UCF Accommodation of Clients with Disability in the Workplace Discussion

1. The summary of the case selected with the disability; make an accurate description of what and when the disabling condition interferes with job performance.
2. Contact information: Name (manager and the company), phone, email, address of location, and work setting of the employer interviewed. Onet Classification of employment.
3. The length of the interview, date, and time it occurred.
4. The primary and secondary tasks and duties for the client.
5. A description of the clients potentially employed at the site.
6. Appropriate consultation information to facilitate prevention of your client’s disability in the workplace
7. Ways to minimize risk factors of employees and employers
8. Accessibility and issues related to ADA compliance.
9. Assistive Technology to consider
10. Employer practices that affect the employment or return to work of individuals with disabilities and how they utilize those practices to help facilitate successful employment.
11. Employers work conditioning or work hardening strategies and resources.

Name: Eileen
Age: 28
Race: Caucasian
Gender: Female
Occupation: N/A
Education Level: Bachelor’s in interior design
Marital Status: Single
Case Conceptualization
Eileen is a 28-year-old interior designer. She has worked in her field for about 6 years, but she has
had seven jobs in that length of time. Eileen has always been very conscious of her appearance,
although she had never been happy with it. From the time she was little, Eileen has been aware of
what she believes is a serious flaw in her appearance. When she turned 13, this flaw became more
of an issue for her because she suddenly became interested in boys, and she was sure no one
would be interested in her because of this flaw. Eileen has tried numerous ways to conceal the flaw
but is never satisfied with the result. The flaw is located on her left ear. At the top of her ear where it
would normally curled edge, Eileen’s ear is flat. When she was little, it was easy to cover with her
hair in pigtails or braids or a ponytail that other girls wore. If her mother was insistent, Eileen would
wear earmuffs all day until she could take out her braids or pigtails. If anyone noticed it or asked
about it, she said she had “cold ears”.
As Eileen has gotten older and wanted to try different hairstyles, she has become acutely aware of
this defect, to the point that she spends hours every day focused on it. Getting through high school
was a very difficult for Eileen because she was so self- conscious about her appearance. She
refused to present in class and used to sit with her head downcast, her head resting in her hand
covering her ear. She did not date in high school because she was so self-conscious that she was
unable to make eye contact with anyone who spoke to her, which earned her a reputation as a snob.
Eileen developed one good friend in high school, Kate. Kate was willing to listen to Eileen’s concerns
and would sympathize to a degree. However, once Kate went to college, she changed, and told
Eileen that she had a “problem” and needed help to deal with it. This event prompted devastation in
Eileen, and she cried for weeks, expressing feelings of worthlessness. Eileen and Kate have not
spoken since that time. While Eileen was studying for her interior design career, she arranged all her
classes for later in the day, so she would have plenty of time to work on covering up her flawed ear.
Since getting her design credentials, Eileen has had numerous jobs. The reason is that she usually
quits or loses the job because she is unable to keep her appointments in a timely fashion and often
has difficulty focusing on client conversations and desires due to her preoccupation with her ear
flaw. It typically takes Eileen 3 hours to prepare for work. Every morning when she is getting ready
for work, she spends most of her time fussing with hair to cover the flawed part of her ear and then
moving around the room, as she might do if she was working at a client’s home, to see if the flaw is
revealed. If she does find that certain movements display the ear, then Eileen attempts to control her
movements more closely, resulting in stilted and awkward movements that actually draw more
attention to her than usual. During the workday, Eileen is so obsessed with her hair and her ear, that
she frequently checks herself in store windows, the car mirror, and in the bathroom. Many days, she
wears a hat to cover her flaw and then has to spend time rearranging or adjusting it. These
behaviors have resulted in client requests for another designer and have cost her the job in several
cases. The loss of her last job resulted in another significant episode of depression.
As a result of the obsession with her ear flaw and her inability to work or concentrate on anything
else, Eileen has no social life. She does not have the money to live independently, so she lives at
home with her single mother, a teacher. Eileen’s mother has tried numerous strategies to help Eileen
address her concerns, even agreeing to take her to a plastic surgeon, particularly following Eileen’s
most recent depressive episode. The surgery proposed by the physician, however, was so
expensive that Eileen could not afford it, and since she is over age, she no longer covered by her
mother’s insurance. The physician did recommend a psychiatric consult, based on Eileen’s
depression, which her mother thought would be a good idea. This encounter has convinced Eileen
that her preoccupation with her ear flaw may actually be abnormal and that perhaps she should think
about seeing a psychiatrist, especially since she has already experienced two depressive episodes.
