CLINICAL HANDBOOK OF PSYCHOLOGICAL DISORDERS

At the initial evaluation, Denise reported that she was a 59-year-old widow, who had been living alone for the last year. Denise’s husband had been diagnosed with brain cancer three years prior and died approximately one year ago. She had two grown unmarried children (27 and 25 years old) who were pursuing ca- reers in other parts of the country. Denise had an undergraduate degree and had worked until age 30 but stopped after marrying. Denise de- scribed her major problems as depression (over the last year and a half), difficulty coping with daily life, and loneliness. She reported one prior episode of major depression around age 25, following the death of her father.

Denise said she had become increasingly so- cially isolated with the onset of her husband’s illness (brain cancer). She reported having had normal friendships as a child, teenager, and young adult. She and her husband had led a rel- atively quiet life together, mostly focused on raising their children and respective work. When they had free time, they had enjoyed in- tellectual and cultural activities together (muse- ums, lectures, concerts, and fine restaurants). They had a few close friends with whom they socialized but those friends had retired in Florida and Arizona during the time of the hus- band’s illness.

Denise was diagnosed with a major depres- sive disorder, recurrent, on Axis I. Her test scores verified the diagnosis of depression. Denise’s Beck Depression Inventory (BDI) score was 28, placing her in the moderate to severe range of depression. Her most prominent depressive symptoms included loss of pleasure, ir- ritability, social withdrawal, inability to make decisions, fatigue, guilt, difficulty motivating herself to perform daily functions, and loneliness.