Table of Contents
Case Study
In a telephone conversation between Julia and a Mental Health professional, the professional asks how she would be assisted. Surprisingly, she says she does not think the mental health professional can help and asserts a friend gave her the number. Nevertheless, the mental health professional identifies as Cindy and requests to ask Julia some standard questions. Julia concurs with her. First, she is asked when she was born and responds the date well. Then, Cindy, the MHP inquiries regarding her living situation. Julia says she was on a winter break as she had finished her finals at western university. She continues how her mother was hammering her by saying she was skinny and that she needed to eat more food instead of salad. However, Julia responds to her mother that she was similar to other students at the school. Further, Cindy asks some questions, which require a yes or a no answer. Julia is asked if she makes herself sick when feeling uncomfortably full, lost control over how she ate, lost more than two pounds in past three months, believe she is fat even when others claim she is thin, and if food dominates her way of life. Julia responds to all these questions with a yes. Ultimately, Cindy schedules her with an appointment on Thursday at ten in the morning with MS Jessica.
We can do it today.
Systematic Differential Diagnosis
Concerning this information, the six steps of differential diagnosis are significant to Julia’s eating disorder. The first step is to rule out factitious and malingering disorder. Evidently, this step is essential to make sure a patient is honest with symptoms. According to First (2014), malingering disorder is driven by a patient motivation to avoid recognizable goals such as avoiding responsibilities. On the other hand, factitious disorder involves a patient taking a sickness role for psychological reasons and hence, both are not mental disorders. For instance, in our telephone conversation case, Julia sometimes makes herself sick, as she feels uncomfortably full. Evidently, Julia has a factitious disorder due to that feeling and hence a psychological food problem. Therefore, the factitious disorder cannot be ruled out in her case.
The second step will involve ruling out any substance use. First (2014) asserts that psychiatric presentation in a patient can be due to substance use. This determination will be done by ordering laboratory tests on Julia, interviewing his parents and family members, and looking for any signs of intoxication. If Julia diagnosis of substance abuse is negative, the third step will be paramount to rule out mental disorder due to general medical state. Clinicians should diagnose medical conditions that are general, which could account for symptoms of psychiatry. General medical conditions might cause issues of mental health through a brain psychological effect, such as cancer diagnosis or stroke (First, 2014). Therefore, the temporal relationship of Julia will be assessed to determine if the eating disorder began after being affected by a general medical condition.
The fourth step will involve determining the particular primary disorder. Evidently, the symptoms and clinical history of Julia such as losing control over how she ate, losing more than two pounds in past three months and believing she is fat even when others claim she is thin is an indication of an eating disorder. Furthermore, a fifth step is paramount that will involve differentiating disorders of adjustment from categories that are unspecified. According to First (2014), clinicians should use adjustment disorder to patients who present severe symptoms of subthreshold nature that cause clinical distress. Finally but importantly, the last step will involve determining the impact of symptoms to social and occupational impairment. Reportedly, Julia has a perception that everyone at school resembles her and hence, she does not look skinny. Therefore, she is socially and occupationally impaired.
Sociocultural Perspective
Eating disorders affect mostly upper socioeconomic classes in industrialized countries. In these countries, young women prime thinness as goals regarding how they organize their lives. Most important, women believe that being thin is the shape an ideal woman should have (Zhang, 2014). For instance, ballet dancers and cheerleaders serve as ideal role models for other women. Conversely, overweight women are regarded as weak. Evidently, the greater the desire for women to become thin, the more likely they are to report eating disorders behavior. In fact, chubby teenagers suffer disapproval from other kids and are seen as fat. This attitude is evident in Julia where she considers herself having an ideal body as other students in school.
Evidence and Non-Evidence Based Treatment
Evidence and non-evidence methods exist for the treatment of the eating disorder. One of the evidence-based techniques for treating children with the eating disorder is the use of Maudsley or Family-based treatment therapy (Campbell & Peebles, 2014). This therapy is not only effective but also cost effective and time efficient. Evidently, Julia has the eating disorder due to her low self-esteem and insecurity of her body. In her telephone conversation, she inquires if her therapy could be rescheduled to which the MHP affirms. Therefore, this treatment will be sufficient for her as it is also time effective. On the other hand, an example of a non- evidence based is the use of pharmacotherapy (Lock, 2015). Few studies demonstrate efficacy in pharmacotherapy agents to treat children with the eating disorder. Additionally, no randomized controlled trials are published regarding the use of antidepressants in treating the eating disorder in children (Keel & Haedt, 2008).The poor efficacy of pharmacotherapy as an eating disorder treatment renders it as a non-evidence based practice.
Historical and Theoretical Inappropriate Perspective
Improper theoretical orientations exist regarding eating disorder. They include nutritional counseling and group therapy (Thompson-Brenner, Boisseau, & Satir, 2009). The nutritional therapy involves counseling a child or a teenager concerning the type of food to take. However, most teenagers relapse from this type of therapy as their eating disorder is related to the fear of food. Following a specific routine of food becomes problematic as it is a psychological problem. Moreover, a group therapy is inappropriate in this case as some patients may feel shy and hence, unable to share their eating disorder problem. For instance, Julia does not want to acknowledge to the MHP that she needs help. In this case, nutritional and group therapies would be inappropriate.
Establishment of eating disorder in children has different historical perspectives. The first approach of eating disorder was tied as a female diagnosis and no males were mentioned. According to Zhang (2014), women between fifteen and twenty-three years of age characterized the eating disorder and hence were separated from their family. Later, the eating disorder was reframed as a psychiatric issue linked to a family dysfunction. Thus, it regarded men with eating disorder as homosexuals and were isolated from their families (Zhang, 2014). Ultimately, these two historical perspectives are inappropriate in our case as Julia eating disorder is a psychological problem, not a female or male diagnosis problem.
- Campbell, K., & Peebles, R. (2014). Eating Disorders in Children and Adolescents: State of the Art Review. PEDIATRICS, 134(3), 582-592. doi:10.1542/peds.2014-0194
- First, M. B. (2014). DSM-5 TM handbook of differential diagnosis. Washington: American Psychiatric Association.
- Keel, P. K., & Haedt, A. (2008). Evidence-Based Psychosocial Treatments for Eating Problems and Eating Disorders. Journal of Clinical Child & Adolescent Psychology, 37(1), 39-61. doi:10.1080/15374410701817832
- Lock, J. (2015). An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents. Journal of Clinical Child & Adolescent Psychology, 44(5), 707-721. doi:10.1080/15374416.2014.971458
- Thompson-Brenner, H., Boisseau, C. L., & Satir, D. A. (2009). Adolescent eating disorders: treatment and response in a naturalistic study. Journal of Clinical Psychology, n/a-n/a. doi:10.1002/jclp.20646
- Zhang, C. (2014). What can we learn from the history of male anorexia nervosa? Journal of Eating Disorders, 2(1). doi:10.1186/s40337-014-0036-9