Case Study of Kimberly, Part One Kimberly is a 17-year-old female brought in for an evaluation by her mother, Diana. Even before you meet them, you hear the commotion in the waiting room, which concludes with Kimberly calling Diana a "stupid fucking bitch" and kicking a chair across the room. Once in your office, the contrast between them is striking. The family lives in one of the pricier suburbs, and Diana works as an advertising executive. She is successful and well regarded, as is her husband, Kimberly's father, who works in international banking. Diana says that he regrets not being present, but there was a sudden meeting in Barcelona that required his attention. Diana is well-dressed, poised, and soft-spoken. Kimberly, on the other hand, is quite gaunt, surly, noticeably unwashed, and dressed in full anarchist punk regalia. You count 11 piercings, some quite large, involving her tongue, lower lip, both nostrils, one eyebrow, and both ears; there may be more hidden by her dramatically dyed and styled hair. Diana gives the following account as Kimberly shreds a Styrofoam cup, dropping the small pieces on the carpet, sighing loudly, scowling, and mumbling, "Bullshit." Diana notes that she and her husband have "bent over backwards" to accept Kimberly's "lifestyle choices" and her friends. Kimberly has not been appreciative, but they understand that adolescence is a difficult time. In the past few months, however, Kimberly has lost 25 pounds and has become verbally abusive. She also displays dramatic mood swings and is physically violent, and she is completely disengaged from school, family, and her old friends. She has also taken to hoarding strange objects, and Diana has noticed strange burns on Kimberly's arms. Diana has concluded that Kimberly has developed an eating disorder and is perhaps engaging in self-mutilation. Diana fears for Kimberly's health and for the loss of educational opportunity that will occur if Kimberly continues nonparticipation in the expensive private school she attends. When you ask Kimberly her view on her mother's concerns, she says, "Whatever." You take some initial background information. Kimberly has one sister, four years older, who attends an Ivy League school on the East coast. Her sister had "eating disorder issues" in her freshman year in college, but worked through them in therapy and is now doing well. Diana reports that Kimberly was without problems until last year, when she began hanging around "a rougher element." Kimberly and her friends often spent weekends in a cabin in an isolated rural area, and Diana initially discounted the dangers of these rougher companions, thinking, "How bad can they be if they are into nature?" When questioned, Diana says that Kimberly has been hoarding all sorts of odd flasks and containers, "just junk," but Diana has not otherwise examined them because they smell bad. "They must be filthy; I wonder if she got them out of a dumpster." She also reports that Kimbe.

1. Case Study of Kimberly, Part One
Kimberly is a 17-year-old female brought in for an evaluation
by her mother, Diana. Even before you meet them, you hear the
commotion in the waiting room, which concludes with Kimberly
calling Diana a "stupid fucking bitch" and kicking a chair across
the room.
Once in your office, the contrast between them is striking. The
family lives in one of the pricier suburbs, and Diana works as
an advertising executive. She is successful and well regarded, as
is her husband, Kimberly's father, who works in international
banking. Diana says that he regrets not being present, but there
was a sudden meeting in Barcelona that required his attention.
Diana is well-dressed, poised, and soft-spoken.
Kimberly, on the other hand, is quite gaunt, surly, noticeably
unwashed, and dressed in full anarchist punk regalia. You count
11 piercings, some quite large, involving her tongue, lower lip,
both nostrils, one eyebrow, and both ears; there may be more
hidden by her dramatically dyed and styled hair.
Diana gives the following account as Kimberly shreds a
Styrofoam cup, dropping the small pieces on the carpet, sighing
loudly, scowling, and mumbling, "Bullshit."
Diana notes that she and her husband have "bent over
backwards" to accept Kimberly's "lifestyle choices" and her
friends. Kimberly has not been appreciative, but they
understand that adolescence is a difficult time. In the past few
months, however, Kimberly has lost 25 pounds and has become
verbally abusive. She also displays dramatic mood swings and is
physically violent, and she is completely disengaged from
school, family, and her old friends. She has also taken to

