Bulimia nervosa is a disorder whose victims exercise life-threatening eating patterns. Victims are characterized by binging and purging of eaten food. The disorder is classified into two, purging bulimia where after taking a lot of food, the victims indulge in vomiting and the use of diuretics to get rid of all the taken food (Burby, 1998). The second classification is non-purging bulimia, methods like excessive exercising, dieting and fasting are used to prevent weight gain. The following is a case study for Bulimia nervosa victim, to enhance a dip understanding of the disorder.
The patient is a white college female student age 25 years. She is not married and has no children. She is in the final year of her college education and stays with her mother. She previously used to stay with her roommate at an off-campus apartment. She works as a part-time daycare aid (“Mando NYC …..”,n.d.).
She was 15 years when the urge for eating a lot started she would spend up to $200 per day on food. She would steal her mother’s credit card to order food, she ate in the parking lot and carried the rest. The excessive eating resulted to weight gain, and she had to cut down by eating and inducing vomiting almost instantly (“Mando NYC …..”,n.d.). The problem persisted for ten years, alongside other eating disorders like anorexia nervosa. She was uncomfortable with her changing shape, and size. She wanted to find a corrective measure, but the option was leading to a life-threatening experience.
Mental Health Status
The patient had constant mood swings; she had abnormal thinking patterns that were characterized by obsessional behaviors, depression 5.4 and anxiety 4.5. She regularly used abusive language towards her mother. She confessed to having obsessed with suicidal behaviors but had never attempted suicide. The main reason she moved in with her mother is the inability to pay her bills due to her uncontrollable appetite ( “Mando NYC …..”,n.d.). She detached from her friends and the anti- social behavior developed. She preferred solitude, she would lock herself in her room for a whole day and never spoke to anyone. She had stopped going to school since she had developed phobia for public
Her first diagnosis was based on DSM-IV; she had received seven treatment for eating disorders since she was 15 years old. Depressive history characterized her life, her father and mother were separated. She was not contented with staying with her mother and her brother staying away with her father. She was stressed about the situation and turned to food for rescue and consolation (“Mando NYC …..”,n.d.).The option did not work for her; she gained weight, and the urge to shake off the excess weight turned into the Bulimia Nervosa disorder. She would indulge in excess calories intakes and later would regret about the situation. She would lose weight and feel her clothes loose, but that was enough. She would go on strict dieting and turned to be gaunt, the cycle of getting thin and fat went on and on.
Her father and brother could not accept that she had eating disorder.However, her mother had agreed that she was having the eating disorder and adjusted her eating behavior to accommodate her daughter. The adjustment was tearing her mother’s emotions apart; she would sometimes cry over her daughters suffering. She sorted treatment from different hospitals, but the procedure did not work on her.
She had been diagnosed with anxiety, depression, suicidal and obsessive-compulsive behaviors. She was prescribed 60 mg of Prozac daily to treat her mental conditions. She was placed on a mandometer treatment program, which helps to rehabilitate eating disorders patients. Mandometer is a computerized biofeedback patient they are used to meter client’s adjustment to eating disorders treatment. She had been diagnosed with anti-social behavior and the program offered comprehensive treatment. She was subjected to thermal treatment, restriction to excessive physical activity (“Mando NYC …..” n.d.). Her social skills were reconstructed under normal interactions designed in the program. She attended the mandometer treatment program every week for six days. Within the program, all psychopharmacological treatments were stopped for the program does not involve chemical drugs. The procedure utilizes the client’s ability to realize they can overcome the eating disorders over guided sessions.
She had been hospitalized twice for heart problems. She was having high blood pressure, which is a predisposing factor for stroke and other complications. Her condition was hindering the exploitation of her full academic potential. She was having a headache and was subjected to use pain killers like ibuprofen for relief. On medical tests she had cavities in her teeth due to the regular exposure to the digestive acids from the vomit ( “Mando NYC …..”,n.d.). She recorded 10- 15 vomits daily.Her body mass index (BMI) was always irregular ranging between 18.1-30 Kg/m2.The BMI indicated that her weight was fluctuating from normal weight to obese level.
