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Initial Assessment and Medication Consultation for a School-Based Professional

Binge-Eating Disorder, Moderate

Intake / Referral: Imani, a 44-year-old non-binary person, arrives for an intake session at a K-12 school counseling office where they are employed as a lead administrator. They were referred by their primary care physician (PCP) due to concerns about escalating 'uncontrollable eating habits' and significant emotional distress. Imani states, 'I feel like I’m losing my mind two or three nights a week; I just can’t stop eating until I’m physically in pain.' Demographics & Context: Imani identifies as Black and non-binary (using they/them pronouns). They have worked in the school district for 12 years and are highly respected by colleagues. Imani is currently single and lives alone, having recently ended a long-term partnership six months ago. They report feeling a lack of 'true community' outside of work, despite being active in their church. History of Presenting Problem: Imani reports that their eating behaviors worsened shortly after their breakup. They describe episodes, occurring at least twice weekly for the last five months, where they consume large quantities of high-calorie foods (e.g., entire boxes of cereal, multiple fast-food meals) in a single sitting. These episodes occur in private, are characterized by a sense of loss of control, and are followed by intense feelings of disgust, shame, and depression. Imani denies any compensatory behaviors such as purging, excessive exercise, or laxative use. Psychiatric, Medical & Family History: Imani was diagnosed with Generalized Anxiety Disorder in their 30s but has not been in therapy for several years. They were recently prescribed Vyvanse by their PCP to help with 'focus and binge urges,' but Imani admits, 'I haven't been taking it consistently because I'm worried it will change my personality.' They have a family history of Type 2 Diabetes (mother) and Depression (maternal aunt). Imani’s own BMI has increased significantly over the last year, which they find distressing. Social, Substance & Trauma History: Imani consumes 2-3 glasses of wine on weekends but denies illicit drug use. They report a history of 'minor' bullying in childhood related to their gender expression but deny any history of physical or sexual abuse. They describe their current social support as 'wide but shallow,' noting they rarely share their internal struggles with others. Current Functioning & Mental Status: Imani appears well-groomed and professional. Their mood is dysthymic with a constricted affect when discussing their eating habits. Thought processes are logical and goal-oriented. They demonstrate high insight into the psychological nature of their eating but exhibit poor judgment regarding medication adherence. Sleep is disrupted by late-night binge episodes. Occupationally, they remain high-functioning, though they report 'brain fog' in the afternoons. Risk & Protective Factors: Imani denies current suicidal or homicidal ideation, plans, or intent. They identify their career and their faith as significant protective factors. The primary risk factor is the physical health impact of rapid weight gain and the psychological toll of chronic shame. Collateral / Additional Information: A brief note from the PCP indicates that Imani’s blood pressure is borderline hypertensive and suggests that therapeutic support is 'critical' for managing the behavioral components of their metabolic health.