Alicia is a 28 year old female that has been referred for outpatient services after being admitted into an acute psychiatric ward for 5 days. Alicia complains of persistent numbness on the right side of her body, extending from her face down to her leg. Twice, Alicia was admitted into the hospital from the emergency room with a visible amount of paralysis on the right side of her face. After numerous tests, ruling out Bell’s Palsy and Parkinson’s disease, Alicia was sent home.
Alicia now complains that aside from the numbness in her body that she is now feeling considerable shortness in breath and chest aches. There is a history of heart disease, stroke and heart attacks on the maternal side of her family and recently, Alicia’s father had heart surgery. Since she was a child, her mother states, Alicia was a very sensitive person, very emotional and compassionate. Alicia often felt sorry for others that were less fortunate and ill. Mother reports that Alicia was often stricken with colds, fevers and pneumonia as a child and that she suffered socially, always being kept indoors and protected from bacteria and other germs. Alicia tends to be very shy, withdrawn and socially inept. Alicia has never dated and reports that she has no long term relationships with anyone other than her parents and immediate family. Alicia states she wishes she could mingle and find companions her age. Parents report that Alicia is very delicate and they demand that she be seen at least twice a week. Mother reports and supports Alicia in saying that there must be a medical reason for all her illnesses and complaints. Alicia becomes severely emotional when confronted with the number of negative tests that have been done. She will seclude herself and not eat, shower or speak with anyone and after a while turn from tearful to angry. “No one believes me but there is something seriously wrong with me” she cries during her hospital assessment.
Alicia’s parents demand that they be a part of her individual treatment and demand that they are a part of every treatment decision that is made. “She is not capable of making her own decisions” her father reports. “She is very gullible, sensitive and extremely delicate”, mother states. When asked if she wants to return to inpatient care, Alicia looks to parents for their input. Alicia rarely answers any questions directed at her without parental guidance.
2. CASE STUDY: DAVID
David is a 13 year old boy who has recently been admitted to a juvenile detention facility in San Luis Obispo, California. Police reports indicate that he and another boy were arrested for breaking and entering into a private residence. He has also been charged with assaulting police officers at the time of the arrest.
David grew up in an upper middle class section of San Luis Obispo. David's father, Oliver, is a professor at a small college, and his mother, Sharon, is a dentist who works for a large health care group. David has an older sister, Sarah, who is 15 years old. Their family has had no prior contact with law enforcement agencies.
Even as a small child, David seemed unable to restrain himself. He would bound around the house, crashing into walls and objects, frequently breaking items or destroying house plants. These activities became more pronounced just after meals and when he was angry or disappointed. David seemed to require very little sleep, and he would quickly become bored with most activities. However, he would spend long hours playing computer games, and also enjoyed playing with the family dog, Jessie. David entered a period of low mood at the age of 11 when Jessie died.
David's parents say that David has always been an insecure child. David was slow to complete toilet training, and his parents admit that they gently teased him about his frequent "accidents" which continued until he was 8 or 9 years old. David seems unable to compete with his precocious...