Joellen is a 21 year old college student. Up until now she has been doing well in college, earning A's and B's. She considers herself a "perfectionist," and strives to do her very best at everything she does. She often studies long hours into the night. People who know her feel that she works too hard, and often devotes a major effort to tasks that are not very important. Joellen finds it difficult to accept help from anyone else. Some people consider her cold and unfriendly.

This semester Joellen is taking some fairly difficult courses in her major (biology) for the first time. Since the beginning of the semester she has been having increasing difficulty with what she calls "anxiety attacks." Her anxiety attacks are centered on a staircase she must climb to get to her Biology 211 class. She experiences extreme anxiety when she approaches the staircase. Near the beginning of the semester, she was able to climb the staircase despite her anxiety. When she arrived in class, however, she was exhausted from the effort and had difficulty paying attention. More recently, she has not been able to make herself ascend the stairs at all, with the result that she has stopped coming to class. She is getting behind in her work, and is now seeking counseling to deal with her anxiety attacks so that she can continue her schooling. Initially, Joellen consulted a physician about her anxiety attacks. The physician noted that Joellen's blood pressure is undesirably high, but referred her for psychological counseling, stating that counseling would be the best course of action at this time.

Give a DSM-IV diagnosis for Joellen, using all 5 axes. You do not need to worry about using correct DSM-IV terminology on axes I and II. English language will do. Just make sure that you code the correct information on each axis.

What forms of assessment do you think would be particularly useful in getting information about this case? Justify your answers.

Axis I:

Axis II:

Axis III:

Axis IV:

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Jeremy is a 13 year old boy who has been in a class for the "educable mentally retarded" since he started school. (He has the characteristic facial features of a person with Down Syndrome, and this diagnosis has been confirmed by chromosomal analysis.) He functioned well in this class and seemed to enjoy school until about 2 years ago. Two years ago, his mother was killed in an automobile accident. Although Jeremy is adequately taken care of by his father, his teachers say that he has not been the same since. Although Jeremy used to be friendly and outgoing, teachers report that he has become increasingly withdrawn over the past year. He rarely smiles, is often teary, and seems to take no pleasure in school or in other activities that he used to enjoy. He has lost about 20 pounds over the past year, and now looks distinctly gaunt. His father reports that Jeremy is having difficulty sleeping at night. Jeremy's father often wakes up to find him wandering around the house in the middle of the night, and this may happen several times in one evening. Although Jeremy used to be able to take care of himself, pretty well, dressing himself, toileting himself, making his own lunch, etc., all of this has deteriorated in the past 6 months. He forgets to dress himself unless his father helps; he has wet his pants several times each week, and he seems totally helpless in the kitchen, so his father must prepare all of his meals. By the time Jeremy comes to see you, he is almost completely unable to function in school. Both Jeremy's teacher's and his father are seriously concerned because he seems so "down" that they think he may try to hurt himself. Last week Jeremy was nearly hit by a car while running across the street; witnesses thought that it looked like a deliberate suicide attempt. When you talk to Jeremy he confirms that he would like to be dead so he could be with his mother. He says he would be dead already if he could just figure out how to do it.

Give a DSM-IV diagnosis for Jeremy, using all 5 axes. You do not need to worry about using correct DSM-IV terminology on axes I and II. English language will do. Just make sure that you code the correct information on each axis.

What forms of assessment do you think would be particularly useful in getting information about this case? Justify your answers.

Axis I:

Axis II:

Axis III:

Axis IV: