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:    . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation

Question: Based on the client’s clinical presentation, what topic should be discussed to help develop initial treatment plan goals?
(A): Social isolation and other interpersonal deficits
(B): The effects of internalized biphobia
(C): Cognitions associated with depressed mood
(D): Behaviors maintaining maladaptive eating

Correct Answer: Behaviors maintaining maladaptive eating
Explanation: You would first identify behaviors maintaining maladaptive eating. Goals related to the client’s maladaptive eating patterns are prioritized because binge-eating disorder is the client’s primary diagnosis, and the client has expressed the desire to stop binge eating. There are several areas of exploration for this client, including depressive symptoms, her relationship with her family since coming out, her spirituality, and binge eating. The client prioritized the focus of treatment by stating, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating” While treatment engagement is generally accomplished using a strengths-based approach, best practices for eating disorders suggest identifying and changing maladaptive eating first, followed by addressing any underlying issues. Therefore, the correct answer is (B)
Competency: treatment planning