Eileen has agreed to think about it, primarily because she is so unhappy and has found herself
recently thinking about suicide.
Presenting Problem
Eileen is having depression and anxiety episodes due to her flawed ear, as well as worrying about
her inability to keep a job and having suicidal thoughts.
Family Information and Background
Eileen comes from a middle-class household, urban background, and single home family. Eileen’s
mother has always been supportive of her only child and all her struggles. Eileen’s mother has been
a single mother since Eileen was two years old, after discovering her husband’s infidelity and
deciding not to try again. Eileen as a child was always described as a “happy baby”. There wasn’t a
time when she didn’t smile or laughed, but it all shifted when she got to her teenage years. Eileen
was born with a defect in her left ear, ear lidding deformity which is caused when the curved
cartilage in the top of the outer ear fails to develop completely. When Eileen turned 13 that’s where
all her life started spiraling down for her and her mother. Her mother has been called to pick her
daughter up on numerous occasions, and it was always the same reason. She didn’t want to keep
her head up in class, there were instances when she didn’t want to leave the restroom because she
was afraid of being teased. Eileen’s mother was always working to keep up with their lifestyle and
making sure Eileen had everything she wanted to divert her mind off her faulty ear.
Diversity Issues
Eileen had always felt like she didn’t belong in society, had low self-esteem, and always felt like
she couldn’t live up to the narrow beauty standards of conventional western society.
Strengths
Eileen is receptive to the concept of seeking assistance and, more significantly, is driven to find a job
she can keep. She also has her mother as social support and is open to learning interventions and
techniques that will help her daughter manage her disorder. They are both willing to seek assistance
and obtain the resources they require.
Diagnosis
Body Dysmorphic Disorder DSM-5 300.7 (F45.22)
According to the DSM- 5, BDD is characterized by a preoccupation with perceived defects or flaws in
physical appearance. A history of a recurrent behavioral component centered on the perceived
physical abnormalities is also present, such as examining oneself in the mirror constantly, grooming
to cover or fix a perceived fault, or seeking comfort from others about one’s looks without
satisfaction. Symptoms include:
•
Thinking about the perceived defect for hours everyday
•
Distress about their preoccupation
•
Worrying about their failure to match the “physical perfection” of models and celebrities
•
Constantly looking at their reflection or taking pains to avoid catching their reflection (for
example, throwing away or covering up mirrors)
•
Depression and anxiety, including suicidal thoughts
Obsessive- Compulsive Disorder DSM-5 300.3 (F42)
According to the DSM-5, OCD is characterized by obsessions, recurrent thoughts, urges, or images
that experience as intrusive and unwanted that the person attempts to ignore or suppress.
Symptoms include:
–
Compulsive behavior
–
Meaningless repetition of actions
–
Anxiety
–
Depression
–
Repeatedly going over thoughts
Differential Diagnosis
•
Social Phobia – a form of anxiety illness marked by a fear of social engagement. Someone
who suffers from social phobia may be afraid of being judged, criticized, ridiculed, or
humiliated. The underlying difficulties may be BDD if the avoidance is caused by anxieties
about their looks.
•
Agoraphobia – An anxiety condition marked by apprehension of events or places from which
escape appears difficult. A person with agoraphobia may be confined to their home in
severe circumstances. A person who stays at home out of dread of publicly displaying their
defect, on the other hand, may have BDD rather than agoraphobia.
•
Anorexia nervosa – Because of the fixation with beauty, BDD is sometimes misdiagnosed as
anorexia nervosa. Anorexia nervosa, on the other hand, is defined by a strong desire to lose
weight. An individual can have both anorexia nervosa and BDD at the same time.
•
Hypochondriasis – The preoccupation with the development of disease. However, the
person with BDD is preoccupied with their looks, not their health.
•
Trichotillomania – The uncontrollable desire to pluck or pull hairs. The underlying problem
could be BDD if the conduct is triggered by concerns about appearance.
•
Delusional Disorder – is characterized by recurrent thoughts that are help with delusional
conviction.
Assessments
•
Body Dysmorphic Disorder Questionnaire (BDDQ) – It is a brief self- report screening
measure for BDD; a follow up in person interview is needed to confirm the diagnosis.
