Reference no: EM133352309
SH was very conscious about her weight, especially since she started gaining more of it over the past couple of years. At 30 years old, she was 5'5" and, although she once weighed a slender 100 pounds, she now tipped the scales at 155 pounds. Sometimes she blamed the weight gain on her job as catering manager of a resort hotel. She came into contact with food practically all day long and it was too tempting for her and she seemed to lose control easily. One day, after a particularly rigorous day at her job, SH felt sick to her stomach. She ended up vomiting after a heavy lunch and consequently felt much better. That was when she first got the idea to throw up after eating large amounts of food so that she wouldn't feel so stuffed and hopefully help minimize any weight gain. When she started her new weight-control habit, her co-workers began noticing changes in her behavior. She showed increasing signs of depression, rarely joined her co-workers for happy hour, and was always going to the restroom after eating. She also was defensive about her appearance and when someone complemented her on her recent 15-pound weight loss, she took it the wrong way and became very annoyed. Many days, she dreaded going in to work due to all the tempting food she would come into contact with. SH was scared that she was unable to stop making herself binge and purge.
Background
Bulimia nervosa is an eating disorder that is characterized by frequent and recurrent episodes of binging (consuming large amounts of food). Generally, people with bulimia nervosa are unable to control this behavior. The binge-eating episodes are typically followed by methods to rid the body of the excess food and calories including purging (eg, vomiting, excessive use of laxatives or diuretics), fasting, and/or excessive exercise. Due to the excess consumption of food, patients with bulimia can fall within the normal range for their age and weight and are not typically underweight. They often fear gaining weight, want desperately to lose weight and are intensely unhappy with their body size and shape. Generally, the binging and purging behaviors are done privately, because individuals with this eating disorder tend to feel disgust or shame. Patients with bulimia often have other mental health illnesses including depression, anxiety or substance abuse problems. Individuals with this eating disorder also are at increased risk of electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems due to the frequent purging behavior. In addition, patients with bulimia may show sings of frequent vomiting, such as swollen cheeks or jaw area, rough skin on knuckles (if using fingers to induce throw up), teeth that look clear, and broken blood vessels in the eyes. Like other eating disorders, bulimia nervosa affects predominately more females than males.
Case study (continued)
The hotel manager took notice of the changes in SH and was concerned. Her teenage daughter had been diagnosed with an eating disorder the previous year, and she was familiar with the signs and symptoms of bulimia nervosa. She talked to SH and expressed her concerns. She told her that she was worried about her behavior and that she may benefit from professional help. She confided to SH about her daughter and recommended her therapist. SH was upset and teary eyed, but admitted that she had a problem and was glad to be able to tell someone about it.
The psychiatrist who evaluated SH recommended cognitive behavioral therapy (CBT), which has been shown to be effective in changing binging and purging behavior and eating attitudes. Her psychiatrist also prescribed fluoxetine to help treat her depression. He informed SH that fluoxetine was the only FDA-approved antidepressant for treating bulimia nervosa and that it appears to reduce binge-eating and purging behavior, reduces the risk of relapse, and improves eating attitudes. He also referred her to a dietitian for nutritional counseling.
After 3 months of therapy for her bulimia, SH felt much better and was more accepting of her body and shape. Although she was conscious about what she ate, she did not obsess about gaining weight. She also incorporated an exercise regimen into her schedule and felt and looked better than she had in years. A year later, she felt good and weighed 120 pounds, but this time she had done it the healthy way: by eating sensibly and exercising regularly. Her co-workers noticed the change in her and were happy for her. She looked forward to going to work now and no longer felt as if the sight of food would make her lose control.
Symptoms of this disorder - Compare the symptoms presented in the case with symptoms indicated in the DSM-5.
Medical concerns - What are the physical considerations in this case? What are the physical concerns for clients with this diagnosis? Cite your sources, with intext citations