1) Introduction to case study-: photo
2) Different types of case studies-: photo
3) Introduction to disorder-:
Bulimia Nervosa
Bulimia Nervosa is an ’EATING DISORDER’ characterized by binge eating followed by purging and
other methods to avoid weight gain. It is characterized by first binging which refers to eating a
large amount of food in a short amount of time. And then Purging which refers to the attempts
to get rid of the food consumed by vomiting or laxatives. People with bulimia are usually at a
normal, healthy weight. But they judge themselves harshly based on their view of their body
shape and/or weight. They usually have self-esteem issues closely linked to their body image. it
was not until 1979 that a London psychiatrist, Gerald Russell, identified 40% of his Anorexia
Nervosa patients with an ‘ominous variation’ of the disorder – the variation being that they from
time to time went on binges.
Symptoms of BN: Bulimia nervosa has both physical and behavioural or emotional symptoms.
Behavioral and emotional symptoms of bulimia nervosa include:.
Excessive exercising.
Preoccupation with body image.
Intense fear of gaining weight.
Depression, anxiety or substance abuse.
Feeling out of control.
Feeling guilty or shameful about eating.
Withdrawing socially from friends and family.
The physical symptoms of bulimia nervosa can include:
Swollen cheeks or jawline.
Gastrointestinal problems such as constipation and acid reflux.
Scars, scrapes or calluses on your knuckles (from forced throwing up).
Fainting.
Irregular menstrual periods.
Muscle weakness.
Bloodshot eyes.
Dehydration.
Treatment of BN: bulimia nervosa can be treated using a variety of techniques which may
include-
o COGNITIVE BEHAVIORAL THERAPY- It is a type of individual counseling. It focuses on
changing your thinking (cognitive) and behaviour. Treatment includes techniques for
developing healthy attitudes toward food and weight. It also includes approaches for
changing the way you respond to difficult situations.
o NUTRITIONAL COUNSELLING- Nutrition counseling involves learning healthier ways to
eat by working with a registered dietitian or counselor to get back on track.
o MEDICATION- Selective serotonin reuptake inhibitors are a type of antidepressant. They
can reduce the frequency of binge eating and vomiting. But the long-term effectiveness
of these drugs isn’t clear. They’re also effective at treating anxiety and depression which
are common among people with bulimia nervosa.
4) Introduction to subject -:
Jessica a 22 yrs old female presented to the centre with a four year history of binge eating,
vomiting and laxative use. She was diagnosed with bulimia Nervosa which is an eating disorder.
5) Socio-Demographic Information -:
Name: Jessica
Age: 22
Gender: Female
Residence:
Marital Status:
Family members:
Siblings:
Occupation:
Education:
Onset:
Duration of illness:
Stressor:
Precipitating factor:
6) Chief complaints of client -:
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7) History of present illness -:
Jessica stated that at the age of 18, following the break-up of a one-year relationship with her
boyfriend (she did not want to become intimate with him). She had begun to eat excessively at
times (comfort eating) as a way of coping with the heartache it caused.
Jessica put on some extra weight, approximately 4 kg over the course of a few months and was
very upset when she discovered that some of her outfits were not fitting her, especially in the
run up to a summer holiday. Jessica had known about people vomiting as a means of weight
control and recalled some of her school friends telling her it was a handy way not to put on
weight. However, she had never really considered doing this herself, as she thought it was a
‘disgusting thing to do’.
She stated that one evening after a particularly large bout of over eating, she felt very
uncomfortable and thought that if she could only vomit it would at least relieve the discomfort.
Using her forefinger, she stuck it down the back of her throat and began vomiting . Afterwards
she felt unwell, her throat was raw and her stomach sore, but she admitted feeling some relief
from the feeling of guilt and regret of having eaten too much. She vowed at the time never to do
it again.
A few evenings later after a night out with friends and having consumed ‘a few too many‘
alcoholic beverages she engaged in what she described as a ‘feeding frenzy ‘, eating almost
anything she could get her hands on in the fridge and cupboard. It seemed easier to vomit this
time and the next day she bought a packet of laxatives, to clear out the system, taking 3 times
the recommended dose.
Jessica tried starving herself over the next few days, feeling determined to try and get her
weight under control and start a ‘new chapter in her life’. This lasted until day 3 when weak with
hunger and coming home from a late night at work, she could not resist the temptation to stop
off at a local Chinese restaurant as she passed by it. They had a buffet–style service that meant
she could keep going back up to eat whatever she wanted. Having left feeling stuffed and very
guilty, vomiting seemed the obvious option and laxatives were used the following day.
Over the course of the next few months a pattern developed whereby she would attempt any
and every new diet, she lasted 2 to 4 days and this would end up in bingeing and purging
behaviour. Jessica Weight was 9st-8lbs and her Height was 5ft-3ins
None of Jessica’s family or friends were aware of her difficulties, although they know she was
constantly dieting. Jessica felt very unhappy with life, the thought of suicide had occasionally
crossed her mind but it always occurred after a night out drinking followed by a binge and
purging episode. Jessica was taking 40 mg of Fluoxetine (Prozac) when she attended therapy.
