CASE 18 You Decide: The Case of Julia
This case is presented in the voices of Julia and her roommate, Rebecca. Throughout the case, you are asked to consider a number of issues and to arrive at various decisions, including diagnostic and treatment decisions. Appendix A lists Julia’s probable diagnosis, the DSM-5 criteria, clinical information, and possible treatment directions.
Julia Measuring Up
I grew up in a northeastern suburban town, and I’ve lived in the same house for my entire life. My father is a lawyer, and my mother is the assistant principal at our town’s high school.
My sister, Holly, is 4 years younger than I am. My parents have been married for almost 20 years. Aside from the usual sort of disagreements, they get along well. In fact, I would say that my entire family gets along well. We’re not particularly touchy-feely: It’s always a little awkward when we have to hug our grandparents on holidays because we just never do that sort of thing at home.
That’s not to say that my parents are uninterested or don’t care about us. Far from it; even though they both have busy work schedules, one of them would almost always make it to my track and cross-country meets and to Holly’s soccer games.
My mother, in particular, has always tried to keep on top of what’s going on in our lives. In high school, I took advanced-level classes and earned good grades. I also got along quite well with my teachers and ended up graduating in the top 10 percent of my class.
I know this made my mother really proud, especially since she works at the school. She would get worried that I might not be doing my best and “working to my full potential.” All through high school, she tried to keep on top of my homework assignments and test schedules. She liked to look over my work before I turned it in, and would make sure that I left myself plenty of time to study for tests.
Describe the family dynamics and school pressures experienced by Julia. Under what circumstances might such family and school factors become problematic or set the stage for psychological problems?