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For the Love of Nancy

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Meredith Robie

on 4 December 2014

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Transcript of For the Love of Nancy

For the Love of Nancy
307.1
Diagnostic Criteria
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the content of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Female
Late adolescent
Caucasian
Two brothers
In-tact family
Upper-Middle class
Recent high school graduate moving away for college
Genesis Goma
&
Meredith Robie

University of Southern California
Dr. Greg Henderson
Psychopathology, November 10, 2014

(National Association of Anorexia Nervosa and Associated Disorders, 2014)
"Eating disorders have the highest
mortality
rate of any mental illness."

Anorexia Nervosa
Client Information
Other Conditions That May Be a Focus of Clinical Attention
Problems Related to Family Upbringing
V61.20
(Z62.820)
Parent-Child Relational Problem
Other Problems Related to the Social Environment
V62.89
(Z60.0)
Phase of Life Problem
Summary Diagnosis
Differential Diagnosis
Cyclothymic Disorder 301.13
(F34.0)
Diagnostic Criteria
Specify if:
With anxious distress:
The presence of at least two of the following symptoms during the majority of days of the current or most recent episode of mania, hypomanic, or depression:
1. Feeling keyed up or tense (yes)
2. Feeling unusually restless (no)
3. Difficulty concentrating because of worry (no)
4. Fear that something awful may happen (yes)
5. Feeling that the individual might lose control of himself or herself (yes)

Moderate:
Three symptoms


Specify current severity:
A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
E. The symptoms are not attributable to the physiological effects of a substance of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Multicultural Considerations
Approximately 90-95% of all cases of anorexia nervosa occur in females (Comer, 2013).
Western society associates thinness with health
and
beauty.
Anorexia Nervosa often follows a major life transition (i.e. leaving parents' home for college).
Historically, eating disorders have been more prevalent in upper socioeconomic classes & white Americans; however this discrepancy is decreasing as dysfunctional eating patterns and eating disorders are on the rise amongst lower SES and minority groups.
Treatment Plans
1st Priority:
Curb the dangerous eating pattern ASAP - supportive nursing care, nutritional counseling, & implementation of high-calorie diet (i.e. likely need for tube & intravenous feeding).

Subsequent Actions:
Option 1
:
Cognitive Behavior Therapy
Cognitive component
: Teach alternative, more functional ways of handling life stressors. Present more appropriate ways to implement control in daily activities.
Behavioral component
: Monitor feelings, hunger levels, and food intake in a journal.
Option 2:
Supplement w/ Family Therapy

Facilitate client in separating his/her feelings & needs from family members' feelings & needs

During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
Specify whether:
Restricting Type
(F50.01)
Specify current severity:
Mild: BMI > or equal to 17 kg/m2

Moderate: BMI 16 - 16.99 kg/m2

Severe: BMI 15 - 15.99 kg/m2

Extreme: BMI < 15 kg/m2
Nancy's BMI is 11.9
Co-morbid Diagnosis
Separation Anxiety Disorder 309.21
(F93.0)
A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.

5. Persistent and excessive fear of or reluctance about being alone or without major being near a major attachment figure.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas o functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations covering separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.
Bio
No prior medical conditions to hospitalization. Currently severe kidney failure (nephrocalcinosis).
Psycho
307.1
(F50.01)
Anorexia Nervosa, Restricting Type
Severity: Extreme
Co-morbid with 309.21
(F93.0)
Separation Anxiety Disorder
Social
V62.89 (Z60.0) Phase of Life Problem
V61.20 (Z62.820) Parent-Child Relational Problem
References
American Psychiatric Association. (2013).
Diagnostic and
Statistical Manual of Mental Disorders, 5th Edition: DSM-5.
Washington, DC: American Psychiatric Press.

Comer, R. J. (2013).
Abnormal Psychology - DSM-5 Update.
New York: Worth Publishing.

Google Images. (2014).
Electric Holiday.
http://www.wikinoticia.com/images2//
monkeyzen.hipertextual.netdna-cdn.com/files/2012/11/Electric-Holiday-Disney-para-Barneys-NY-2012.jpg

Google Images. (2014).
Tracy Gold, For the Love of Nancy.
http://
a1.files.xojane.com/image/upload/c_fit,dpr_1.0,q_80,w_620/MTI0ODY0MDU4Mjk3MDIwMzg2.jpg

National Association of Anorexia and Associated Eating Disorders (ANAD).
(2014).
Get Information: About Eating Disorders: Statistics
. http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
(Google Images, 2014)
(American Psychological Association, 2013)
(American Psychological Association, 2013)
(American Psychological Association, 2013)
(American Psychological Association, 2013)
(American Psychological Association, 2013)
(American Psychological Association, 2013)
(American Psychological Association, 2013)
(Comer, 2013)
(American Psychological Association, 2013)
(Google Images, 2014)
Full transcript