Sally is a 16-year-old schoolgirl who has been referred by her local GP for nutr
ID: 3485730 • Letter: S
Question
Sally is a 16-year-old schoolgirl who has been referred by her local GP for nutritional advice regarding low weight. She presents with a weight of 130 pounds, height 5‘7. Her recent blood tests are normal. She lives at home with her mother, older brother, and sister. Her parents are divorced and she sees her father regularly. Sally excels in her school work and studies hard. She has become increasingly socially isolated, spending a lot of time in her bedroom. She is a straight-A student, but her mother has noticed that Sally does not just spend time on her schoolwork. She is frequently browsing the internet for exercise tips and the latest news about fashion. Despite being of normal weight, she frequently tells her mother that she is fat, and she uses "dieting" as an excuse to skip dinner. However, her mother has recently found evidence of a LOT of junk food in Sally's bedroom - there were fast food bags, candy wrappers, and trash everywhere. She has had no previous counseling for an eating disorder or any other problems. When her GP asks Sally how she is dieting, Sally admits that she skips meals. When she does eat (usually in her room), she will occasionally throw it up afterwards. She will also go for very long runs, but this is not part of a regular exercise routine. Sally complains of frequent indigestion when she eats, and her teeth have recently become sensitive to hot or cold foods.
Provide a DSM-5 diagnosis for Sally and ascribe her degree of functional impairment. List additional psychosocial concerns or stressors. Provide an explanation for your diagnosis.
What are some treatment goals for her?
Explanation / Answer
The child sally May qualify for a DSM 5 diagnosis of Bulimia Nervosa.
points in favour :
Maintainence of near normal weight
Her behaviours are based on her perception of physical attributes or perceived fatness.
Compensatory behaviours like fasting and throwing up
Discrete periods of binge eating in her room.
Functional impairment as Per DSM 5 is difficult to ascertain as number of binge eating episodes is not mentioned so difficult to say the severity.
Possible stressors could include her parents divorce and potential concern could be health hazards due to thorwing up and fasting excessively which could leave her prone to infections and vitamin deficiencies.
Treatment Goals : Maintenance of Nutritive nature of Food/ avoidance of junk food
Challenging Thought regarding perceived fatness by CBT.
Maintainence of Body weight and BMI
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