Case Studies in Abnormal PsychologyYou Decide The Case of J.docx

Case Studies in Abnormal Psychology
You Decide: The Case of Julia
This case is presented in the voices of Julia and her roommate,
Rebecca. Throughout the case, you are asked to consider a
number of issues and to arrive at various decisions, including
diagnostic and treatment decisions. Appendix A lists Julia’s
probable diagnosis, the DSM-5 criteria, clinical information,
and possible treatment directions.
Julia Measuring Up
I grew up in a northeastern suburban town, and I’ve lived in the
same house for my entire life. My father is a lawyer, and my
mother is the assistant principal at our town’s high school. My
sister, Holly, is 4 years younger than I am.
My parents have been married for almost 20 years. Aside from
the usual sort of disagreements, they get along well. In fact, I
would say that my entire family gets along well. We’re not
particularly touchy-feely: It’s always a little awkward when we
have to hug our grandparents on holidays, because we just never
do that sort of thing at home. That’s not to say that my parents
are uninterested or don’t care about us. Far from it; even though
they both have busy work schedules, one of them would almost
always make it to my track and cross-country meets and to
Holly’s soccer games. My mother, in particular, has always
tried to keep on top of what’s going on in our lives.
In high school, I took advanced-level classes and earned good
grades. I also got along quite well with my teachers, and ended
up graduating in the top 10 percent of my class. I know this
made my mother really proud, especially since she works at the
school. She would get worried that I might not be doing my best
and “working to my full potential.” All through high school, she
tried to keep on top of my homework assignments and test

schedules. She liked to look over my work before I turned it in,
and would make sure that I left myself plenty of time to study
for tests.
Describe the family dynamics and school pressures experienced
by Julia. Under what circumstances might such family and
school factors become problematic or set the stage for
psychological problems?
In addition to schoolwork, the track and cross-country teams
were a big part of high school for me. I started running in junior
high school because my parents wanted me to do something
athletic and I was never coordinated enough to be good at sports
like soccer. I was always a little bit chubby when I was a kid. I
don’t know if I was actually overweight, but everyone used to
tease me about my baby fat. Running seemed like a good way to
lose that extra weight; it was hard at first, but I gradually got
better and by high school I was one of the best runners on the
team. Schoolwork and running didn’t leave me much time for
anything else. I got along fine with the other kids at school, but
I basically hung out with just a few close friends. When I was
younger, I used to get teased for being a Goody Two-Shoes, but
that had died down by high school. I can’t remember anyone
with whom I ever had problems.
I did go to the prom, but I didn’t date very much in high school.
My parents didn’t like me hanging out with boys unless it was
in a group. Besides, the guys I had crushes on were never the
ones who asked me out. So any free time was mostly spent with
my close girlfriends. We would go shopping or to the movies,
and we frequently spent the night at one another’s houses. It
was annoying that although I never did anything wrong, I had
the earliest curfew of my friends. Also, I was the only one
whose parents would text me throughout the night just to check
in. I don’t ever remember lying to them about what I was doing
or who I was with. Although I felt like they didn’t trust me, I
guess they were just worried and wanted to be sure that I was
safe.
Julia Spiraling Downward

I couldn’t believe it when the scale said I was down to 115
pounds. I still felt that I had excess weight to lose. Some of my
friends were beginning to mention that I was actually looking
too thin, as if that’s possible. I wasn’t sure what they meant—I
was still feeling chubby when they said I was too skinny. I
didn’t know who was right, but either way I didn’t want people
seeing my body. I began dressing in baggy clothes that would
hide my physique. I thought about the overweight people my
friends and I had snickered about in the past. I couldn’t bear the
thought of anyone doing that to me. In addition, even though I
was running my best times ever, I knew there was still room
there for improvement.
Look back at Case 9, Bulimia Nervosa. How are Julia’s
symptoms similar to those of the individual in that case? How
are her symptoms different?
Around this time, I started to get really stressed about my
schoolwork. I had been managing to keep up throughout the
semester, but your final grade basically comes down to the final
exam. It was never like this in high school, when you could get
an A just by turning in all your homework assignments. I felt
unbearably tense leading up to exams. I kept replaying
scenarios of opening the test booklet and not being able to
answer a single question. I studied nonstop. I brought notes
with me to the gym to read on the treadmill, and I wasn’t
sleeping more than an hour or two at night. Even though I was
exhausted, I knew I had to keep studying. I found it really hard
to be around other people. Listening to my friends talk about
their exam schedules only made me more frantic. I had to get
back to my own studying.
The cross-country season was over, so my workouts had become
less intense. Instead of practicing with the team, we were
expected to create our own workout schedule. Constant studying
left me little time for the amount of exercise I was used to. Yet
I was afraid that cutting back on my workouts would cause me
to gain weight. It seemed logical that if I couldn’t keep up with
my exercise, I should eat less in order to continue to lose