2. hoarding strange objects, and Diana has noticed strange burns
on Kimberly's arms.
Diana has concluded that Kimberly has developed an eating
disorder and is perhaps engaging in self-mutilation. Diana fears
for Kimberly's health and for the loss of educational
opportunity that will occur if Kimberly continues
nonparticipation in the expensive private school she attends.
When you ask Kimberly her view on her mother's concerns, she
says, "Whatever."
You take some initial background information. Kimberly has
one sister, four years older, who attends an Ivy League school
on the East coast. Her sister had "eating disorder issues" in her
freshman year in college, but worked through them in therapy
and is now doing well. Diana reports that Kimberly was without
problems until last year, when she began hanging around "a
rougher element." Kimberly and her friends often spent
weekends in a cabin in an isolated rural area, and Diana initially
discounted the dangers of these rougher companions, thinking,
"How bad can they be if they are into nature?"
When questioned, Diana says that Kimberly has been hoarding
all sorts of odd flasks and containers, "just junk," but Diana has
not otherwise examined them because they smell bad. "They
must be filthy; I wonder if she got them out of a dumpster." She
also reports that Kimberly has broken furniture, driven one of
the family sports cars through the rose garden in a rage, and
very recently physically threatened the housekeeper when she
attempted to clean Kimberly's room, to the extent that the
housekeeper quit.
Diana has spoken to her other daughter's therapist, who
suggested that as the eating disorder worsens, Kimberly's self-
esteem is plummeting, and as a result she associates more with
"degrading people and objects." The therapist speculated that
Kimberly might be giving herself cigarette burns. Diana also

3. notes that Kimberly has taken up cigarette smoking in this
period, and "smokes like a chimney."
Use this outline to structure your case assignments.
1. Case Summary
· Provide a brief summary of what you have learned about the
individual reviewed in the case. Include information about the
individual in terms of demographics and general history, and
the sources of that information, and the reason that the
individual was referred, and by whom.
· Summarize any information you may have about evaluations
that have been conducted, including the results.
2. Clinical Impression (Diagnosis)
Write the clinical impression in the DSM-5 format:
XXX.xx (Yyy.yy) Primary Diagnoses (list in order of salience).
(DSM-5 Code is first, as in XXX.xx, and ICD-10 codes next, in
parentheses.)
OTHER FACTORS:
Use the V and Z codes, or simply appropriate descriptors to
psychosocial and contextual factors of importance to the
diagnostic case. These replace the DSM-IV-TR Axis IV & V
used to address these concerns.
3. Recommendations
Explain any recommendations for interventions, treatment,
and/or disposition.
4. Questions
Address the specific questions that were asked in the
instructions for this assignment.

4. Here is a sample assignment question and an appropriate brief
response:
Question: Describe what further information you would need to
accurately diagnose this case.
Response: To diagnose this case accurately, I would also need
to review any pertinent medical records. I would want to
interview this client’s mother, with whom he lives, to
corroborate the clinical interview data supplied by the client,
and to learn more about his developmental history. I would also
want to…Mental Status Evaluation (MSE) Checklist1.
Appearance
a. Physical Appearance. Client appears stated age, appears
older, or appears younger, hairstyle, fingernails, and so on.
b. Dress. Appropriate, clean, pressed, wrinkled, disheveled, and
so on.
c. Hygiene. Clean, well groomed, presence of body odor, and so
on.
2. Behavior and Mannerisms
a. Gait limping, slow, hurried, and so on.
b. Posture. Slumped or rigid.
c. Eye Contact.d. Mannerisms. Foot tapping, eye blinking, hand
rolling, head nodding, and so on.
3. Attitude
a. Toward Interviewer.b. Toward Treatment.c. Toward Others.4.
Mood and Affect
a. Mood. Sad, elated, happy, bored, and so on.
b. Affect. Outward expression of mood such as smiling,
frowning, crying, or laughing.
c. Appropriateness. Does the affect match the mood and the
situation?
5. Speech
a. Quantity. Talkative, poverty of speech, and so on.
b. Quality. Circumlocution, monotonous, loquacious, loud, and
so on.c. Rate of Production. Mumbles, slow production,
pressured speech, and so on.6. Perceptual Disturbances

5. a. Hallucinations. False perceptions.
b. Illusions. Misperceptions of reality.7. Thought
a. Thought Content. Delusions, obsessions, phobias, suicidal
ideation, homicidal ideation, and so on.
b. Thought Processes. Flight of ideas, poverty of thought,
relevancy, and so on.
8. Sensorium and Cognition
a. Alertness. Awareness of surroundings, goal-directed thinking,
responding to the environment, and so on.
b. Orientation. Person, place, time, and situation.
c. Memory and Concentration. Remote, recent past, recent, and
immediate recall.
d. Abstract Thinking. Conceptual thinking, ability to understand
abstract ideas, ability to use inductive and deductive reasoning.
e. Intellect and Fund of Knowledge basic knowledge and
intelligence.
9. Impulse Control
a. Sexual. Ability or lack of ability to control sexual impulses.
b. Physical. Ability or lack of ability to control physical
impulses such as hitting, biting, or yelling.
c. Social. Ability or lack of ability to control social impulses.
10. Judgment and Insight
a. Social Judgment. Awareness of others, empathy, social
decision making, and so on.b. Insight. Awareness and
understanding of one’s mental illness, insight into cause, effect,
and course of illness.c. Reliability. Is the client a good source
of information, is he or she honest, aware, and able to report to
the therapist his or her daily happenings?
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