Substance use history
Her family recorded no history of drug addiction, but she had started to abuse a variety of medicines. The abuse was a result of the realization that she couldn’t control her obsession for food. She used to abuse alcohol to manage her depressive mood. Her parents noticed the new habit and soon she was introduced to tricyclic antidepressants for the treatment of depression. She started to abuse the anti-depressants and were replaced by a second line anti-depressant treatment by selective serotine reuptake inhibitors. This change ensured her body did not develop a dependence to the tricyclic antidepressants. She had started to abuse constulose, a type of laxative in an attempt to get rid of excessive weight. Those abusing diuretic believe those drugs can help rush the food through the digestive system to excretion before the body absorbs their nutrients. Those who practice eating binge, take them after every meal. Laxative have the effects of causing an imbalance of the electrolyte and minerals in the body. Laxative abuse can cause life-threatening problems like dehydration, poor vision, fainting and renal complications (Cooper, Todd, & Wells, 2008). The substance abuse trends had not gotten worse, and a counselor was capable of helping with the abuse. Her family although separated, provided significant support during the psychotherapy.
She has records of illegal activities; she has been abusing alcohol but before it could raise an alarm to the law defenders, her parents were there to help with her condition. She has no ongoing cases; she had used her mother’s credit card to buy food to quench her craving. But this could not be a case for her mother could not press charge as a parent.
According to DSM-V classification for eating disorders, Bulimia nervosa code is 307.51 (F50.2).
•The victims engage in regular binge eating behavior. The eating pattern is abnormal, the victims take large amounts of food than other people could consume at that moment and under the same circumstance (Cooper, 2008). The time interval could be between 3 hours before taking the next large amount. During the time of binge eating, an individual loses the sense of when to stop feeding.
•Frequent inappropriate compensatory behaviors to stop weight gain. The victims would induce vomiting. There is use the laxatives for of clearing all the food taken before it is digested (Cooper, 2008). The victims may practice fasting and excessive physical exercise.
•The binge eating and inappropriate compensatory disorder, occur averagely once per week over a period of three months (Burby, 1998).
•Body shape and weight is the scale used for self -evaluation, victims prefer to look thin and wrong inputs to take control get them into the eating disorder.
Differential diagnosis is the process of evaluating the possibility of the presence of a disease against another. Often conditions with comparable presentation causing illness in a patient are considered.
Anorexia nervosa (307.1(F50.01)), According to DSM-V criteria the following signs are used to diagnose anorexia nervosa victims (Kaye, 2014).
•The victim has extremely low body weight because of persistent restriction of energy intake required, in the context of age, physical health, growth and development, and sex.
•There is either an intense fear of gaining weight or becoming fat. They take initiatives that keep their weight low, even when the BMI is below average for a healthy person (Kaye, 2014). They may resort to over exercising or strict dieting to keep their weight and shape at their standards which is abnormal.
•Individuals’ suffering from Anorexia nervosa experiences a disturbance concerning their body weight and shape. On self-evaluation, the patients do not recognize their current significant low weight.
In differential diagnosis, this disorder was ruled out for there were no episodes of binge eating and trying to clear the food from the body
Body dysmorphic disorder (300.7(F45.22)), It is mental disorder where a person has a distorted image of their appearance. The following criteria is used in diagnosis;
•The patients present with distress over their shape or general body image. The wrong perception could be as a result of a scar, a birthmark or some features on their body that they may find unattractive even when they are normal (Cooper, 2008).
•The victims have a consistent feeling of dissatisfaction with their appearance that is not realistic.
•While the perceived flaw is not visible or appears to be reasonable to other people. The victims get so concerned, and as a result they ruin their personal and interpersonal relationships (Cooper, 2008).
•In most cases of body dysmorphic disorder, the patient focus on one part of their body they are not happy with.
This disease was ruled out for the victim concentrates on a particular feature of the body they are not satisfied with.There is no correlation between eating habits or specifically body weight as in Bulimia nervosa.
