Question: Diagnose each person with the appropriate psychological disorder and provide rationale for your diagnosis. Descriptions of psychological disorders are found in chapter 14. Provide a treatment plan for each case. The treatment plan should include psychotherapy, drugs, or a combination of the two. You should be as specific as possible here, and include

1. Diagnose each person with the appropriate psychological disorder and provide rationale for your diagnosis. Descriptions of psychological disorders are found in chapter 14.

2. Provide a treatment plan for each case. The treatment plan should include psychotherapy, drugs, or a combination of the two. You should be as specific as possible here, and include the specific kind of psychotherapy and the specific kinds of drugs most likely to help the person. The treatment plan you propose should be appropriate and supported by evidence.

Rhonda is a very thin 19-year-old single ballet student who comes in at the insistence of her parents for a consultation concerning her eating behavior. Rhonda and her family report that she has had a lifelong interest in ballet. She began to attend classes at age 5, was recognized by her teachers as having impressive talent by age 8, and since age 14 has been a member of a national ballet company. Rhonda has had clear difficulties with eating since age 15 when she began to induce vomiting after what she felt was overeating. The vomiting was preceded by many years of persistent dieting begun with the encouragement of her ballet teacher. Over the past 3 years, Rhonda’s binges have occurred once a day in the evening and have been routinely followed by self-induced vomiting. The binges consist of dozens of cinnamon sugar rice cakes or, more rarely, a half gallon of ice cream. Rhonda consumes this food late at night, after her parents have gone to bed. For some time, Rhonda’s parents have been suspicious that their daughter has a problem with her eating, but she consistently denied difficulties until about a month before this consultation.

Brief History

Rhonda reached her full height of 5’8” at age 15. Her highest weight was 120 pounds at age 16, which she describes as being “fat.” For the past 3 years, her weight has been reasonably stable at between 100 and 104 pounds. She exercises regularly as part of her profession, and she denies the use of laxatives, diuretics, or diet pills as methods of weight control. Except when she is binge eating, she avoids the consumption of high-fat foods and sweets. Since age 15, she has been a strict vegetarian and consumes no meat or eggs and little cheese. For the past 3 or 4 years, Rhonda has been uncomfortable eating in front of other people and goes to great lengths to avoid such situations. This places great limitations on her social life. Rhonda had two spontaneous menstrual periods at age 16 when her weight was about 120 pounds, but she has not menstruated since.

After completing high school, Rhonda became a full-time member of the ballet company. Ballet classes and rehearsals occupy her for about 4 hours a day, and she spends most of the rest of her time reading. She finds historical novels particularly interesting.

Rhonda’s parents describe her as being a serious and able student, although they are concerned about her social isolation. She has few friends and has never dated or had any sexual experiences. She says she doesn’t do very well in social situations because she never knows what to say or how to act, and she feels intimidated by any gregariousness in others. She can “just tell” that others don’t like her and don’t enjoy being around her, and that they think what she says is stupid. The friends she does have are women she has known since childhood, who have learned to be very gentle with her and say only kind and supporting things.

During the interview, Rhonda is embarrassed and somewhat guarded in describing her eating behavior and chooses her words carefully. She reports concern about her inability to control her overeating, fearing that it might cause her to gain weight, but thinks she has no particular problems otherwise. Her demeanor is serous and humorless, but she does not seem depressed. There is no evidence of a formal thought disorder.