Introduction
Brandy is a nineteen-year old caucasian female. She is five foot, five inches tall and currently weighs one hundred and sixteen pounds. Brandy has survived by her mother and father. Brandy’s mother was a severely overweight female. The relationship between her parents was unhealthy. Brandy’s father was verbally abusive to her mother concerning her weight. Her father also was sexually inappropriate to Brandy, she was never molested, but the dialogue between parent and child was sexually inappropriate.Brandy suffers from distorted thinking, maladapted attitude towards herself, negative misconceptions about her body and has isolated herself socially. She is restrictive of her food intake and goes through periods of binging on bad days followed by purging. Brandy has an eating disorder called, binge- purge anorexia nervosa.
Symptoms and Diagnosis
Anorexia Nervosa is a psychological illness that affects the body in extreme ways. According, to the DSM-5 anorexia nervosa criteria is, “persistent restriction of energy intake leading to significantly low body weight. Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain. Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight” (APA, 2013).
There are two subtypes but in this case the individual, Brandy has binge- purge anorexia nervosa. The subtype consists of losing weight by through restricting one’s eating then vomiting through force after eating large meals.
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Brandy’’s symptoms include restriction of food intake which she considers her “good days”, by choosing to limit the amount of calories consumed in each meal she has. She does this by eating all of her food dry and making low fat or diet choices. She also binges on her “bad days” by eating candy bars and cookies. Following this period she will purge by vomiting because she feels fat and disgusted with herself, other diets to control her weight have not worked. Brandy believes this so intensely that she thinks that people do not want to be around her because of her obese behavior, and it interferes with her ability to gain weight. Brandy’s negative self evaluation has caused her to become depressed and isolate herself from the outside world. She does this by being psychological controlled by her maladaptive thoughts. This causes a lack of comprehension for the seriousness of her bodily state,
According to Comer, in the text Abnormal Psychology, anorexia nervosa begins after a stressful event such as issues in home life (2015). This is acknowledged through the verbal abuse Brandy witnessed by her father in regard to her mother’s weight. Brandy’s mother was an overweight individual. This showed her that others do not like people that are overweight and that people do not want to be around them. This is highlighted in Brandy’s thoughts about her social interactions. In addition, Brandy’s father was sexually inappropriate toward her and would analyze her body speaking to her sexually. This home environment is a breeding ground for psychological disturbances for a developing adolescent portraying negative body views. Thus, creating low self esteem and depression in Brandy’s behavior. the act of starving oneself can have adverse health risks, one of them is amenorrhea. Brandy suffers from this. Amenorrhea is when your body does produce a menstrual cycle.
Differential Diagnosis
Bulimia Nervosa according to the DSM-5 consists of, “repeating binge eating episodes, repeated performance of ill-advised compensatory behaviors to prevent weight gain, symptoms take place at least weekly for a period of three months, and inappropriate influence of weight and shape on appraisal of oneself” (APA, 2013). Brandy shows evidence of this disorder by binging on soft high calorie foods on her “bad days” consisting of candy bars and cookies. She will experience maladaptive thoughts post binge by feeling overweight and assuring herself that people do not want to be around her because she is overweight. After, she will feel as though she has to compensate for her actions she does this by purging or vomiting. In turn this causes her to be more disgusted with herself, she then hides her actions because she does not want anyone to know what she is doing. Since,Brandy is experiencing low self esteem and depression to do the health issues she is having as a result of her purging. This is dental issues. “Repeated vomiting bathes teeth and gums in hydrochloric acid, leading…to have serious dental problems such as breakdown of enamel and even loss of teeth” (Comer, 2015).
Often, anorexia nervosa and bulimia nervosa overlap. But Brandy is showing signs of “pleasing others and being attractive to others…as well as mood swings, and have trouble coping effectively or controlling their impulses and strong emotions” (Comer, 2015). This is indicative of bulimia nervosa. She wants to lose weight to look better for other people because they will like her better that way and when she becomes agitated and distant when friends show her concern. But in the information provided about Brandy it does not give specific time frames which are key according to the DSM-5 to diagnosing the disorder. “Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances and the binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months” (APA, 2013). Since the windows of time were not collected during Brandy’s initial introduction, her diagnosis is still binge-purge anorexia nervosa.
Treatment
The treatment of eating disorders is multidimensional. When treating eating disorders there must be a correction of the eating pattern (binge-purge), by regaining and recovering from the lost weight, and learning to eat healthy again by establishing better habits. This takes place through nutritional counseling. Different types of therapy, typically behavioral and cognitive, are utilized to teach individuals, in this case Brandy, how to identify, challenge and change negative thoughts that cause her to display these behaviors. I think these steps would be beneficial for Brandy. I also think the use of a diary to let her release her feels and have control over them. Due to her depression, I think a medication could be best especially while going through the thralls of therapy, it will be hard, and it can ease the blow. Additionally, if her parents are willing family therapy could be beneficial to Brandy because that is the jumping off point to how her eating disorder began, through her home environment.
Prognosis
The prognosis for Brandy is positive as long as she takes the steps necessary during treatment to change her thinking and create better habits for positive self care. Since, stress can trigger a relapse it is best that she examine and treat her interpersonal issues in therapy and stay away from environments that propose the idea of less-than.
