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Nancy Walsh

References

Comer, Ronald J., (2013). Abnormal Psychology. New York, New York: Worth Publishers

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing

Hoyal, H. D., & Spangler, D. L., (2005). Anorexia Nervosa. In Freeman, A., Felgoise, S.H., Nezu, C.M.& Reinecke, M.A (Eds), Encyclopedia of Cognitive Behavior Therapy (pp. 29-32). Springer US

Hsu, G.L.K. (2005). Treatment of Anorexia Nervosa. In Goldstein, D.J., & Stunkard, A.J., (Eds) The Management of Eating Disorders and Obesity (2nd ed). (pp. 71-84). Totowa, New Jersey: Humana Press

Mehler P.S.,Gray, M.C., & Schulte M.(1997). Medical complications of anorexia nervosa. Journal of Women's Health. 6: 533–541.

Romano, S.J. (2005). Anorexia Nervosa. In Goldstein, D.J., & Stunkard, A.J., (Eds) The Management of Eating Disorders and Obesity (2nd ed). (pp. 61-70). Totowa, New Jersey: Humana Press

Symptoms

Prognosis

Nancy's symptoms include:

  • Very restrictive eating

  • Extremely low body weight

  • Fear of becoming fat

  • Lack of recognition of the dangers of low body weight
  • Depressed mood most of the day everyday day

  • Diminished interest or pleasure in almost all activities

  • Fatigue or loss of energy

Assets:

Family Support – Close, Affectionate, Caring, Invested

Financial Resources

Disadvantages:

Family Problems– Enmeshed, Controlling, Expressive, Dependent, Entangled

Potential Relapse

Cultural Setting

Potential to Recover

Diagnosis

Mental Status Exam

307.1 Anorexia Nervosa, Restricting Type, Extreme (Primary Diagnosis)

269.22 Major Depressive Disorder, Moderate, with Melancholic Features

V61.8 High Expressed Emotion Level Within Family

V62.89 Phase of Life Problem

  • Nancy appeared to be very sick and unhealthy due to her thin and fragile body, as well as very colorless complexion.

  • Her psychotomotor behavior came across as very slow and weak, with her only able to remain stiff in certain comfortable positions.

  • Mood and affect was very lethargic, while also being angry and pessimistic.

  • Her speech was very soft with long pauses and came across very dull.

  • Nancy's cognitive processing was of concern due to the fact that she is in complete denial about her illness.

  • Her thought patterns are illogical with lots of doubt about her condition.

Differential Diagnosis

307.59 Avoidant/Restrictive Food Intake Disorder

300.7 Body Dysmorphic Disorder

309.0 Adjustment Disorder with Depressed Mood

V61.20 Parent – Child Relational Problem

V62.3 Academic or Educational Problem

Reason for Visit

Treatment

  • Sally and Thomas Walsh believe that Nancy's symptoms began after getting her wisdom teeth removed.

  • She began using that as an excuse not to eat and became more and more restrictive.

  • In addition, Nancy started her first semester of college and upon her return her family and friends became very worried about her weight loss.

  • She began lacking interest in the activities and relationships that used to bring her happiness

  • Due to Nancy's refusal to seek treatment the family is considering taking to legal action to gain rights to her medical decisions.

  • They are seeking family therapy in order to avoid having to go that far.

Short Term Goals:

  • Immediately refer to physician for medical evaluation.
  • Restore Nancy’s weight/BMI to a level that reduces her health risk

Health Risks: death, organ failure including kidney problems, gastrointestinal problems, heart failure (Mehler, Gray, & Schulte, 1997), amenorrhea, drop in white blood cells, electrolyte deficiencies, osteopenia or osteoperosis, and generally compromised medical state (Romano, 2005).

Long Term Goals:

  • Family Therapy - Interpersonal Functioning
  • Individual Therapy for All Family Members
  • Nutritional Counseling, CBT For Nancy

1. Build Trust

2. Establish Normal Eating & Weight

3. Identify, Evaluate, and Modify Beliefs

4. Relapse Prevention

(Hoyal & Spangler, 2005)

Intake Date: 11/1/13

Interns: Christina Reed, MFTI, Rachael Topel, MFTI

Clients: Nancy Walsh, Sally Walsh, Thomas Walsh, Sr.

Treatment: Family Therapy

Timing of Session: Prior to court

hearing

Referred by: Parker Pavillion

Christina Reed

Rachael Topel

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