What event prompted gina's first symptoms of bipolar disorder

Based on the authors’ own clinical experiences, these seventeen comprehensive case histories reflect the most common psychological disorders. Rich in detail, inte- grated in approach, and fully updated for the DSM-5, each case describes patient symptoms and history, the formulation and implementation of a treatment plan, and results. Each case also includes the perspective of a family member or friend. This unique viewpoint emphasizes the impact of psychological disorders on those closest to the patient as well as the importance of considering sociocultural factors in diagnosis and treatment. Each case study concludes with assessment questions that help students check their understanding of the symptoms, diagnosis, and treatment of the disorder exhibited by the patient. Three additional cases provide opportunities for students to identify disorders and suggest appropriate therapies. Diagnostic information and treatment strategies for the patients in these “You Decide” cases are provided in appendices for students to check their assessments.

About the Authors Ethan E. Gorenstein is clinical director of the Behavioral Medicine Program at Columbia-Presbyterian Medical Center and a professor of clinical psychology in the department of psychiatry at Columbia University. He is also the author of The Science of Mental Illness (Academic Press). He has an active clinical practice de- voted to the use of evidence-based psychological treatment methods for problems of both children and adults.

Ronald J. Comer is a professor in the psychology department at Princeton Univer- sity and director of clinical psychology studies. He is also chair of the university’s Institutional Review Board. A clinical psychologist, he is the author of the text- books Abnormal Psychology and Fundamentals of Abnormal Psychology (Worth Publishers), Psychology Around Us (John Wiley and Sons Publishers), and producer of numerous educational videos on subjects ranging from abnormal psychology to introductory psychology and neuroscience.

For complete information on our books, electronic materials, and faculty and student resources, visit us at www.worthpublishers.com

C A S E S T U D I E S I N

ABNORMAL PSYCHOLOGY E t h a n E . G o r e n s t e i n a n d R o n a l d J . C o m e r

S E C O N D E D I T I O N

CASE STUDIES IN ABNORMAL PSYCHOLOGY S E C O N D E D I T I O N

W O R T H

Gorenstein ■ Com

er C A S E S T U D I E S I N

ABNORMAL PSYCHOLOGY E t h a n E . G o r e n s t e i n a n d R o n a l d J . C o m e r

S E C O N D E D I T I O N

Cover image: Gary Waters/Illustration Source

7.5 × 9.125 SPINE: 0.688 FLAPS: 0

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Case Studies in Abnormal Psychology SeCond edition

Ethan E. Gorenstein Behavioral Medicine Program

Columbia-Presbyterian Medical Center

Ronald J. Comer Princeton University

WoRtH PUBLiSHeRS Macmillan education

Vice President, Editing, Design, and Media Production: Catherine Woods Publisher: Kevin Feyen Senior Acquisitions Editor: Rachel Losh Senior Developmental Editor: Mimi Melek Assistant Editor: Katie Garrett Marketing Manager: Lindsay Johnson Marketing Assistant: Tess Sanders Art Director: Diana Blume Director of Editing, Design, and Media Production: Tracey Kuehn Managing Editor: Lisa Kinne Project Editor: Edgar Bonilla Production Manager: Sarah Segal Composition: Northeastern Graphic Printing and Binding: RR Donnelley Cover image: Gary Waters/Illustration Source

Library of Congress Control Number: 2014937988

ISBN-13: 978-0-7167-7273-6 ISBN-10: 0-7167-7273-6

© 2015, 2002 by Worth Publishers All rights reserved

Printed in the United States of America First printing

Worth Publishers 41 Madison Avenue New York, NY 10010 www.worthpublishers.com

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For Margee, eleazer, and Julian —e. e. G.

For delia and emmett —R. J. C.