Depression, this is a mood disorder that is characterized by a constant melancholic feeling and loss of interest, especially for things that used to be fun before. The DSM-V code for depression varies depending on the type of depression being experienced. The code starts by a whole number 296.21, .22, 3.6 and so on. The following criteria is used to diagnose general depression cases;
•The victims exhibit a day long depressed mood, and this could be a daily routine. The person may feel sad and unworthy, this could be on subjective account or other people observation of the patient (Burby, 1998).
•Based on subjective and other people account, the patient shows no interest in activities for pleasure, to almost all activities.
•The victims may experience fatigue or loss of energy for most of the days in a week.
•The victim is characterized with weight loss in circumstances they are not dieting or gaining weight.
•The patient may have constant and exaggerated guilt and feels unworthy which may result in a delusional experience.
•The victims experience suicidal thoughts and ideas concerning death
For the diagnosis of Bulimia nervosa, depression was ruled out since the patient exhibited signs and symptoms that were not primarily based on binging or purging of food.
Obsessive-Compulsive Disorder (300.3), the patience suffers from obsessions that lead to repetitive behaviors. The obsessions compel them to repeat same behavior for emotional of physical gratification (Von Ranson, Kaye, Weltzin, Rao, & Matsunaga, 2014). The following criteria is used in the diagnosis of the obsessive-compulsive disorder.
•The victim’s obsession consumes a big portion of their time daily, which interferes which important aspects of their life like career and relationship.
•In presences of another axis one disorder, the components of the obsession are not limited to the issues of career and relationship. For instance if the individual has an eating disorder, they may be preoccupied with food (Von Ranson, 2014). In the presence of Trichotillomania, the victim may experience a constant compulsion to pull her hair.
•The disorder is not linked to any physiologic effect of a substance or any general medication.But rather out of repeated natural obsession that becomes a burden when repeated severally
The Obsessive-Compulsive Disorder was ruled out since the disorder is not linked to any eating disorder as the underlying cause. Aspects like weight and shape of the patient is not a concern in this disorder, as considered in Bulimia nervosa.
Bulimia is caused by a set of genetic predisposition, family behaviors, and a set of social values. For this context, there are no genetic predisposition neither her family has a history of Bulimia nervosa or any eating disorder. The main reason for Bulimia nervosa in this context is a set of social values. The patient like any college student, especially girls are always concerned with their appearance in terms of shape and weight. College and high school student have a set of standards to associate with a perfect lady and gentlemen. Everyone struggle to achieve them which is a good influence. The problem starts when a person seeks perfection and may practice destructive behavior to achieve the set standards. Some of the destructive behaviors include excessive exercising, binging and purging of food. The victim was involved in regular strict dieting and induced vomiting, and this are among the reasons why she developed Bulimia nervosa.
The victim was diagnosed with two major mental illness that is depression and Bulimia nervosa. Their prognosis and complication take a different path as explained below.
Prognosis of depression, before a major episode of depression occurs, there are two to three weeks of signs and symptoms .within this period, the patient develops anxiety at the loss of concentration and becomes easily fatigued. An average episode of depression can last for eight months, but untreated cases can last between 6 and 18 months (Von Ranson, 2014). 7% of depression victims of age 30 years and above, develop episodes of mania especially if they have experienced four to five depressive episodes during the time of their illness.
People who experience depression are more likely to experience recurrent episodes of the condition, and the subsequent ones can be easily initiated than the first one. Most depression victims recover from their cases after treatment especially those mild wild depression even on placebo treatment. Patients are suffering from severe depression respond to antidepressant treatment, the use of placebo treatment for this victims cannot lead to recovery. For instance, the patient in the case study had developed severe depression and anti-depressant prescription was used to treat her case (Romano, Halmi, Sarkar, Koke, & Lee, 2014). Victims of depression who have been exposed for a long time on anti-depressant drugs, are like to suffer bi-polar disorder as a reaction to the treatment
Prognosis of Bulimia nervosa, Treatment for Bulimia nervosa in its early stage can be easily achieved than its advanced level. Unlike some of eating disorders like anorexia nervosa, for Bulimia nervosa no hospitalization is required to achieve treatment goals. For treatment of this condition to be successful, any mental disorder diagnosed must treated as well. Prognosis is likely to be controlled if it starts from an adolescent. The prognosis gets worse when the patient is suffering from other mental disorder just like in depressive cases.
