Can you please read the Sarah's Case Study? Imagine that you are scheduled to see Sarah for her first visit this week:

• Describe three ethical issues that you would incorporate into your first contact with Sarah and her parents.

• Identify the legal issues you would consider regarding confidentiality.

• Discuss the importance of cultural background in Sarah's case.

• Identify the physical and physiological issues you would consider before recommending that Sarah's parents seek physician consultation regarding the possible use of medication as part of Sarah's treatment plan.

Sarah's Case Study

Sarah is a 15-year-old Caucasian girl who is the eldest of three children. Her father is an attorney, and her mother works at a community college. Sarah's family describes her as "a perfectionist" who works hard in school and does not get into trouble.
At the age of 13, Sarah became quite worried about her weight. She had gained about 10 pounds in 6 months and had begun menstruating. She began dieting because "kids were teasing me at school about my weight." She ate low-calorie foods, started to run 2 to 3 miles a day, and did aerobics at home once a day.

Because of these techniques, she lost about 5 pounds in 1 month. She reported feeling a sense of control and accomplishment. It became common for her to skip breakfast and lunch. Sarah also began spending more time either studying or exercising and became increasingly self-critical. She would ruminate that she could not make friends because she was not interesting and had nothing to offer. She believed that she was not smart, and she would become extremely upset if she did not make the highest score in class on a test. Sarah became more irritable with her family and isolated from her friends. She would not eat with her family and had frequent arguments with her younger sisters and parents. Her family became relieved when she was in her room, because she was so disruptive. They believed that she must be going through an adolescent phase and hoped things would be back to normal soon. Her parents became concerned about her weight when she began to look "a little too thin" and they could hear her exercising in the middle of the night in her room.

Sarah reported a persistent sadness centered on the feeling that she would be a failure if she gained weight. She believed that the only way she could feel better was to diet more. She reported less interest in hobbies that did not relate to dieting or exercising, was not interested in seeing friends, and had difficulty sleeping. She also reported persistent worrying about minor matters, usually related to weight and food, but also many important matters, such as what college to attend and if she would be successful in life.Sarah also reported a preoccupation with doing things perfectly. This caused her to spend more time on homework, because she would end up recopying the same assignment three or four times to make sure it was perfect. She also reported spending two to three hours each day cleaning and compulsively organizing her room so that her books and clothing were arranged according to size and color. Sarah's mother initiated counseling for her daughter. There is some question about the father's support of this decision.