Question

Anorexia Nervosa Case Study - see below before answering questions 1-5

Melissa is in her second week of hospitalization in an inpatient eating disorder specialized hospital unit. She is a 15-year-old Hispanic female who immigrated to the Unites States 6 years ago. Her parents report preoccupation with her body and food intake beginning at 12 years of age. Upon admission, Melissa’s weight is 78 pounds, her height is 62.25 inches, and her body mass index (BMI) is 14.2.

Patient began menses at the age of 12 and, due to typical adolescent developmental changes, reported feeling uncomfortable in her body. At this time, she measured 58 inches and weighed 93 pounds, 76th percentile BMI for age). She learned she could restrict through seeing her mom diet at home and began counting her calories. She would aim for less than 1000 calories per day and began walking for 30 to 60 minutes daily. After 6 months, halfway through her sixth-grade year, Melissa had dropped to 82 pounds and did not grow in height during this time; she dropped to the 46th percentile (BMI for age) and stopped menstruating. Melissa’s parents began worrying and started to adapt a Maudsley/family-based therapy approach that included eating all meals at home with them. She would continue to restrict at school and exercise as much as she could but was able to gain weight back and by the beginning of 7th grade was up to 105 pounds and grew 2 inches.

Melissa continued to be monitored by her pediatrician and entered high school with a height of 61 inches and weighed 112 pounds. Entering high school, Melissa quickly became stressed with the high demand of her classes and began restricting again, this time down to approximately 500 to 800 calories per day. By January of this year Melissa’s weight had dropped to 89 pounds, so she began outpatient treatment. Her typical daily intake before admission was 1 cup coffee in the morning with an apple. For lunch she had salad that she packed from home with 3 ounces of sliced turkey on it and a ½ cup of brown rice with balsamic vinegar. For dinner she had two pieces of Laughing Cow cheese with steamed vegetables in her room, telling her parents she had too much work to do to sit at the table. If she got hungry at night, she would have an individual bag of fat-free popcorn. She also reported 60 to 90 minutes of walking or running per day at the gym after school.

Since her first onset of menses, Melissa was getting her period on average 4 to 5 times per year; however, it has now been 6 months since her last period. Melissa denies any purging or laxative abuse. At her most recent pediatrician appointment, Melissa lost another 2 pounds since the week prior, and her heart rate was 68. The doctor recommended inpatient hospitalization for refeeding.

Since being in the hospital, Melissa has struggled with eating 100% of her meals and has been caught hiding food in her napkin and spilling her supplements out in the garbage when staff is not looking. The staff report she is consuming on average 60% to 75% of her three meals and two snacks. She reports fearing any foods high in fat such as cheese, fried foods, desserts of any kind, meat, oils, and potato chips.

Medical history: Amenorrhea, hypokalemia

Current medications: MVI with trace minerals, thiamine daily

Inpatient calorie prescription: 3000 kcal/day + 8 fl oz Ensure Plus

BP: 89/58

Pulse: 58

1. List the essential criteria for the diagnosis of anorexia nervosa (AN). Indicate Melissa’s AN subtype.

2. What indications supporting hospitalization did Melissa meet before her admission?

3. What would you expect to find in nutrition-focused physical examination of Melissa?

4. What is a reasonable weight gain goal during hospitalization for Melissa?

5. What are some behavioral or psychological treatment approaches that could be used to help Melissa?

Answer 1

1.Essential criteria for anorexia nervoxa are following

-restriction of energy intake relative to requirements leading to significantly low body weight in context of age,sex,developmental trjectory,and physical health

-intense fear of gaining weightor becoming fat ,even though underweight

-disturbance in way in which one's weight or shape is experienced,undue influence of body weight or shape or self .evaluation or denial of seriousness of current low body weight.

2.restricted food intake,weight loss,exercising even in low weight-indications

3.nutrition focused physical findings

we need to check muscle ,subcutanous wasting,oral health,hair,skin.nails,signs of edema,appetite and affect

in her case she has weight loss, malnutrition(hypokalemia),amenorrhea,obesophobia

4.her height is 61 inches,so her weight can be ranging between 101 to 123 lbs

5.cobnitive behavioural therapy - a form of psychotherapy to encourage melissa to develop thinking patterns that will counertact their unhealthy eating behaviour,also will help to prevent relapse once their weight had been restored to normal level.