Alexandra Smith

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-Patient Admission Form-

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Patient Full Name: Smith, Alexandra

Age: 18
DOB: 03/19/1993
Gender: Female.
Address: 18 Wallobrough Street.
City: Dallas.
State: Texas.
Ethnicity: Caucasian.
Height: 5'5.
Weight: 105 lbs.
Eye Color: Dark brown.
Hair Color: Dark brown/Black.
Distinguishing Marks: I have my ears pierced and a birthmark resembling the shape of a star on my left collerbone.

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Medical History:

Please list any and all allergies and age of onset below:

None.

Are you aware of any ongoing medical issues?:

None.

If yes, list age of diagnoses by medical professionals, or age of onset below:

Not Applicable.

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:

Not Applicable.

Do you smoke tobacco, consume alcohol, or use street drugs? If yes, please list number of packs per day, number of drinks per day and/or names of consumed drugs below:

No.

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Psychiatric History:

Have you been diagnosed with any psychiatric issues? If so, please list diagnoses and age of diagnoses below:

At the age of fourteen I was diagnosed with bulimia nervosa by my familys personal doctor when my father noticed a difference in the way I was acting he called him in and asked him to talk to me about it. The doctor started to talking to me when I was thirteen and only finally discovered my condition almost a year later.

At age fifteen I was diagnosed with mild depression and at least several months later I was again diagnosed by the doctor who said that my depression had increased and his theory was that being bulemic had caused my mind to work against myself in a way that can put me in a state of sadness and low moods.

If you answered yes to the above, please list any and all prescriptions, including dosage and frequency of dosage, and other treatment plans below:

Anti Depressants, Prozac, 30mg - Two tablets a day, one in the morning and one at night.
Due to my Bulemia the doctor requested he visited me once a week to talk to me about anything I wanted to which was also about my feelings to ease my depression aswell as work out how I felt about the way I looked.

If you answered yes to the above, please describe your feelings, symptoms, triggers and any incidents associated with the diagnoses, such as outbursts, suicide attempts or any other signs of non-typical behaviors, and approximate ages of incidents below:

My feelings towards the doctors first diagnosis was negative. I didnt and still dont believe Im sick and there is nothing truly wrong with me. Being told I was bulemic felt wrong, it shouldnt have happened because I am perfectly fine.

I didnt like the medication because it made me feel as if I was sick when I wasnt and Im still not. My father would bring the tablets in for me in the morning and at night. I had told him I felt uncomfortable that he was there whilst I took then so he knew to leave. When I knew he was away from my bedroom I crushed the tablets and flushed them down the toilet in my en suite. No one was going to make me think I was sick.

My parents didnt seem to notice I wasnt taking the pills and after a few more visits by the doctor he just assumed that the pills were not working so he boosted my intake from two pills to three. I went along normally and whenever the pills came around I just got rid of them the same way I did before. The doctor couldnt work it out so at one of our discussions he asked me to take one of the pills in front of him. I refused and he understood why i wasnt getting better. It didnt make a difference and since he knew I wasnt going to take the pills he gave up and tried a different method of trying to get through to me through our discussions. My feelings arent any different for any pills and even though I still have the pills I dont touch them because I know they wouldnt have an effect anyway because they are only supposed to work on sick people.

Have you ever been hospitalized for these diagnoses? If yes, please provide facility name(s) and age of admissions and discharges as well as what diagnoses you were you hospitalized for, or what incidents lead to hospitalization:

Not much longer after the doctor had worked out that I wasnt taking the pills, my supposed illness got worse which caused me to go into st.marys hospital for approximately five months until I gained a bit more weight. The experience was traumatizing, as I sat in that hospital bed I felt the fat building up inside of me and I just want to tear it away. When I was released I was so much more relieved and I showed it because my bad moods disappeared for about two weeks. A short time for some but for me it was an eternity. My doctor reffered to me as an outpatiant due to the fact that I could have to go back into the hell hole they call hospital at any sign that my illnesses were getting worse. Ive always been a good actress, its one of the things I inherited from my mother. So for three months after that I acted as if I was getting better, or in there eyes I was. I still dont understand whats wrong with me. The doctor didnt lay into me as much about eating and feeling happy but after they started thinking I was better I gave up and went back to normal. It was tiring, pretending to be what they thought was normal.