•
Body Image Disturbance Questionnaire (BIDQ) – This brief self-report measure uses
continuous response scaling and is a significantly modified self-report version of the BDDQ.
In a non-clinical population, it has good psychometric qualities, although more sensitivity and
specificity are needed. To confirm the diagnosis, a follow-up in-person interview is required.
•
Beck’s Anxiety Inventory (BAI) – consists of 21 self-reported items (on a four-point scale)
that are designed to assess the severity of somatic and cognitive anxiety symptoms
throughout the past week.
•
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) – is a 10-item scale designed to
measure the severity and type of symptoms in people with obsessive-compulsive disorder
(OCD) over the past seven days. The symptoms assessed are obsessions and
compulsions.
•
The SAFE-T card Suicide Assessment Five-Step Evaluation and Triage – Clinical staff
are guided through five steps that address the patient’s level of suicide risk and recommend
suitable actions.
•
O* NET Interest Profiler – self-assessment career exploration tools that might assist clients
in identifying the types of employment activities and occupations that they enjoy. Clients
determine which broad interest areas are most relevant to them and learn about them. They
can use the findings of their interest tests to investigate the world of work. It will assist Eileen
get an understanding of her interest and jobs that she will find comfortable to work without
the preoccupation of her flawed ear.
•
Ear evaluation- an ear evaluation is necessary for Eileen to screen for ear problems
Treatment Goals
Long Term Goals 1 year
•
Reduce time involved with or interference from obsessions
•
Significantly reduce frequency of compulsive or ritualistic behaviors
•
Function daily at a consistent level with minimal interference from obsessions and
compulsions.
•
Resolve key life conflicts and the emotional stress that fuels obsessive compulsive behavior
patterns.
•
To maximize time free of obsessions and compulsions, let go of crucial thoughts, beliefs, and
past life events.
Short Term 6 months
•
Discuss how treatment might help the client desensitize learned fear, examine obsessional
concerns and underlying beliefs, and gain confidence in handling fears without compulsions.
•
Enroll the client in BDD exposure and ritual prevention therapy in a non-intensive (weekly)
small, closed group setting.
•
Schedule periodic “maintenance’ sessions to help the client maintain therapeutic gains and
adjust to life without OCD/BDD
•
Teach the client to interrupt obsessive thoughts using the thought -stopping technique of
shouting STOP to herself silently while thinking of a red stop sign and the n thinking about a
calm scene.
Goals & Objectives
GOAL: Resolution of depressive symptoms
Objectives:
•
Eileen will contact staff for safety check at least once a week
•
Eileen will identify two coping skills related to (specific stressors)
•
Each night, the patient will aim to get and report at least 6 hours of restful sleep
•
Eileen will eat at least two out of three meals a day
GOAL: Alleviation of anxiety symptoms and improvement in ability to function independently
Objectives:
•
Patient will identify at least three new coping skills she can utilize
•
Patient will participate in at least two complete groups or activities per week
•
Patient will identify feared situations and discuss at least one such situation in a journal once
a week
GOAL: Reduction in the amount of time spent focused on obsessive thoughts of flawed ear and
performing compulsive behaviors
Objectives:
•
Eileen will identify the relationship between obsessions and compulsions
•
Eileen will participate in a daily relaxation routine.
•
Patient will identify at least three behaviors with response prevention
GOAL: Gain full employment
Objectives:
•
Eileen will take the O*NET Interest Profiler assessment
•
Eileen will update her resume or LinkedIn profile
•
Eileen will identify a target list
•
Eileen will try to target one interview per week
Treatment Plan
•
Behavioral therapy
•
Cognitive behavioral therapy
•
Psychotherapy
•
Exposure and Response Prevention therapy
•
Support group
•
Aversion therapy
•
Rational emotive behavior therapy
•
Systematic desensitization
•
Group psychotherapy
•
Acceptance and commitment therapy
•
Family therapy
•
Neurosurgical treatment (e.g., deep brain stimulation)
•
Practice self-care
•
Psychiatrist
•
Intensive outpatient and residential treatment programs
•
Transcranial magnetic stimulation (TMS)
•
ENT
•
Medication
–
SSRIs (Eases symptoms of depressed mood and anxiety)
Fluoxetine: (symptoms: nervousness, nausea, heartburn, yawning etc.)
