Reference no: EM133404994
When Sandy, an 18 year-old white female, first arrived at the clinic, she had the look of an emaciated fashion model at a height of 5 feet 7 inches and a weight of 79 pounds. Unlike a model, she was dressed in secondhand clothes and worn-out flip-flops, which stood in stark contrast to her parents' more polished professional presentation. However, her personal hygiene was good. Sandy didn't really think there was anything wrong with her, but her parents knew that her current condition warranted immediate clinical attention. Sandy had been evaluated by a physician earlier and he reported the following medical problems -irregular heartbeat, amenorrhea (loss of menstrual cycles due to malnutrition) for the past 7 months, and potassium deficiency. The medical evaluation also found no significant medical history and no physical illness to explain her weight loss.
During the parental interview, Sandy's parents reported significant weight loss and hoarding behavior from their daughter (e.g. saving food from other students' lunches and bringing it home). They mentioned that she would always read food labels to count calories/fat grams and also talk about food constantly. They said that Sandy was an athletic girl who used to be very involved in her high school's dance society and sports teams like soccer and volleyball. However, she dropped out of these extracurricular activities a year ago and at about the same time, her grades deteriorated drastically. Her parents punished her deterioration in schoolwork by grounding her for five months. She did not appear to mind this punishment, and often locked herself up in her bedroom for 2-3 consecutive days.
During the interview with Sandy, she vehemently denied the seriousness of her weight loss and prolonged loss of periods. She said that her involvement with sports was attributed to concerns about fitness and not appearance. However, at one point she admitted to being afraid of becoming fat even though she was extremely underweight. She thought that "her arms and thighs were monstrous and ugly compared to the women on the streets and the cover models on Cosmopolitan". She also reported restricted intake to 500 calories a day but with no binging, purging, self-induced vomiting, laxative abuse, or diuretic use. She denied any depressed moods. In school, her relationships with her female peers were troublesome and appeared to revolve around disturbed eating attitudes. She reported that a majority of the girls compared their diets during lunch. Dieting with them was one way for her to enter their world and to gain acceptance or attention. Her school counselor referred Sandy for group psychotherapy at school with girls her age who also have eating problems. However, she discontinued after two sessions, dismissing them as a complete waste of time.
When family history was probed further, several issues of importance surfaced. Her maternal aunt experienced depression at 28 and her maternal uncle had obsessive-compulsive disorder at 22. The reaction of the entire extended family to this was not very supportive. Most members were against the use of psychotropic medication because they thought it meant that her aunt and uncle were "crazy".
The fear of the stigma of mental illness was also apparent in Sandy's parents, who expressed their strong desire to avoid any forms of psychopharmacology for their daughter. Such transgenerational dynamics were also uncovered in terms of the attitudes towards food and eating. Sandy does not like visiting her maternal grandparents, whom she thought of as hypercritical. She mentioned that they always accused her of wasting food and money. However, her parents highly valued family interconnectedness and insisted that Sandy must somehow learn how to cope with difficult relatives.
They also acknowledged that these family dinner gatherings were filled with conflicts and even had trouble resolving them. Sandy's father revealed that he was first of three sons who grew up with parents who were Russian peasants. The family lived through a series of famines, and thus as a child, all of the children were force-fed, sometimes to the point of vomiting. They were then forced to eat the vomit. It is reasonable to conclude that both parents came from families where the meaning of food was over determined; food and eating were associated with fear of starvation and competition for scarce food supplies. After four consultation sessions, it was obvious that Sandy did not really have a say in many family issues (e.g. her attendance at family gatherings).
1. What is 1 potential cause for Sandy's anorexia nervosa diagnosis? Identify the model of abnormality that corresponds with the cause and explain how the cause connects to the model of abnormality.
2. One of the symptoms of anorexia nervosa is the restriction of energy intake, leading to a significantly low body weight. How does Sandy present with this symptom? Give an example directly the case study that describes this symptom.
3. One of the symptoms of anorexia nervosa is the intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though they are significantly overweight. How does Sandy present with this symptom? Give an example directly the case study that describes this symptom.
4. One of the symptoms of anorexia nervosa is disturbed body perception, places inappropriate emphasis on weight or shape in self-judgments, or persistent lack of recognition of the seriousness of currently low body weight. How does Sandy present with this symptom? Give an example directly the case study that describes this symptom.