Creative Case Identifying Information: Lisa

Creative Case

Identifying Information: Lisa Simpson is an eight-year-old Caucasian female with bright yellow skin and hair, and large white eyes. She lives with her parents Homer and Marge, as well as her older brother, Bart, and her younger sister, Maggie. Bart is ten and Maggie is a toddler. The Simpson family lives in Springfield, where Lisa attends Springfield elementary school.

Presenting Problem: Lisa is seeking counseling services for feelings of depression and anxiety.

History of Presenting Problem: Lisa claims to have been experiencing symptoms for several seasons.

Description of Personality: Lisa is precocious, curious, and highly intelligent. Her vocabulary is sophisticated, and she speaks with maturity beyond her years. She is an honors student at Springfield Elementary, and has served as student council president, and is a member of the Springfield chapter of Mensa. Lisa is an avid reader of books, and prefers creative non-fiction and literature to books that are specifically geared towards her age group. Lisa has a strong social and political conscience. She has participated in political protests that cover the gamut of feminism, vegetarianism, and environmentalism. Lisa participated in several high-profile protest events including a long-term stance living in a tree to prevent it from being cut down. Lisa self-identifies as a Buddhist. From an early age, Lisa has demonstrated musical prowess. Her primary instrument is the saxophone. In addition to playing with the school band, Lisa has worked with professional jazz musicians like Bleeding Gums Murphy. Although Lisa does not participate in team sports, she has played hockey.

Lisa's main challenges include mitigating sense of moral and intellectual superiority. She has few close friends, and does not feel close to any of her family members. Lisa considers her family members boorish and even described her father as being "dumb." Her political activism borders on fanaticism, and it is likely Lisa has forgotten that she is a little girl. She simultaneously isolates herself from others, while also bemoaning her loneliness. Lisa escapes into fantasy worlds, imagining herself in positions of power such as President of the United States.

Theoretical Basis: Lisa fits the description of an individual suffering from an anxiety disorder. Her symptoms fit the description of generalized anxiety disorder, outlined in the Diagnostic and Statistical Manual IV-Text Revision (DSM IV-TR). She has experienced excessive anxiety and worry for much longer than six months. Lisa claims that her constant state of anxiety has become a "part of who I am."

The primary focus of her worry is school, but she has recently come to worry about her health and her social relationships. Lisa's identity depends on her academic achievements. She refers to herself as "one of the smartest kids in school," and claims that physical education is the only class she does not receive regular "A's" in. Lisa is also highly active in extracurricular activities. She participates in a number of volunteer groups and clubs at school, serving in most cases as a leader. Lisa finds it hard to meet other kids her age who are like her. Most of her peers "do not care about school" and don't understand anything about the issues she cares about such as environmentalism and Tibet. Lisa worries excessively about external, global events such as global warming and wars in Africa. Many of the people she refers to as "friends" are much older than she is, although she admits most of them are mentors.

A person with generalized anxiety disorder finds it difficult to control worry. Lisa has been unable to control her worry successfully via Buddhist meditation or tai chi. She writes regularly in a journal and claims that this does help but not enough. Although she finds temporary relief in music and schoolwork, her feelings of worry and anxiety creep back into her consciousness as soon as she is doing something else. She experiences the most anxiety when with her family in public, which is why Lisa has been assessed for social anxiety disorder. Because Lisa has a penchant for public speaking and is not afraid of it, social anxiety has been ruled out.

Lisa's anxiety acts up around her family for several reasons. She feels that her family "does not reflect who I am." Lisa claims that she sometimes thinks she was adopted. She used to get along well with her brother, but lately they have grown apart as her brother is not interested in intellectual matters. Lisa "can't stand" her father but says she "loves him no matter what."

Her worry and anxiety is associated with restlessness, irritability, muscle tension, and insomnia. Her symptoms also include occasional somatic manifestations such as stomachaches. The symptoms and cognitions associated with her anxiety are starting to cause Lisa problems in school and socially. Lisa worries that she will not get into a good college, even though she is only in fourth grade.