weight. I carried several cans of Diet Coke with me to the
library. Hourly trips to the lounge for coffee were the only
study breaks I allowed myself. Aside from that, I might have a
bran muffin or a few celery sticks, but that would be it for the
day. Difficult though it was, this regimen worked out well for
me. I did fine on my exams. This was what worked for me. At
that point, I weighed 103 pounds and my body mass index was
16.6.
Based on your reading of either the DSM-5 or a textbook, what
disorder might Julia be displaying? Which of her symptoms
suggest this diagnosis?
After finals, I went home for winter break for about a month. It
was strange to be back home with my parents after living on my
own for the semester. I had established new routines for myself
and I didn’t like having to answer to anyone else about them.
Right away, my mother started in; she thought I spent too much
time at the gym every day and that I wasn’t eating enough.
When I told her that I was doing the same thing as everyone
else on the team, she actually called my coach and told him that
she was concerned about his training policies! More than once
she commented that I looked too thin, like I was a walking
skeleton. She tried to get me to go to a doctor, but I refused.
Dinner at home was the worst. My mother wasn’t satisfied when
I only wanted a salad—she’d insist that I have a ‘’well-balanced
meal” that included some protein and carbohydrates. We had so
many arguments about what I would and wouldn’t eat that I
started avoiding dinnertime altogether. I’d say that I was going
to eat at a friend’s house or at the mall. When I was at home I
felt like my mother was watching my every move. Although I
was worried about the upcoming semester and indoor track
season, I was actually looking forward to getting away from my
parents. I just wanted to be left alone—to have some privacy
and not be criticized for working out to keep in shape.
Was there a better way for Julia’s mother to intervene? Or
would any intervention have brought similar results?
Since I’ve returned to school, I’ve vowed to do a better job of

keeping on top of my classes. I don’t want to let things pile up
for finals again. With my practice and meet schedule, I realize
that the only way to devote more time to my schoolwork is to
cut back on socializing with friends. So, I haven’t seen much of
my friends this semester. I don’t go to meals at all anymore; I
grab coffee or a soda and drink it on my way to class. I’ve
stopped going out on the weekends as well. I barely even see
my roommate. She’s asleep when I get back late from studying
at the library, and I usually get up before her to go for a
morning run. Part of me misses hanging out with my friends,
but they had started bugging me about not eating enough. I’d
rather not see them than have to listen to that and defend
myself.
Even though I’m running great and I’m finally able to stick to a
diet, everyone thinks I’m not taking good enough care of
myself. I know that my mother has called my coach and my
roommate. She must have called the dean of student life,
because that’s who got in touch with me and suggested that I go
to the health center for an evaluation. I hate that my mother is
going behind my back after I told her that everything was fine. I
realize that I had a rough first semester, but everyone has
trouble adjusting to college life. I’m doing my best to keep in
control of my life, and I wish that I could be trusted to take care
of myself.
Julia seems to be the only person who is unaware that she has
lost too much weight and developed a destructive pattern of
eating. Why is she so unable to look at herself accurately and
objectively?
Rebecca Losing a Roommate
When I first met Julia back in August, I thought we would get
along great. She seemed a little shy but like she’d be fun once
you got to know her better. She was really cool when we were
moving into our room. Even though she arrived first, she waited
for me so that we could divide up furniture and closet space
together. Early on, a bunch of us in the dorm started hanging
out together, and Julia would join us for meals or parties on the

weekends. She’s pretty and lots of guys would hit on her, but
she never seemed interested. The rest of us would sit around
and gossip about guys we met and who liked who, but Julia just
listened.
From day one, Julia took her academics seriously. She was sort
of an inspiration to the rest of us. Even though she was busy
with practices and meets, she always had her readings done for
class. But I know that Julia also worried constantly about her
studies and her running. She’d talk about how frustrating it was
to not be able to compete at track at the level she knew she was
capable of. She would get really nervous before races.
Sometimes she couldn’t sleep, and I’d wake up in the middle of
the night and see her pacing around the room. When she told me
her coach suggested a new diet and training regimen, it sounded
like a good idea.
I guess I first realized that something was wrong when she
started acting a lot less sociable. She stopped going out with us
on weekends, and we almost never saw her in the dining hall
anymore. A couple of times I even caught her eating by herself
in a dining hall on the other side of campus. She explained that
she had a lot of work to do and found that she could get some of
it done while eating if she had meals alone. When I did see her
eat, it was never anything besides vegetables. She’d take only a
tiny portion and then she wouldn’t even finish it. She didn’t
keep any food in the room except for cans of Diet Coke and a
bag of baby carrots in the fridge. I also noticed that her clothes
were starting to look baggy and hang off her. A couple of times
I asked her if she was doing okay, but this only made her
defensive. She claimed that she was running great, and since
she didn’t seem sick, I figured that I was overreacting.
Why was Rebecca inclined to overlook her initial suspicions
about Julia’s behaviors? Was there a better way for the
roommate to intervene?
I kept believing her until I returned from Thanksgiving. It was
right before final exams, so everyone was pretty stressed out.
Julia had been a hard worker before, but now she took things to

