

    • She does these behaviors several times a week for the last few years
    • Early signs of dental decay
    • Electrolyte imbalance

– Persistent Depressive Disorder:

– Low mood

  She reported that she began to lose interest in things she once enjoyed

– She finds it difficult to find the energy to get going

– poor appetite and overeating; changes in appetite (binging/ compensatory behaviors)

– Feelings of worthlessness, feels like something was wrong with her and others would never accept her

– Negative thoughts about herself and body image (low self esteem)

– life is stressful (parents recent divorce, going to college)

– Depressed mood more days than not for the last two years.

  1. Cognitive-behavioral maintenance process: Identify the main cognitive-behavioral process that appears to be underpinning and maintaining the client’s problems and explain how this process is  serving to maintain the problems.
  • Cognitive: attachment to unhelpful thoughts and beliefs
  • She has negative thoughts and beliefs about her body shape and size, that impede her life on a daily basis.
  • The thoughts are maintaining her mental health problems because they are a constant thought in the back of her head even when she has made friends that value her. The thoughts persist enough to cause her to engage in behaviors that she believes will make her feel more accepted by others.
  1. Treatment Plan: Identify two treatment goals that are specific, measurable, observable, and attainable. Explain why you identified the goals. Then, identify one intervention. Describe how the intervention would be carried out and explain how the intervention would both target for change the process maintaining the client’s struggles and how the process might help the client attain treatment goals.

Treatment goals:

  • Eat three normal sized meals a day with family
  • Schedule and do one activity that you enjoy once per week

I identified these goals because they are both specific and measurable because they are on a daily and/or weekly basis. Both goals are observable by herself, and her parents, and they are easily attainable because they are not time consuming or too drastic. The goal of eating three normal sized meals a day with family helps combat her eating disorders because she will be eating regularly and not over indulging or restricting.The goal of scheduling and doing one activity that she enjoys once per week would help her start enjoying the things she lost interest in and help elevate her mood and energy.

One intervention that I would put in place is to do cognitive behavioral treatment to combat the negative thoughts about her body image that maintain her behaviors. Her automatic thoughts are negative thoughts about her body size and shape. He reaction is negative and thus causes her to engage in behaviors like binge eating and compensatory behaviors. These thoughts are a core belief for her. This intervention would be carried out using cognitive restructuring to turn these thoughts into something more productive that do not result in negative behaviors. Since the thoughts may occur during meal times, a journal would be helpful to log the food that she ate along with a diagram of her negative thoughts that have to do with body shape and size. We would work on diagraming that thought as it comes to her head to have her work through it and not see it as something that controls her life. This way she can actively see and write the negative thoughts as they occur to help her work through them. This cognitive restructuring process would help her maintain her treatment goals because it would allow her to have a positive self esteem and eat full meals with the family instead of binging alone and it would help her start taking invest in the things she once enjoyed.