Case Formulation – Ms. Lewis - Best Assignment Doers

Trevor Lewis, a 32 year old single man living with his parents was brought to his psychiatric

consultation by his mother. She noted that since adolescences he had been concerned with

germs, which led to a long-standing hand washing and showering rituals. During the prior 6

months, his symptoms had markedly worsened. He had become preoccupied with being

infected by HIV and spent the day cleaning not only his body but all of his clothing and linen. He

had begun to insist that the family also wash their clothing and linen regularly, and this had led

to the current consultation.

Mr. Lewis had in the past received a selective serotonin reuptake inhibitor and cognitive

behavioral therapy for his symptoms. They had had some positive effect, and he had been able

to complete high school successfully. Nevertheless, his symptoms had prevented him from

completing college or working outside the home: he had long felt that home was relatively germ

free in comparison to the outside world. However, over the past 6 months he had increasingly

indicated that home, tow was contaminated, including with HIV.

At the time of presentation, Mr. Lewis had no other obsessive compulsive and related disorder

symptoms such as sexual, religious, or other obsessions; appearance or acquisition

preoccupations or body focused repetitive behaviors. However, in the past he had also

experiences obsession concerning harm to self and others, together with related checking

compulsions (e.g. checking that the stove was switched off). He had a childhood history of

motor tics. During high school, he found that marijuana reduced his anxiety. Referencing his

social isolation, he denied having had access to marijuana or any other psychoactive substance

for at least a decade.

On mental status examination, Mr. Lewis appeared disheveled and un kempt. He was

completely convicted that HIV had contaminated his home and that his washing and cleaning

were necessary to stay uninfected. When challenged with the information that HICV was spread

only by bodily fluids, he answered that HIV might have come into the home via the sweat or

saliva of visitors. In any event, the virus might well be surviving on clothes or linen, and could

enter his body via his mouth, eyes, oer other orifices. He added that his parents had tried to

convince him that he was excessively worried, but not only did he not believe them, but his

worries kept returning even when he tried to think of something else. There was no evidence of

hallucinations or of formal thought disorder. He denied an intention to harm or kill himself or

others. He was cognitively intact.

Prepare a Case Formulation based on the Mr. Lewis case in which you address the following:

Describe the external or environmental factors that might be relevant in the etiology and maintenance of the client’s presenting problems.
Describe the internal factors (biological, affective, cognitive) that might be relevant in the etiology and maintenance of the client’s problems.
Examine the different theoretical perspectives which might be applicable to this particular case and how they apply.
Detail the complete DSM-5-TR diagnosis you would assign for this particular case.

To successfully complete this assignment, you will need to be concise in covering each of the above four items.

Use the DSM APA Manual as Reference

Requirements: 1,000-1,250 words

Case Formulation – Ms. Lewis