new extremes. She dropped off the face of the earth. I almost
never saw her, even though we shared a room. I’d get up around
8:00 or 9:00 in the morning, and she’d already be gone. When I
went to bed around midnight, she still wasn’t back. Her side of
the room was immaculate: bed made, books and notepads
stacked neatly on her desk. When I did bump into her, she
looked awful. She was way too thin, with dark circles under her
eyes. She seemed like she had wasted away; her skin and hair
were dull and dry. I was pretty sure that something was wrong,
but I told myself that it must just be the stress of the upcoming
finals. I figured that if there were a problem, her parents would
notice it and do something about it over winter break.
When we came back to campus in January, I was surprised to
see that Julia looked even worse than during finals. When I
asked her how her vacation was, she mumbled something about
being sick of her mother and happy to be back at school. As the
semester got under way, Julia further distanced herself from us.
There were no more parties or hanging out at meals for her. She
was acting the same way she had during finals, which made no
sense because classes had barely gotten going. We were all
worried, but none of us knew what to do. One time, Julia’s
mother sent me a message on Facebook and asked me if I had
noticed anything strange going on with Julia. I wasn’t sure what
to write back. I felt guilty, like I was tattling on her, but I also
realized that I was in over my head and that I needed to be
honest.
How might high schools and universities better identify
individuals with serious eating disorders? What procedures or
mechanisms has your school put into operation?
I wrote her mother about Julia’s odd eating habits, how she was
exercising a lot and how she had gotten pretty antisocial. Her
mother wrote me back and said she had spoken with their family
doctor. Julia was extremely underweight, even though she still
saw herself as chunky and was afraid of gaining weight.
A few days later, Julia approached me. Apparently she had just
met with one of the deans, who told her that she’d need to

undergo an evaluation at the health center before she could
continue practicing with the team. She asked me point-blank if I
had been talking about her to anyone. I told her how her mother
had contacted me and asked me if I had noticed any changes in
her over the past several months, and how I honestly told her
yes. She stormed out of the room and I haven’t seen her since. I
know how important the team is to Julia, so I am assuming that
she’ll be going to the health center soon. I hope that they’ll be
able to convince her that she’s taken things too far, and that
they can help her to get better.
Ethnocentrism: Consider your textbook's description of
ethnocentrism (pp. 52 - 53), along with the Topic 4 Lesson
Presentation (slide 18). In a post of between 150 and 250 words,
discuss the following prompt: First, write your own brief
definition of the term "ethnocentrism." Then, discuss at least
one example or phenomenon in which ethnocentrism plays a
part. Finally, describe any situations in which you have
experienced ethnocentrism, either negatively or positively.
(slide 18)
An Important Concept: Ethnocentrism
Many times the language we use reflects our attitudes. William
Graham Sumner coined the term ethnocentrism to refer to the
tendency to assume that one’s own culture is normal, or
superior, to all others. In order to become a critical thinker, a
researcher, a sociologist, or an informed citizen, you need to
recognize when you are judging someone by your own cultural
standards and ignoring their way of life.
(pp. 52 – 53)
Ethnocentrism
Once we acquire the cultural ways peculiar to our own society,

they become so deeply in- grained that they seem second nature
to us. Additionally, we have difficulty conceiving of alternative
ways of life. Just as a fish never “notices” water unless it is out
of it, so we tend never to notice our own culture until we are in
someone else’s. We judge the behavior of other groups by the
standards of our own culture, a phenomenon sociologists call
ethnocentrism. Sumner (1906:13) described this point of view
as one “in which one’s own group is the center of everything,
and all others are scaled and rated with reference to it.” A Peace
Corps volunteer living in Blantyre, Malawi, several decades ago
found a perfect example: The post office had two letter slots,
one labeled “Blantyre” and the other labeled “Elsewhere”
(Selin, 2002).
All groups are ethnocentric: families, tribes, nations, cliques,
colleges, fraternities, busi- nesses, churches, and political
parties. The notion that one belongs to the “best people” can be
functional for groups because it provides a kind of social glue
cementing people together. But it can also be dysfunctional
when it generates intergroup conflict. Combined with
competition for scarce resources and a power imbalance
between groups, ethnocentrism is particularly destructive (Noel,
1968). It plays a part in group conflicts ranging from small
skirmishes to world wars. It can also be of more immediate and
prac- tical significance. Some analysts blame our sur- prise at
the September 11 attacks partly on ethnocentrism. Although
the threat to civilians was not secret, it seemed “too outlandish
to be taken seriously. . . . In the world of intelligence, this is
known as mirror-imaging: the projection of American values
and behavior onto America’s enemies and rivals” (Goldberg,
2003).
a humane measure (Murdock, 1934). The Inuits believe that
individuals experience in the next world a standard of health
similar to that which they enjoyed in the period preceding
death. Consequently, the Inuits see the practice as min- imizing
the disabilities and infirmities their loved ones would encounter
in the hereafter. Social scientists have pointed out that the prac-

tice can be adaptive for a people whose subsis- tence is
precarious and who must strictly limit their dependent
population. For Americans who are appalled at the traditional
Inuit custom, it is worth noting that many Japanese find quite
abhorrent our practice of placing our elderly infirm in nursing
homes rather than caring for them at home.

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