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Preface vii

Case 1 Panic Disorder 1

Case 2 Obsessive-Compulsive Disorder 16

Case 3 Hoarding Disorder 31

Case 4 Posttraumatic Stress Disorder 45

Case 5 Major Depressive Disorder 60

Case 6 Bipolar Disorder 79

Case 7 Somatic Symptom Disorder 97

Case 8 Illness Anxiety Disorder 113

Case 9 Bulimia Nervosa 130

Case 10 Alcohol Use Disorder and Marital Distress 152

Case 11 Sexual Dysfunction: Erectile Disorder 170

Case 12 Gender Dysphoria 187

Case 13 Schizophrenia 202

Case 14 Antisocial Personality Disorder 220

Case 15 Borderline Personality Disorder 231

Case 16 Attention-Deficit/Hyperactivity Disorder 249

Case 17 Autism Spectrum Disorder 264

Case 18 You Decide: The Case of Julia 281

Case 19 You Decide: The Case of Fred 289

Case 20 You Decide: The Case of Suzanne 296

CONTENTS

Preface vii

Case 1 Panic Disorder 1

Case 2 Obsessive-Compulsive Disorder 16

Case 3 Hoarding Disorder 31

Case 4 Posttraumatic Stress Disorder 45

Case 5 Major Depressive Disorder 60

Case 6 Bipolar Disorder 79

Case 7 Somatic Symptom Disorder 97

Case 8 Illness Anxiety Disorder 113

Case 9 Bulimia Nervosa 130

Case 10 Alcohol Use Disorder and Marital Distress 152

Case 11 Sexual Dysfunction: Erectile Disorder 170

Case 12 Gender Dysphoria 187

Case 13 Schizophrenia 202

Case 14 Antisocial Personality Disorder 220

Case 15 Borderline Personality Disorder 231

Case 16 Attention-Deficit/Hyperactivity Disorder 249

Case 17 Autism Spectrum Disorder 264

Case 18 You Decide: The Case of Julia 281

Case 19 You Decide: The Case of Fred 289

Case 20 You Decide: The Case of Suzanne 296

vi Contents

Appendix A You Decide: The Case of Julia 304

Appendix B You Decide: The Case of Fred 306

Appendix C You Decide: The Case of Suzanne 308

References 311

Name Index 345

Subject Index 349

Appendix A You Decide: The Case of Julia 304

Appendix B You Decide: The Case of Fred 306

Appendix C You Decide: The Case of Suzanne 308

References 311

Name Index 345

Subject Index 349

Several fine case study books available today provide in-depth descriptions of psychological disorders and treatments. In writing Case Studies in Abnormal Psychology, Second Edition, we wanted to maintain the clinical richness of such books and in addition offer a number of important and unique features that truly help bring clinical material to life. In both the previous edition and this one, our approach helps readers to appreciate the different perspectives of clients, friends, relatives, and therapists; reveals the nitty-gritty details of treat- ment programs; and challenges readers to apply their clinical insights, think critically, and make clinical decisions. We believe that Case Studies in Abnormal Psychology, Second Edition, can stimulate a deeper understanding of abnormal psychology by use of the following features that set it apart from other clini- cal case books:

1. Multiple perspectives: As with other case books, our cases offer in-depth de- scriptions of clinical symptoms, histories, and treatments. In addition, however, each case looks at a disorder from the point of view of the client, the thera- pist, and a friend or relative. These different points of view demonstrate that a given disorder typically affects multiple persons and help readers to empa- thize with the concerns and dilemmas of both clients and those with whom they interact.

2. In-depth treatment presentations: Extra attention is paid to treatment in this book, particularly to the interaction between client and therapist. Our detailed treatment discussions help readers to fully appreciate how theories of treatment are translated into actual procedures and how individuals with particular problems respond to a clinician’s efforts to change those problems.

3. Research-based treatments, integrated approaches: The treatments de- scribed throughout the book represent approaches that are well supported by empirical research. In most of the cases, the treatment is actually an

PREFACE

viii Preface

integration of several approaches, again reflecting current trends and findings in the clinical research.

4. Balanced, complete, accurate presentation: Overall, a very balanced view of current practices is offered, with cases presented free of bias. Readers will find each of the major models of abnormal psychology—behavioral, cogni- tive, psychodynamic, humanistic, biological, and sociocultural—represented repeatedly and respectfully throughout the book, with particular selections guided strictly by current research and applications.

5. Stimulating pedagogical tools: An array of special pedagogical tools helps students process and retain the material, appreciate subtle clinical issues, and apply critical thinking. For example, every page of the book features marginal notes that contain important clinical and research points as well as other food for thought, each introduced at precisely the right moment. Testing shows that readers greatly enjoy this exciting technique and that it helps them to learn and retain material more completely.

6. Readers’ interaction and application: The final three cases in the book are presented without diagnosis or treatment so that readers can be challenged to identify disorders, suggest appropriate therapies, and consider provocative questions (stated in the margins). By taking the perspective of the therapist, readers learn to think actively about the cases and apply their clinical knowl- edge and insights. These three special cases, each entitled “You Decide,” are followed by corresponding sections in the appendix that reveal probable di- agnosis, treatment approaches, and important clinical information about the disorder under discussion.

7. Diagnostic checklists: Each case is accompanied by a diagnostic checklist, a detailed presentation of the key DSM-5 criteria for arriving at the diagnosis in question.

8. Real clinical material: The cases presented in this book are based on real cases, as are the treatments and outcomes. They are taken from our own clinical experiences and from those of respected colleagues who have shared their clinical cases with us.

9. Interwoven clinical material, theory, and research: Each case weaves to- gether clinical material, theoretical perspectives, and empirical findings so that readers can appreciate not only the fascinating clinical details and events but also what they mean. Similarly, they can recognize not only what and how treatment techniques are applied but why such techniques are chosen.

