Carlos, a 10-year-old Hispanic male, is brought to therapy by his parents upon suggestion of Carlos’ pediatrician. Carlos is markedly overweight and has started refusing to go to school. He tells you, “the kids all tease me and call me names. I look like a fat pig and I hate myself”. His mother is quite concerned. She tells you, “Carlos rarely leaves the house and won’t participate in family events. He locks himself in his room and I often hear him crying. I try to comfort him but he tells me to leave him alone.” His mother tells you that Carlos will only eat one meal a day, but seems to be gaining weight. Carlos’ father describes his son as, “he’s such a momma’s boy. He needs to be a man and just get some exercise. I try to get him to play sports, go hiking and exercise with me, but he just runs back to his momma.” Recently, when the mother was cleaning Carlos’ room, she found boxes of cookies and bags of chips under his bed. The mother is tearful as she tells you how worried and concerned she is for her son. The father looks angry and disgusted over his son’s behavior. You notice that the mother is significantly overweight herself. The father appears to be physically fit. Carlos is the youngest of 5 boys. His siblings are quite a bit older than him and are all grown and live outside the home. The mother tells you that, “all my sons love to eat, but it doesn’t seem to affect them like my Carlos.” The father tells you, “my wife’s family are all obese. I was disappointed when my wife gained all that weight and now I see my son following in her footsteps.” Carlos tells you, “I hate when my parents argue. Food has always been my best friend. Now it’s my enemy.”
1. Using the DSM-5 criteria, what is your diagnostic assessment of Carlos? What co-occurring disorders do you suspect? What is the evidence that supports your diagnostic assessment? In your evaluation of Carlos, what social, environmental, familial, gender-related and cultural factors contribute to your assessment and evaluation? How does might his relationship with his mother and his position in the family as the youngest of 5 boys be relevant to your evaluation?
2. In consideration of the above assessment and evaluation, what concerns do you have about Carlos with regard to his physical and emotional health? How would working with his referring pediatrician be important? In consideration of the family dynamics that we see, what evidence-based individual and family therapy modalities might be effective with Carlos and his parents? Would you suggest couples counseling for his parents? Consider culture and gender roles in your response.