This case study summarizes Angela, a 44-year-old African American school teacher and guidance counselor who is morbidly obese and uses food to cope with stress. Several assessments were used to evaluate her including an intake assessment, mental status examination, MMPI-2, and MCMI-III. The assessments found evidence of panic disorder with agoraphobia and defensiveness in her test responses. A treatment plan of ongoing counseling, participation in a support group, and potential family counseling was recommended to help Angela address her anxiety, eating behaviors, and relationship issues.

1. Case Study of Angela
Counseling 621
Kelli Cofer
November 11, 2011

2. Client Description
• Angela
• 44 year old African American female
• School teacher & guidance counselor
• Morbid obese
– Recommendation for gastric by-pass
surgery
• Uses food to copy with stress
• Additional health problems

3. Purpose of Assessments
• Initial intake assessment
– Determine adequate support system
– Clarify purpose of evaluation
• Mental status examination (MSE)
– Statement of how client looks, feels, and behaves during initial
examination
• Minnesota Multiphasic Personality Inventory – Second Edition (MMPI-2)
– Highlights red flags in profile
– Assess patterns of personality and emotion disorders
• Million Clinical Multiaxial Inventory – Third Edition (MCMI-III)
– Identifies predominant personality traits

4. Assessment Procedures
and Protocol
• Initial intake interview
– Performed during initial visit
– Notice of Privacy Practices (HIPAA form)
– Consent of treatment
– Release of information
• Mental Status Examination (MSE)
– Performed during initial visit
– Series of questions
• Minnesota Multiphasic Personality Inventory – Second Edition
(MMPI-2)
– 567 items
– True, False, Cannot Say answers
– Results evaluated using computer software
• Million Clinical multiaxial inventory – Third Edition (MCMI-III)
– Distinguish psychiatric disorders
– Complex scoring done by computer

5. Medical/Developmental History
• Weight condition evident, age 16
• Morbid obese, age 25
• Fourth of six children
• Family history of obesity
• Two sons
• Divorced twice
• Marital history of abuse and infidelity
• Mother died of heart attack seven years ago

6. Familial Psychiatric History
• Family history of drug and
alcohol abuse

7. Work History
• Elementary school teacher
• Guidance counselor
• No record of reported work absences
• Weight affects occupation

8. Home Behavior/Social
• Family of origin
– Fourth of six children
– Mother died about seven years
ago
– Father still living
• No reference to family closeness
• No reference to social activities
• Divorced, two sons

9. Assessments Used & Appropriate
Interpretations
• Initial intake assessment
– Determine support system
• Mental Status Examination (MSE)
– Organize client information
• Minnesota Multiphasic Personality Inventory – Second Edition
(MMPI-2)
– Personality characteristics
• Million Clinical multiaxial inventory – Third Edition (MCMI-III)
– Assist in diagnostic process
– Differentiate psychiatric disorders

10. Summary of Findings
• Intake assessment
– Mentally alert
– Poor support system
• MCE
– Functions well in occupation
– History of binge eating
– Food used as stress management
• MMPI-2
– Elevated L Scale
– No Cannot Say responses
– Defensiveness
• MCMI-III
– Evidence of panic disorder with agoraphobia
– No sense of hopelessness
– No cyncicism
– Unevaluated mental health disorders

11. DSM Diagnosis
Axis I: 300.00 – Anxiety disorder NOS
Axis II: V79.01 – No diagnosis
Axis III – High blood pressure, diabetes, orthopedic problems, obesity
Axis IV: None reported
Axis V: Current GAF - 60

12. Treatment Plan &
Recommendations
Angela reports symptoms of anxiety, but she seems to be
mildly or moderately defensive in her test responses. An
ongoing counseling relationship is recommended to help her
with her panic attacks, and will be helpful in dealing with
anxiety following surgery. Angela will benefit from
participation in a support group with people experiencing
similar medical concerns after gastric by-pass surgery. Family
counseling services can help with addressing issues involving
her bad relationships, eating behaviors, nutritional
guidance, and transition in self-image.

13. References
• Whiston, Susan C. (2008). Principles and applications of
assessment in counseling (3rd ed.). Thomson Brooks/Cole:
Belmont, CA.
• American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders: DSM-IV TR.
Washington, DC: American Psychiatric Association.