Case Study
Patient Demographic: Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate
Mental Status Exam: Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent
Presenting Problem: You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”
Other Contexts: The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. You address her ambivalence to change, as well as obstacles she has experienced in the past. When discussing exercise, the client states, “You don’t understand! I’ve tried exercise, and it never works.” You provide the client with self-monitoring sheets to record the following in real-time: daily food intake, maladaptive eating patterns, and thoughts and feelings that accompany binge eating. She is hesitant but agrees to give it a try for one week.  After her setback, the client states, “I’ll never control my eating

Question: After her setback, the client states, “I’ll never control my eating.” Which of the following maladaptive styles of thinking is reflected in the client’s statement?
(A): Self-fulfilling prophecy
(B): Dichotomous thinking
(C): Catastrophizing
(D): Overgeneralization

Correct Answer: Overgeneralization
Explanation: Overgeneralization is a maladaptive thinking style that uses one event to create a sweeping rule for all other situations. This is reflected in the client’s statement: “I’ll never be able to control my eating” The setback is one event, and the general rule for the client is that this setback means the client will never succeed at controlling her eating. Catastrophizing occurs when a person embellishes a situation in such a way that the outcome is exaggerated. (Eg, “This setback means I’m a failure at life!”) Dichotomous thinking, or black and white thinking, occurs when one engages in all-or-nothing beliefs. (Eg, “I binged after breakfast. My whole day is ruined”) Self-fulfilling prophecy is used when making future predictions and then acting in ways that guarantee the prediction comes true. (Eg, “I’ll always be defined by my weight”). Therefore, the correct answer is (B)
Competency: counseling skills and interventions