You will select and review ONE case study. You will be responsible for reviewing the case and assigning a diagnoses. You will also be responsible for providing a rationale for the diagnoses, as well as a discussion of rule outs, differential diagnoses, and prognosis. This assignment should be 2-3 pages in length (typed, double-spaced, one inch margins). 50 points

Robin Henderson is a 30-year-old married Caucasian woman with no children

who lives in a middle-class urban area with her husband. Robin was referred to a

clinical psychologist by her psychiatrist. The psychiatrist has been treating Robin

for more than 18 months with primarily anti-depressant medication. During this

time, Robin has been hospitalized at least 10 times (one hospitalization lasted 6

months) for treatment of suicidal ideation (and one near lethal attempt) and

numerous instances of suicidal gestures, including at least 10 instances of drinking

Clorox bleach and self-inflicting multiple cuts and burns.

Robin was accompanied by her husband to the first meeting with the clinical

psychologist. Her husband stated that both he and the patient’s family considered

Robin “too dangerous” to be outside a hospital setting. Consequently, he and her

family were seriously discussing the possibility of long-term inpatient care.

However, Robin expressed a strong preference for outpatient treatment, although

no therapist had agreed to accept Robin as an outpatient client. The clinical

psychologist agreed to accept Robin into therapy, as long as she was committed to

working toward behavioral change and stay in treatment for at least 1 year. This

agreement also included Robin contracting for safety- agreeing she would not

attempt suicide.

Clinical History

Robin was raised as an only child. Both her father (who worked as a salesman)

and her mother had a history of alcohol abuse and depression. Robin disclosed in

therapy that she had experienced severe physical abuse by her mother throughout

childhood. When Robin was 5, her father began sexually abusing her. Although

the sexual abuse had been non-violent for the first several years, her father’s sexual advances became physically abusive when Robin was about 12 years-old. This abuse continued through Robin’s first years of high school. Beginning at age 14, Robin began having difficulties with alcohol abuse and bulimia nervosa. In fact, Robin met her husband at an A.A (Alcoholics Anonymous) meeting while she was attending college. Robin continued to display binge-drinking behavior at an intermittent frequency and often engaged in restricted food intake with consequent eating binges. Despite these behaviors, Robin was able to function well in work and school settings, until the age of 27.She had earned her college degree and completed 2 years of medical school. However, during her second year of medical school, a classmate that Robin barely knew committed suicide. Robin reported that when she heard of the suicide, she decided to kill herself as well. Robin displayed very little insight as to why the situation had provoked her inclination to kill herself. Within weeks, Robin dropped out of medical school and became severely depressed and actively suicidal.

A certain chain of events seemed to precede Robin’s suicidal behavior. This chain

began with an interpersonal encounter, usually with her husband, which caused

Robin to feel threatened, criticized or unloved (usually with no clear or objective

basis for this perception. These feelings were followed by urges to either self mutilate or kill herself. Robin’s decision to self-mutilate or attempt suicide were often done out of spite- accompanied by the thought, “I’ll show you.” Robin’s self injurious behaviors appeared to be attention-seeking. Once Robin burned her leg very deeply and filled the area with dirt to convince the doctor that she needed medical attention- she required reconstructive surgery.

Although she had been able to function competently in school and at work,

Robin’s interpersonal behavior was erratic and unstable; she would quickly and

without reason, fluctuate from one extreme to the other. Robin’s behavior was

very inconsistent- she would behave appropriately at times, well mannered and

reasonable and at other times she seemed irrational and enraged, often verbally

berating her friends. Afterwards she would become worried that she had

permanently alienated them. Robin would frantically do something kind for her

friends in an attempt to bring them emotionally closer to her. When friends or

family tried to distance themselves from her, Robin would threaten suicide to keep

them from leaving her. During the course of treatment, Robin’s husband reported that he could not take her suicidal and erratic behavior any longer. Robin’s husband filed for divorce shortly after her treatment began. Robin began binge drinking and taking illegal

pain medication. Robin reported suicidal ideation and feeling of worthlessness.

Robin displayed signs of improvement during therapy, but this ended in her 14

month of treatment when she committed suicide by consuming an overdose of

prescription medication and alcohol.