Trichotillomania Case Study

2450 Words 10 Pages
Diagnostic Impressions My initial diagnostic impressions of Madeline are that she is suffering from a comorbid presentation of trichotillomania and depression. I believe both disorders present in Madeline due to the set of symptoms which are paramount of both disorders. In discussing this diagnosis in depth, we will be able to better understand her disorder and the best course of action that will lead to her recovery. The primary diagnosis for which Madeline entered the inpatient facility is best described as Major Depressive Disorder. The presentation of a slew of symptoms that are paramount to childhood depression make this a very prevalent secondary diagnosis. Symptoms including: Somatic issues (reported GI problems despite physicians …show more content…
Generally, children under the age of 11 do not have the cognitive ability to have insight into their own disorder (Bratton et al. 2005). This is due to a lack of cognitive insight into her own disorder simply due to her age and place in her development. While CBT is necessary, we need to tailor the way we conduct the therapy for Madeline. Methods such as play therapy have been found to be very effective with children at her age. (Bratton et al. 2005) These methods address issues including self esteem and teaching social skills. The clinician hopes to help Madeline deal with stressful situations and emotions she may be holding onto. These methods allow the clinician a way to model appropriate and healthy social interactions. Play therapy can also allow the child to, in a safe place, deal with emotions they are unaware of but are projecting. The clinician would be largely non-directive and helps the child deal with emerging conflicts and emotions that come up in the play scenarios (Bratton et al. 2005). There are other aspects of CBT that could be used in her case. This includes things like activity scheduling could help structure her day to day life. This could help decrease any anxiety she has about handling the day to day …show more content…
2013).This would include understand exactly what Madeline’s hair pulling behaviors consist of. Where is she pulling? What are the situations that may trigger her pulling? Essentially we look to understand her compulsion. This will help tailor the habit reversal therapy to her needs. Once the clinician has a grasp on Madeline’s habits and behaviors, they would engage Madeline in awareness training and self-monitoring. For example, trying to get her to recognize for herself the things that set off the pulling or at least when she is pulling to become aware of it. The clinician would also teach Madeline things like forms of stimulus control and competing response procedures. This includes the avoidance of situations where pulling might happen and attempting to substitute other stimulus for pulling when the compulsions to pull arise. With the convergence of the use of selective serotonin re-uptake inhibitors, and the behavioral treatment therapies to teach her ways to address her pulling, the clinician acts to treat her symptoms very aggressively. This should address both the cognitive and any biological basis of her disorder that may be

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