Are you aware of a history of psychiatric complaints in your family? If yes, please list family member(s), diagnoses, and how this affected you personally:

My aunt lucia had a large effect in my life since she was my best friend. She was very thin and I always thought she was beautiful, when I was younger I remember my parents talking about her saying that she was an anorexic. When I questioned her about it she said that she didnt eat because it was the easy way to lose weight and it didnt affect her at all. She told me all about how she didnt eat and what she did to prevent herself from eating and I learnt a lot from her. She was the person I confided in about how I felt about my looks and I used some of her ways to lose weight and keep beautiful even if I never would be.

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Environmental History:

Are you aware of any complications during your birth? If yes, please explain below:

From what I know my birth was completely normal, my mother had decided on a natural birth because she didnt want to infect her child with drugs but my father told me later on that my mother had told him that I had to be born normally because there was no way any doctor was going to cut her stomach open, she didnt want any scars on her body.

Are you aware of any difficulties in development during your infancy, such as learning disabilities, speech impediments, etc? If yes, please explain below:

None that I know of.

Are you aware of any long term separation from your mother during your infancy? If yes, please explain below:

At a young age I was around my mother a lot, she would even take me to work with her. She was the head of a large modelling company and I would sit there all day watching as pictures were taken of these beautiful, thin, tall models. I knew from that day that I wanted to look exactly like them one day. As I got older my mothers buisness took off so I she hired a tutor for me so that when she needed to go to New York or LA to work with her many modelling agencies she could take me with her without effecting my education.

Please describe the location and environment in which you grew up. Please list town and state, and what it was like and how this affected you:

I grew up in Dallas, Texas. My home life was good. When I was growing up we were near the point of being rich so my dad used to spoil me growing up. He worked for a computer company and since my mum would take me with her when she went on business trips I wasnt always able to see him so when I could we would have our own special daddy daughter time. Growing up I usually spent my time alone and I read a lot which caused me to make up my own fairy tales in my head. The neighborhood I loved in was very high class and I lived in a large house, when I was younger the house seemed so much brighter but as I grew up for some reason the house started to darken and everything looked so much more gloomy.

When I was younger I used to spend a lot of time outside. I loved all the plants and insects I would find. Texas had a lot of nice weather so I was able to sit outside for endless hours when I was home. As I got older and my mothers business expanded even more the need to travel was more important and I spent less time at home which meant I couldn't spend as much time alone in my back garden.

Since my family is so well off my parents hired maids, butlers and a long array of nannies to supply the house. My mother had her own private study which is where she worked and my father also have his own study opposite mums. I would be looked after by the nannies but mother would check in every few hours to see how I was. As I got older my mum didn't hire nannies anymore and just asked the maids to look after me. A particular maid looked after me the most and we had a strong connection. Her name was Ethel and she was really the only person that understood me.

The rest of my home life was pretty normal, I wasn't actually at home that much since I was always travelling with my mother. I didn't ever actually know anyone in my neighborhood due to the fact that i was really the only child there, all of the other houses were owned by some snotty rich adults or elders that didn't want to bother with snotty little kids.

Please describe your educational history. How were you in school, both as a young child and in later grades? How were your grades? Did you enjoy school? What was school socialization like? What were your academic strengths and weaknesses? Please answer below:

I've always been smart, even from a young age. I'm a very fast learner and I was almost always top of the class when I attended school. I've never been a very sociable person which is really the reason I'm so smart, I have more time to study rather than hang out with friends. Instead of having human friends I created my own imaginary ones from the stories I would read. I didn't enjoy school very much because it could get boring at times and a lot of the other kids would pick on me and call me a swot.

