Jane is a 19-year old female. She presents as markedly underweight, with significant agitation. Both of her parents are present for the intake session. Her mother is an attractive Asian woman of slight build. Her father is a Latino male who appears deeply concerned about his daughter. Jane is their only child.

The parents report that when Jane was 2-years old, she was sexually abused by an older female cousin that was diagnosed with autism. While this cousin has not been part of Jane’s life since, this remains a family secret and no legal action was ever taken due to the cousin’s mental illness. The parents do believe this affected Jane and are hoping to approach this issue and find resolution and healing. They have approached their family doctor who has known Jane all of her life. He suggested that the family seek counseling and consider hospitalization for Jane.

Reportedly, Jane has been erratic, impulsive and self-destructive throughout much of her life. Her parents report that Jane suffers from mood swings, angry outbursts and has alienated most of her friends. She has a history of self-abuse and suicidal ideation. While Jane has reportedly never made an attempt on her life, her parents have always been cautious and concerned. Jane has a history of cutting her wrists, but the parents report this was superficial and did not require medical attention. Jane denies doing this at present.

Jane has also been struggling with anorexia and bulimia since age 12. They have taken her to doctors and therapists with no success. In the past few months, Jane has lost a significant amount of weight, is not sleeping and is “talking crazy”. The parents often find Jane up all night having conversations with herself that make no sense. Jane’s mother begins to cry as she expresses a fear that her daughter is using drugs and worries that she will overdose and die. At this point, Jane starts wringing her hands and looking around the room and asks if she can be excused to use the restroom.