Escitalopram: (Symptoms: headache, increased sweating, dry mouth, fatigue etc.)
–
Anxiolytic (Relieves anxiety and tension. May promote sleep)
Buspirone: (Dizziness, drowsiness, blurred vision, tiredness etc.)
–
Antidepressant (Help relieve symptoms of depression and certain anxiety disorders)
Venlafaxine: (Drowsiness, weakness, dizziness, nausea etc.)
Clomipramine: (Drowsiness, dry mouth, constipation, decreased sexual ability etc.)
Assistive Technology
•
Mobile Applications
–
Headspace – The headspace application can help reduce anxiety and stress and
improve well-being by guiding users through mediation sessions.
–
Live OCD Free – This app is based on cognitive behavioral therapy exercises for OCD.
–
Breathe2Relax – Helps the client calm the fight or flight response anxiety disorders
cause by utilizing diaphragmatic breathing exercises.
•
Digital Recorder (Individuals with OCD may have trouble concentrating. A recording
device can allow a person with OCD to go over recorded moments with less pressure
and more control)
Sony ICD-UX530 Series Voice Recorder – this discrete voice recorder has a built in USB
–
for easy transfer of audio recordings.
–
TASCAM DR-05X Portable Digital Recorder- One benefit of this recording device is it
does not change pitch when the playback speed is changed.
Resources
•
The Body Dysmorphic Disorder Foundation- provides information on BDD for friends and
family, as well as offer support groups.
•
1 on 1 Coaching & Wednesday Night OCD Support Group (Online Via Zoom) W / Mike Fink
–
Meeting day and time: Wednesday Night 4-5:15 PST Open To: Individuals struggling
with OCD and family members affected by OCD. Email: mike.r.fink@gmail.com
Phone: (760) 458-6213
•
Rogers Behavioral Health in Miami | International OCD Foundation
–
Intensive treatment program
–
5805 Blue Lagoon Drive Suite 440 Miami, Florida 33126 Phone: (888-927-2203)
Email:Sarah.Norfleet@rogersbh.org
•
Miami Counseling & Resource Center
–
•
CareerSource Florida
–
•
111 Majorca Ave. #B, Coral Gables, Fl 33134 Phone: (305) 448-8325
Assist with job search, career change, resume help etc.
Miami ENT Doctors
–
1330 SW 22nd St STE 403, Miami, FL 33145 Phone: (305) 325-0090
Vocational Resources
•
CareerSource Florida
•
Job Corps
•
Glassdoor
•
USAJobs
•
American Society of Interior Designers
•
IIDA Career Center
Signature Of Agreement
Clinician Signature
Date
Client Signature
Date
References
CareerSource Florida. (n.d.). CareerSource Florida. Retrieved April 13, 2022, from

Home

First, M. B. (2014). DSM-5 handbook of differential diagnosis. American Psychiatric Association.
Interest Profiler (IP) at O*NET Resource Center. (2019). Onetcenter.org.
https://www.onetcenter.org/IP.html
Jerome, L. (1991). Body size estimation in characterizing dysmorphic symptoms in patients with body
dysmorphic disorder. The Canadian Journal of Psychiatry / La Revue Canadienne De
Psychiatrie, 36(8), 620. https://www.proquest.com/scholarly-journals/body-size-estimationcharacterizing-dysmorphic/docview/618100739/se-2?accountid=10901
Klott, J., & Jongsma, A. E. (2006). The co-occurring disorders treatment planner. Wiley.
Mayo Clinic. (2016). Body dysmorphic disorder – Symptoms and causes. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/symptomscauses/syc-20353938
Mayo Clinic. (2020, March 11). Obsessive-compulsive disorder (OCD) – Symptoms and causes. Mayo
Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsivedisorder/symptoms-causes/syc-20354432
Nakagawa, A., Olsson, N. C., Hiraoka, Y., Nishinaka, H., Miyazaki, T., Kato, N., Nakatani, E., Tomita,
M., Yoshioka, K., Murakami, S., & Aoki, S. (2019). Long-term outcome of CBT in adults with
OCD and comorbid ASD: A naturalistic follow-up study. Current Psychology: A Journal for
Diverse Perspectives on Diverse Psychological Issues, 38(6), 1763-1771.
http://dx.doi.org/10.1007/s12144-018-9952-1