I was good at all my lessons except when it came to having to stand up in front of the class. This made Music and Drama much harder than expected. I loved the lessons but I didn't like being in the spotlight. I don't like having a lot of attention and I've never been used to it when I have received it. I was happy when my mother decided I would be home schooled by a private tutor because it meant that I wouldnt be picked on anymore and more importantly I wouldn't need to stand up in front of the class.

Do/did you have many friends growing up? Do/did you have a best friend? If yes, please explain below:

I have never been the type to make friends easily and so, no I didn't actually have any real friends when I was younger. The friends I did have were from my imagination. They were perfect because I created them from what I though the perfect friend would be like. I had a lot of imaginary friends but my two closest imaginary friends were Pearl and Rocky. They would go everywhere with me, school, hospital. Everywhere I would go so would they. From a young age I thought they were real, I didn't realize they were just fragments from my imagination. As I grew older so did they. My father didn't seem to notice my lack is friends but my mother did. She would have many social party's, inviting work colleagues and models from all around the world along with their children, relatives and siblings.

I would be forced to wear expensive dresses and then pushed into meeting everyone there. I hated every moment of it. Being smart I would say hello to a few people and then make an escape through the back way and into the field behind our house. I would take off the shoes my mother had bought and run through the fields with Pearl and Rocky, until collapsing on the ground when we were far enough from the house to still see the lights glowing in the distance but not close enough to be caught. After a few hours I would see the lights dim and the music stop and that would be when I would make my way back to the house. When I would get there the party would be over and I would be hurried to my room by Ethel to be cleaned up and have the dress removed and thrown away, my mother believed in wearing things once anyway so it wouldn't matter. My mother would have been in bed before I had been home and in the morning I would murmur about the first few people I had met and she would be silenced. This happened all through my life and my mother was none the wiser.

Do/did you pursue any extra curricular activities or talents? If yes, please explain below:

Yes. Since I've always been very intelligent, I also have a very good memory. Growing up I was taught how to play the piano as well as the violin and the cello. I was always exceptional when it came to music but when asked to perform in front of people other than my music teacher and Pearl and Rocky I would promptly refuse. Another talent I had was singing, something I would do alone in my bedroom. The sound would go through me and I loved to sing whilst I played the piano. I never let anyone hear me because I felt that they would laugh at me and make a joke out of the whole situation. Other than that and my academic talents the only sports I would play would be football with my father when I got the chance and running through the fields to keep thin.

If sexually active, please list age of onset and sexual preference below. If not sexually active, are you aware of a sexual preference?:

I'm not entirely sure of my sexual preference since no I'm not sexually active. When I was fourteen and I was escaping from another of my mother's dinner party's one of my mother's work colleagues son's followed me out and caught me before I escaped. I had to talk to him since it would have been rude not to. We talked for a while and he seemed really nice when he leaned in and kissed me. I wasn't completely sure what to do at the time so I went along with it cause it felt nice and for once in my life I felt like someone wanted me and that I was pretty. When it ended we smiled at each other and then discovered he had to leave. Never saw him again. In some way this would mean I was straight but all of my life I have had certain feelings towards specific girls. Models mostly since I was always around them and because of this I thought they were truly beautiful. As I grew older I started to have certain fantasy's about them. So I'm not entirely sure about my sexuality.

Please explain a little about your overall life below. What circumstances do you feel have brought you to where you are now? How do you feel about those? Do you have any thing else to note about your life that you feel has had some bearing on your current situation? Please explain below:

I was born into a normal family, both mother and father intact. We got richer over time and we got maids and butlers. The fact that I hate my body has always been in my mind. Being around thin beautiful models and my amazingly skinny aunt Lucia made me feel insecure. The constant need to be thin is just something I have in my mind. I'm not ill, I just need to be perfect. My mother is sending me away from her home because she knows the press will push in on the fact that the owner of a major modelling company's daughter has been diagnosed with bulimia will ruin her career. No one really understands that I'm perfectly fine.

