1. The case study.
Christine is a sixteen year old girl who has severely restricted her dietary intake. She is currently forty nine kilograms and height 163cm. Her mother says she was 60kgs six months ago. In form three, at age fifteen, Christine was removed from the public school she was attending and put into a private school, where she was awarded the dux prize. She did not have any friends during this year as she spent all recesses in the library, reporting that ate alone as she ‘had no friends to eat with anyway’. Her mother says that she attends roller skating sessions up to five nights a week and believes she does this to lose weight. She is pre-occupied with food and is constantly cooking for the family. She does not sit down with the family to eat, saying that she has eaten enough while cooking. An argument with her parents precipitated the diet as she decided that there was ‘one area of her life that she could control and that was what she ate’. She has commenced medication for sleep stating that she is unable to sleep after studying till late at night. She recently took an overdose of sleeping pills and whilst in Emergency Department expressed a desire to die. The family live on a ten acre block and are ten kilometres from town. Her father is an accountant. Her mother is a school teacher and has a diagnosis of bipolar affective disorder. She says she fights a lot with her mother and does not seem to be able to please her father. Her brother, two years younger, left home to join the navy earlier this year. 2. Provide a summary of the diagnosis and describe the course of the illness. Wozniak, Rekleiti and Roupa (2012) outline early signs of anorexia nervosa (AN); preoccupation with food, weight and calories; rigidity and rituals around eating, avoidance of family meals, denial of hunger and excessive exercise. As it progresses the patient may seem withdrawn, absent sense of humour, angry and depressed and no longer spending time with friends. The patient may become very rigid around other things also such as homework as obsessive compulsive behaviours begin to present. Extreme measures are used to reduce weight; strict dieting, purging or eating fibrous foods, use of laxatives, appetite suppressants or diuretics (Australian and New Zealand clinical practice guidelines, (ANZCPG), 2004). To gain a diagnosis of AN a person has the following; a ’refusal to maintain a minimal normal body weight (defined as more than 15 per cent below expected body weight), be intensely afraid of gaining weight despite being significantly underweight, have disturbance in perceiving the correct size or shape of their body and (for postmenarchal females), amenorrhoea’ ((Edwards, Munro, Robins, Welch, 2011).). AN usually begins in adolescence, and is more prevalent in women (0.2-0.5%) than men (Wozniak, Rekleiti and Roupa, 2012). It has a slightly higher occurrence in socio-economic status (ANZCPG, 2004). It has the highest suicide rate of all mental illness at one and a half times higher than major depressive disorder. Approximately 15% die from the disorder 2/3 from malnutrition, one third suicide (Ommen, Meerwijk, Kars, Ellburg, Meijel, 2009). Although 70% of patients regain weight within 6 months of onset of treatment, 15–25% of these relapse, usually within 2 years (ANZCPG, 2004). The prognosis is better for patients with a short duration of illness, if treatment does not require hospital admission and it is treated early. Long term illness can still be treated but with a poorer prognosis. A long duration of illness, vomiting in emaciated patients, coexisting psychiatric illness, disturbed family relationships, serious medical complications and later onset of illness are indicators of a poor outcome (ANZCP, 2004). The psychological impact is immeasurable as formative teenage years are spent in an obsessive eating disordered thinking. Those who ‘recover’ from AN often retain certain features of atypical eating disorder, eating...
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