Ann Case study Identifying Information: Ann is a 44-year-old, twice-divorced,

Ann Case study Identifying Information: Ann is a 44-year-old, twice-divorced, Caucasian woman who has no children, lives alone, and has been working full-time as a Spanish teacher for the past 22 years. Chief Complaint: Ann sought treatment due to an escalation in her depression which started in October, 2015. She reported that she was also binge eating and overusing and abusing laxatives at least once a week, though she was much more concerned by the depression than the eating/laxative problem. History of Present Illness: In October 2011, Ann divorced her second husband and began to develop depressive symptoms (sadness, crying, social withdrawal, severe self-criticism). The depression worsened until it reached the severe level in March, 2013. At intake her symptoms included the following: • emotional symptoms: -sadness, anxiety, lack of interest in almost all activities • cognitive symptoms: difficulty concentrating, believing she was worthless and unlovable • behavioral symptoms: crying, social isolation • physiological symptoms: difficulty falling asleep, tiredness She developed symptoms of bulimia nervosa in September 2013. At intake, she reported that she binged, felt out of control of this behavior, and overused laxatives about once a week; she was (and is) intermittently preoccupied with a misperception that she is fat and is highly self-critical. The major stressors in Ann’s life are social ones. Since her divorce she has withdrawn from friends, family, and co-workers. She has dated several times since her divorce but each date has been a “one-night stand,” which leaves her feeling rejected and defective. She used to derive significant satisfaction from relationships but has isolated herself and now feels sad, lonely, and rejected by others. While she finds it more difficult to do her job, work does not appear to be a significant stressor. Ann restarted Prozac about 2 weeks ago (prescribed by her family physician) but thus far sees no change in her depressive symptoms. Psychiatric History: Ann’s first episode of major depression occurred in 2011 when her first husband divorced her. She was hospitalized for three weeks and given Prozac. She discontinued the medication (against medical advice) at discharge but initiated psychological treatment (cognitive therapy) for the first time. Her depression remitted after four months of outpatient psychotherapy, though she remained in therapy on a biweekly basis for another year, working on Axis II issues. Personal and Social History: Ann grew up the middle child of three. Her parents were Italian immigrants and her mother did not speak English. Ann considered herself the “ugly duckling” of the family. Her older sister was considered thin and pretty while Ann was called “chubette” and “big nose.” She felt as if she were an extra burden to her family since they strongly wanted a boy when she was born. Her younger brother was born 18 months later and received nearly all the family’s attention. She describes her father as having been strict, controlling, demanding, and very concerned about what others thought of him. She describes her mother as quiet, unhappy, not affectionate, and old-fashioned. Ann felt unloved and unable to measure up to her siblings. Ann attended Catholic school where she reports being trained to be “the perfect soldier.” She married for the first time at age 18. She reports that she was abused and controlled by her first husband who was violent at times. She believed she deserved the abuse and submitted to his wrath. When she finally got the courage to leave the marriage, she did not have her family’s approval and to this day resents their lack of support. Ann remarried in 2013. Her second husband reportedly spent a lot of time with young men and Ann suspects he was bisexual. He ceased having any sexual relations with her about three years after their marriage. Though they tried marriage counseling briefly, her husband was unwilling to work on modifying the situation and they divorced in October of 2016. Medical History: Ann did not have any medical problems which influenced her psychological functioning or the treatment process. Image transcription text ATAPS CMHS Module 3.5 Formula Grid Adapted from Winters, Hanson & Stoyanova, 2007 Factors influencing the development and course of t… Show more – please help fill out the table correctly

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