10. Current material and references: The theories and treatment approaches that are described reflect current writings and research literature. Indeed, we are proud to note that several exciting new cases have been added to this

ix Preface

second edition of Case Studies in Abnormal Psychology. In addition, the cases retained from the first edition have been carefully updated to reflect the clini- cal field’s growing insights, new research findings, and DSM-5-based diagnostic changes. Similarly, the second edition’s numerous margin notes are fully up to date, and like the cases themselves, they truly capture the state of affairs in the clinical field and world today.

11. Readability: Of course, every book tries to be interesting, readable, and widely appealing. But case books provide a unique opportunity to bring ma- terial to life in a manner that deeply engages and stimulates the reader. We have worked diligently to make sure that this opportunity is not missed, not only showing the diversity of our clients and therapists but making sure that readers walk away from the book with the same feelings of deep concern, passion, fascination, wonder, and even frustration that we experience in our work every day.

It is our fervent hope that the cases in this edition, like those in the first edi- tion, will inspire empathy for clients, their relatives, their friends, and their ther- apists. The practitioners described in these pages struggle mightily to maintain both their humanity and their scientific integrity, and we believe that humanity is indeed served best when scientific integrity is maintained.

A number of people helped to bring this project to fruition. Foremost are the clinicians and patients who dedicated themselves to the efforts described in these pages. We are particularly grateful to Danae Hudson and Brooke Whisen- hunt, professors of psychology at Missouri State University. These wonderfully talented individuals wrote the cases on somatic symptom disorder (Danae), and gender dysphoria (Brooke) for this edition. In addition, they helped revise and update the rest of the book. Throughout all of this work, their outstanding writ- ing, teaching, clinical, and research skills are constantly on display.

Finally, we are indebted to the extraordinary people at Worth Publishers, whose superior talents, expertise, and commitment to the education of read- ers guided us at every turn both in this edition and the first edition of Case Studies in Abnormal Psychology. They include Kevin Feyen, Rachel Losh, Katie Garrett, Tracey Kuehn, Sarah Segal, Diana Blume, Edgar Bonilla, and develop- mental editor extraordinaire Mimi Melek. They have all been superb, and we deeply appreciate their invaluable contributions.

Ethan E. Gorenstein Ronald J. Comer April 2014

CASe 1

Panic Disorder

2 CASE 1

table 1-1

Dx Checklist

Panic Attack 1. Persons experience a sudden outburst of profound fear or

discomfort that rises and peaks within minutes.

2. The attack includes at least 4 of the following:

(a) Increased heart rate or palpitations.

(b) Perspiration.

(c) Trembling.

(d) Shortness of breath.

(e) Choking sensations.

(f) Discomfort or pain in the chest.

(g) Nausea or other abdominal upset.

(h) Dizziness or lightheadedness.

(i) Feeling significantly chilled or hot.

(j) Sensations of tingling or numbness.

(k) Sense of unreality or separation from the self or others.

(l) Dread of losing control.

(m) Dread of dying.

(Based on APA, 2013.)

table 1-2

Dx Checklist

Panic Disorder 1. Unforeseen panic attacks occur repeatedly.

2. One or more of the attacks precedes either of the following symptoms:

(a) At least a month of continual concern about having additional attacks.

(b) At least a month of dysfunctional behavior changes associated with the attacks (for example, avoiding new experiences).

(Based on APA, 2013.)

Panic Disorder 3

Joe’s childhood was a basically happy one. At the same time, it was steeped in fi- nancial hardship, as his Hungarian immigrant parents struggled to keep the family afloat in the United States during World War II. Joe’s father, after a series of jobs as a laborer, ultimately scraped together enough money to start a small hardware store, which survived, but Joe had to quit school in the ninth grade to help run the business. He put in 9 years at the store before being drafted for the Vietnam War at age 23.

Joe An American Success Story When Joe returned from the army, he took more of an interest in the store, and with some far-sighted marketing strategies turned it into a successful enterprise that ultimately employed 6 full-time workers. Joe was proud of what he had ac- complished but harbored lifelong shame and regret over his shortened education, especially as he had been an outstanding student. The store was thus both the boon and the bane of his existence.

Joe met Florence at age 45, after he took over the store from his father and established himself as a respectable neighborhood businessman. Before meeting Florence, the energetic businessman’s social life was spare; his goal of making a success of himself was his overriding concern. Florence was a 40-year-old col- lege-educated administrator for an insurance company when they met. She was

Panic disorder is twice as common among women as men.

table 1-3

Dx Checklist

Agoraphobia 1. Pronounced, disproportionate, and repeated fear about being

in at least 2 of the following situations: public transportation (e.g., auto or plane travel) • Parking lots, bridges, or other open spaces • Shops, theaters, or other confined places • Lines or crowds • Away from home unaccompanied.