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Legal History:

Do/did you ever abuse controlled substances, including but not limited to prescription medications, street drugs or alcohol? If yes, please explain below:

When I was fifteen I finally went looking around my gloomy house only to find the cellar which contained uncountable amounts of bottles of vintage wine, I picked the nicest looking one that was from France. I read what it said and it talked about how it was from a grape farm in France and was very strong and some other information about the liquid. I decided that for once I was going to do something out of the ordinary and I took the bottle and hid it in the bag that was around my shoulder. I had just been about to go to the park. I left my house feeling curious of the bottle in my bag since I had only every drank a small glass of wine at Christmas. I arrived at the park and walked deeper into the trees that surrounded it. When I found a secluded area I took out the bottle looking it over before taking of the lid and taking a drink. At first it tasted revolting and when I swallowed it burnt down my throat. But I had decided that I was going to drink it and I would go through with my word. I finished the bottle off and then I felt quite dizzy. I managed to screw the lid back on and place the now empty bottle back into my bag. I then slid down the tree and sat there for a while. I guess a drifted off because the next time I woke up I felt someone shaking my shoulder. I saw Ethel in front of me telling me to wake up and that was the end of that. I disposed of the bottle and no one was any wiser. I didn't drink very often but when I felt particularly unwell I would drink then vomit to make myself feel better.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:

No.

If you answered yes to the above, please list sentences connected to these convictions below:

Not Applicable.

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:

No.

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Personal Interview:

Describe yourself to the best of your ability in only five words:

Intelligent, shy, unsatisfactory, dependable, insecure.

You come across a glass of water. The total volume of water in the glass constitutes half of its total capacity. Is the glass half empty, or half full? Explain your answer below:

The glass contains water, one day it may be half empty, another it may be half full but the glass will always contain the same volume of water.

If you could change only one thing in your life, what would it be, and why?:

If I could change one thing in my life, I would make myself beautiful. That would effect my life more than anything because then I would have friends, people would like me and I would be staying at home.

How do you feel about your life and the things you have done in it, looking back? If you have committed crimes, how do you feel about those now?:

I feel that on the outside my life would look amazing, private tutors, both parents still married, maids to answer your every need. But on the inside it it much different. Even if my parents are still married I don't think they've spoken more than two words in the last six years, all of the maids dislike me and I'm ugly. I may be intelligent but I haven't actually done anything in my life time. I never got in trouble, apart from drinking maybe one bottle of wine ever six months I never did drugs, I never smoked. I never went to a party and whenever I had a birthday I didn't know anybody there. My life is a living wreck in my opinion but for some reason I keep on going because I know that there has got to be good somewhere.

What are your goals in life, and how do you feel those would be best accomplished?:

My biggest goal would to finally be beautiful but I don't know how to accomplish that since to me it seems impossible. If I had to say what I want to be then I would love to either be a fashion designer or a teacher. I would want my clothes to be worn all over the world by all different people. But my second option would be able to teach children about everything and anything. Teach them that everyone is beautiful even if I don't think I am.

Lastly, why have you chosen admission at St. Christina Psychiatric Rehabilitation Center, and how do you think this will help you toward your life goals?:

My mother chose this school because it is so far away from our home and there is a low chance anyone will know who I am or who my mother is at the center because they will be too sick to care. I'm just hoping that the school wont be full of lots of doctors who think that they know everything when they really don't and that for once I will have someone else to talk to other than Pansy, my rag doll.

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-Pending-
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Please respond to this application within 72 hours to let us know you are still interested in completing it. If you do not reply within the allotted time frame to let us know you intend to finish it, we will consider this application abandoned and the application - as well as the account it was posted under - will be deleted.