Case Study of Cassandra Liu
By: C. Li
Cassandra Liu is a 16-year old high school student, currently attending Briar Ridge Secondary School. Approximately six months ago, Cassandra began having difficulties in school attendance. She would experience numerous somatic complaints like dizziness, nausea and abdominal pains that would prevent her from going to class. Eventually her parents took her to the family doctor who made a referral to the Youth and Child Services, after medical tests proved inconclusive in explaining her somatic symptoms. At our clinic, a counsellor interviewed Cassandra and her mother in order to assess her needs. A child psychologist was also scheduled to determine if Cassandra met any diagnostic criteria.
Cassandra arrived with her mother for her first appointment at the clinic, neatly dressed and well groomed. Her mother appeared stern and eager as she began describing her concerns regarding her daughter. Cassandra’s symptoms had caused her to miss enough school to impact on her academic performance, and her parents were beginning to worry that this may have a longterm affect on her academic future. Throughout the interview, Cassandra remained quiet and reserved, allowing her mother to do much of the talking. When the therapist tried to directly engage Cassandra, she appeared timid and nervous and seemed to struggle to find responses to the therapist’s questions. Often, Cassandra’s mother would become impatient and interrupt, which caused Cassandra to further withdraw.
It was understood by Cassandra’s mother that her medical tests had turned up negative in regards to her reported physical symptoms. Cassandra’s mother expressed that she was frustrated that their family doctor had found nothing, and that she suspected Cassandra was faking her symptoms to gain attention and rebel against her parents. Cassandra seemed upset by her mother’s accusation, but did not make an attempt to protest. Cassandra’s mother pointed out that she was wasting valuable vacation days to accommodate Cassandra, and that she felt irritated at what she perceived was Cassandra acting out.
When it came time to see the Child Psychologist, Cassandra’s mother was instructed to wait in the waiting room. Cassandra seemed apprehensive about the separation, but did not appear too concerned. The interview session began with Cassandra’s interpretation of her symptoms. Cassandra explained that for as long as she could remember, she would get mild stomach cramps in the morning, before going to school. However, the cramps would eventually subside by the time she arrived in class. Nonetheless, there were times where the stomach pains would get so intense, to the point where she felt too ill to leave the house. Although these episodes did not occur too frequently, Cassandra felt bothered by them because they would cause her to stay home from school. At the start of the school year, Cassandra recalled an incident in class where she suddenly felt very dizzy and lightheaded like she was going to pass out. An intense nausea washed over Cassandra, and she was terrified that she would be sick in front of her classmates. However, when she got up to run to the bathroom she momentarily blacked out and fell to the floor. Cassandra remembers feeling like she couldn’t breathe and that her heart pounded so hard she thought she was going to die. A few moments later, Cassandra’s vision returned and the nausea passed. Cassandra was taken to the school nurse, where she waited for her mother to pick her up. Although she was shaken, by the time Cassandra’s mother arrived at the school Cassandra felt okay again. Cassandra saw the doctor the following day, but they could not find a reason or cause for her illness. This incident profoundly frightened Cassandra, and she admits that she is very worried it will occur again.
In order to avoid another incident, Cassandra has become hypervigilant in...
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