The patient onset for Bulimia nervosa was when she was age 15 years and have suffered the same alongside other mental health disorders. Her response to anti- depressant of could be attributed to the fact that her case was diagnosed when she was a teenager. She was treated for other disorders like depression, the abuse of drugs, and alcohol to ensure that she responds positives to the treatments for Bulimia nervosa. The prognosis of Bulimia nervosa is five years, those patients who go untreated may recover but experiences a relapse. Repulse contributes to more than 30% of total cases (Von Ranson, 2014). Victims who get treatment are mostly like to recover completely.
Recommendation for Treatment
Adolescent women are frequent victims of Bulimia nervosa disorder. For treatment to be a success, psychological, biological, genetic, and social factors need to be considered. Diagnosis using DSM-V than rather DSM-IV is the most appropriate since DSM V has some updates that DSM-IV does not contain. The changes include a drop in the required minimum typical occurrence for categorization of binge eating and compensatory behavior frequency from twice to once in every week. The diagnosis can also be done by the use laboratory test, screening and physical findings (Romano, 2014). For proper treatment, knowledge of comorbid disorders like anxiety disorder, anorexia nervosa, addictive disorders, and personality disorders is vital.
Although a family history of underlying factors like an obsession for thinness and eating disorders, individual consideration for treatment is critical. A multifaceted treatment works well since different symptoms are treated by various specialists (Cooper, 2008). Behavioral therapists are used to modifying the anti-social behavior that the client might have developed. For instance, the patient in the case study had developed anti-social behaviors. She faced constant confrontation with her mother and decided to move from off-campus residence to avoid contact with friends. Circumstances like the separation between her parents and the family at large is a factor to be considered. The patient was not contented with the fact that her father was staying with her brother while she was living with her mother.
Negative thoughts of themselves regularly attack victims; cognitive behavioral therapy can be used to manage the condition. The victims always have unrealistic images that they associate with themselves (Cooper, 2008). The thought controls how they feel and react to their environment. In this context, the victim used to assume that she was extremely fat and indulged in excessive exercising. Binging and purging of food was as a result of the self -attacking thoughts. She was unable to handle confrontation that occurred with her mother and roommates at school. Interpersonal psychotherapy are recommended for the management of the condition.
In conclusion, Bulimia nervosa is a mental disorder and family can be an excellent support for any treatment to work. The family and friends is another form of therapy that has worked overtime. This the reason most cases of Bulimia nervosa unlike anorexia nervosa are not hospitalized. The chance for interaction with friends and friend is an important component of treatment. Patients who have not only suicidal feeling and thoughts but want to commit suicide would be hospitalized to ensure they are protected for self-harm (Cooper, 2008). Patients who have had a longer history of Bulimia nervosa may take longer to recover and for that matter early treatment is preferred for a quick recovery.
Burby, L. N. (1998). Bulimia nervosa: The secret cycle of bingeing and purging. The Rosen Publishing Group.
Cooper, M., Todd, G., & Wells, A. (2008). Treating bulimia nervosa and binge eating: An integrated metacognitive and cognitive therapy manual. Routledge.
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., & Price Foundation Collaborative Group. (2014). Comorbidity of anxiety disorders with anorexia andbulimia nervosa. American Journal of Psychiatry.
Mando NYC – Treatment for eating disorders – Case study 3. (n.d.). Retrieved July 14, 2015, from http://www.mandometernyc.com/en/mandometer/case-studies-/case-study-3/1.aspx
Romano, S. J., Halmi, K. A., Sarkar, N. P., Koke, S. C., & Lee, J. S. (2014). A placebo-controlled study of fluoxetine in the continued treatment of bulimia nervosa aftersuccessful acute fluoxetine treatment. American Journal of Psychiatry
Von Ranson, K. M., Kaye, W. H., Weltzin, T. E., Rao, R., & Matsunaga, H. (2014). Obsessive-compulsive disorder symptoms before and after recovery from bulimia nervosa.