Case Study No. 1: Tara Theona Tara is a 17-year-old female.

Case Study No. 2: Tara Theona Tara is a 17-year-old female.

Her parents referred her because she does not seem to have any friends and they are worried about her health. She has recently lost 15 pounds despite the fact that she is still growing taller.

She is extremely concerned about her weight and weighs herself daily. If she is not losing weight she cuts back on what she eats.

She wanted to go out for track because she thought the exercise would be good; however, she quit after the first practice because the locker room was too dirty and she was afraid that someone would touch her and get their sweat on her.

She has stopped spending time with her friends because she thinks they are too dirty.

w Tara stated that she gets up at least three hours before school in order to weigh herself exactly 10 times and to complete a detailed plan for her diet, exercise, and hygiene. In addition to struggling with weight, when Tara comes home from school she pulls her hair out on a somewhat regular basis. Tara mentioned she does not know why she does this but feel an urge to.

She said now and then she starts to get a balding patch and starts to wear a hat to cover it up.

When asked about her hair pulling in more depth, Tara stated she finds an odd sense of relief right after she pulls her hair out. She looks at the root, and is intrigued by its shape.

She said she likes how it feels. She also said she likes curling her hair tight – pulling the hair she pulled through two of her fingernails.

She likes to see how tight she can get the curls. She likes to also see how many hairs she can pull out with the root whole. When she is done pulling out her hair and curling it tight, she throws it away.

Tara said she has been pulling her hair out for years. She said her first recollection of pulling out hair was when she was 12 years old.

She said her mom often asked her to pull out her grey hairs.

She did. She said she use to find it oddly helpful. She said she liked the immediate relief that came right after she pulled out the hair. Over time she started pulling out her own hair, instead of her mothers.

She said she has not told anyone outside her mother who took her to the doctor when she was 13 just to make sure she didn’t have an underlying medical issues that could be causing such behavior since her mom started to notice a balding patch on her head.

Medical and neurological causes were ruled out, no alopecia otherwise was present. She has no history of psychotic symptoms, and no history substance use could be a contributing factor.

The pediatrician recommended they see a psychiatrist. Tara’s mother was not a fan of that. Tara told her mom that she was embarrassed by her hair pulling and would stop if she did not have to see a psychiatrist. Her mother was fine with that.

The topic never came up again. Tara stopped for several months, until she started again. She did during the times she stopped, she would often look for excuses to pull out someone else’s hair.

She knew her mom did not like grey hair so periodically she would pull a random hair out of her mom’s head and say, "I know you don’t like grey hairs, so thought I might pull that one out for you." She said she would feel that same immediate relief she felt as if she was pulling her own hair. Tara said she would slowly start back up to pulling out her own hair.

If she started to get a balding patch, she would wear a hat or scarf to cover it up. She said the longest she has been able to stop has been four or five months. She said something stressful usually triggered it happening again.

She mentioned that recently she tried pulling out hair on her legs and found she got a huge sense of immediate relief from doing so. She was bothered that she felt an instant relief from this, sat for hours pulling out leg hairs and was frustrated that she couldn’t seem to stop herself.

She wondered if it was time to talk to someone about all her issues.What key signs, symptoms, or other considerations jumped out at you?

1. Based off of these signs and symptoms, what are 4-5 possible diagnoses that come to mind, and why?
2. Walk us through the two most probably diagnoses you are considering for this person. Share how that person meets or does not meet the diagnostic criteria.
3. Of the remaining possible diagnoses you might consider for this person, are there any factors or clues that jump out as to why you might want to still consider this diagnosis instead of one of the two you just described? Would you want to still gather information and consider it as a rule-out diagnosis? Or, can you rule it out now? If you can rule it out now… what helped you make that decision?
4. What might your final, working, or provisional diagnosis be for this person?