CASE STUDY A Client with Anorexia Nervosa

Cindy is a 20-year-old woman who is brought to the inpatient eating disorder unit of a psychiatric research hospital by two older brothers, who support her on either side. She is profoundly weak, holding her head up with her hands.

ASSESSMENT

Cindy gives a history of being a good student in elementary and high school. She delayed plans to attend college to care for her mother, who was very ill. The family further reports that Cindy began to attend exclusively to her mother and the household, totally neglecting herself and becoming extremely perfectionistic about her responsibilities. Although she had always been of normal weight with no prior eating problems, she began to restrict her food intake while spending an inordinate amount of time planning and preparing meals for others in the household. She rarely ate meals with the family and became increasingly socially isolated as she grew thinner. On admission to the unit, her height and weight are taken: At 62 inches (5 2 ) and 58 pounds, her weight is 50% of her ideal body weight. A complete physical examination reveals her to be extremely hypotensive (74/50 mm Hg), bradycardic (54 beats/min), and anemic (hemoglobin, 9 g/dL). Other laboratory test results are abnormal as well, reecting her extreme malnutrition. She is immediately placed on therapeutic bed rest to conserve energy and calories, and an intravenous line is started to increase her hydration. Cindy presents her problem as being one of extreme fatigue and needing to have more energy. She does not acknowledge that her extreme fasting has created the illness. When informed that the treatment would commence with prescription of a dietary supplement to provide nutrition, she does not object. As Cindy slowly begins to furnish a history of her eating pattern, she states that more recently she would begin the day with some water and half a piece of toast. During the day, she might have a piece of fruit. Her only meal is dinner, which consists of a very small quantity of

turkey breast and carrots. She is ultimately unable to eat with others and avoids mealtimes. She eats in isolation. Her thoughts throughout the day are preoccupied with food. She maintains her extremely low weight both by exercising and restricting food intake. Ultimately, she is too lethargic to exercise and maintains her extremely low weight entirely by restricting her food intake. She denies having a history of binge eating or purging. Cindy does not acknowledge that she is too thin, insisting instead that she is too fatigued. She speaks about examining her body daily for evidence of fat. When she sits down, she does not like her thighs to touch. Cindys affect is constricted, and she reports that her mood is depressed. She denies having suicidal thoughts. She is oriented in all spheres, with good attention and memory. Her thinking is concrete when explaining a proverb. This is Cindys rst hospitalization and her rst treatment for anorexia nervosa. She denies having a history of substance abuse or depression before her weight loss. She reports having no history of physical or sexual abuse. Cindy is the youngest of 12 children, with a 10-year difference between her and her next oldest sibling. Cindys father died 2 years ago. Around that time, her 68-year-old mother became very ill. Cindy considers herself an only child because of the difference in ages between her and her siblings and because she lives alone with her mother at a great distance from the rest of the family. Since she began taking care of her mother, she has become socially isolated, which is further complicated by the development of anorexia. She has not maintained contact with high school friends in the past year. Currently, she says, I do not know what I want to be when I grow up.

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2006 by Elsevier Inc. All rights reserved.