Assignment: Diagnosis and Ethical Implications

Assignment: Diagnosis and Ethical Implications

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Assignment: Diagnosis and Ethical Implications

Using the DSM-5, Explain and Justify your Diagnosis for this client.

6-Explain any Legal and/or Ethical Implications related to counseling this client.


Running head: JOURNAL ENTRY 1


Journal Entry

Student’s Name




In this journal entry, the case that shall be discussed is that of a 19year-old girl. This girl came to the health facility accompanied by her mother. She had a wig on her head and it was clear that she was trying to hide something. She was able to speak for herself and she was very ready to share her experience. The mother was only there for moral support. She removed the wig and it was immediately clear what was going on. She said that she could not stop pulling her hair for a very long time, almost 12 months now. She said the problem always existed when she was growing up but it only got worse in the last 12 months. She keeps pulling her hair and at times, she enjoys eating it after closely inspecting the hair. The client cried at some point and said that it was getting hard to go out because she was ashamed of how she looked. She did not want to be considered as a “freak”. The client also said that she started feeling pain in the stomach and she was increasingly getting constipated. She was also nauseated most of the time. When they visited the primary care giver, she narrated the story to the physician and the physician referred her to the facility after diagnosing her with trichobezoar. This is basically a mass of hair that is trapped in the gastrointestinal system and it is common in persons that have har pulling disorder especially after they eat the hair (Pereyra & Saadabadi, 2019).

Hair-pulling disorder is also referred to as trichotillomania. In the DSM 5, this disorder is associated with recurrent pulling of hair that leads to loss of hair. There should be repeated effort to try stopping this habit without success. The pulling of hair leads to distress that is clinically significant. It also leads to impairment in the social as well as occupational areas in the life of the person with the disorder. Important areas of functioning are also affected by the disorder (APA, 2013). The pulling of hair or the hair loss should not be because of other medical conditions such as dermatological condition. Also, a different mental disorder cannot be used to explain the hair-puling disorder. For instance, this should not be a case where the client is trying to improve the appearance of his or her body because of a flaw or defect that they think they have (APA, 2013). For instance, this diagnosis could not have been made if the client was trying to correct a defect or a flaw that she thinks she has.

Two approaches can be used in treating this disorder. The approaches include habit reversal training as well as cognitive behavioral. It should be noted that habit reversal therapy is founded on cognitive behavioral therapy. Habit reversal training is utilized with a view of finding a cognitive distortion as well as though action in order to change them in ways that improve the life of the client. Habit reversal training makes use of a number of techniques including awareness training, competitive response training, stimulus control, social support training and contingency management (Gupta & Gargi, 2012). It is expected that whenever these approaches are used, the client will change her behavior and she will stop feeling the need to pull her hair. This client is a teenager but old enough to make her own decisions regarding treatment. Therefore, she can only be informed about the treatments and the expectations before she gives informed consent. There is also need to consider treating her symptoms because of the accumulation of hair in her GI tract.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub

Gupta, S., & Gargi, P. D. (2012). Habit reversal training for trichotillomania. International journal of trichology4(1), 39

Pereyra, A. D., & Saadabadi, A. (2019). Trichotillomania, Retrieved from