Chapter 1. Prototype


Web-based Case Studies

Anorexia Nervosa
Patient: Carrie

Written by Danae L. Hudson, Ph.D.
Missouri State University

(c) 2007 Worth Publishers

1.1 Presenting Complaint

Carrie, a 24-year-old college student, woke up early one morning and thought to herself, “I can’t live like this anymore. I really think I might die.” Immediately, she also found herself thinking, “You’re just waking up and you are shaky and weak. Don’t overreact, once you work out you’ll feel so much better.” Carrie used to find it strange that she could have two seemingly contradictory thoughts at the same time, but after so many years, she was used to it. She got out of bed and began her morning routine. She nervously undressed and stepped on the scale. It was such a risk; she knew she hadn’t been perfect with her eating yesterday but still she hoped the scale would bring good news. The scale registered 98 pounds, a good 30 pounds less than what would be considered at the lower end of normal for someone with her 5’6’’ frame. Carrie breathed a sigh of relief. She hadn’t lost any more, but at least she hadn’t gained weight. It had been such a battle to get below the 100-pound mark that she vowed never to let herself get past that point again. She felt as though she just needed to lose about 5 pounds more and then she would be satisfied. She had had thought that before, of course, but when she reached her goal she still saw herself as fat. It just wouldn’t seem to go away. She knew intellectually that she weighed less than most of her friends, but couldn’t understand why people referred to her as skinny. Didn’t they see all the fat around her stomach and thighs? Carrie even began to wonder if she had some kind of strange medical condition where her body held onto fat and lost weight from other areas, like her muscles, or even worse, her brain. Lately, she has had such a difficult time concentrating and has noticed that her grades are slipping in her classes. She has always been a straight-A student, so she was not used to these kind of difficulties. However, she viewed it as just one more challenge; she could easily stay up all night to study, if she had to. She had always been a poor sleeper and lately had been waking up at 4:00 AM anyway, unable to get back to sleep.

Carrie continued with her morning routine of writing down everything she was going to eat that day. She never ate breakfast, but after returning from the gym, if she had a successful workout, she would allow herself to eat lunch. A successful workout was defined as 90 minutes of cardiovascular exercise and at least 30 minutes of weight training. She was almost always successful with her exercise, except for the few times she nearly fainted and the manager of the gym suggested that she return home and rest. Today, lunch would consist of a plain salad with no salad dressing, ½ can of tuna, and a diet soda. After class she would drink some coffee with her friends. She often brought a snack, such as an apple or some carrot sticks, with her and would leave it on the table so she could refer to it when her friends would offer her some of their snacks. Most of the time she didn’t want to eat it, but sometimes she felt as though everyone was staring at her, so she would just eat some carrots just to appease them. After doing so, though, Carrie found it very difficult to concentrate in her next class because she would obsess about how many calories she had consumed that day already. She swore she could feel the fat cells in her body enlarging after she ate. Sometimes in the evening, she would try not to eat anything at all, especially if she had eaten something during the day that she hadn’t planned on. She found that drinking a lot of water and diet soda could calm her hungry stomach. Carrie hated feeling hungry. She viewed it as a sign of weakness. She had always prided herself on how much willpower she had compared with other people. In some ways, she enjoyed watching other people eat because it made her feel even more powerful when she did not eat with them.

1.2 Diagnosis

Question 1.1 Making a diagnosis

Refer to the DSM-IV-TR criteria for anorexia nervosa and bulimia nervosa and answer the following questions.

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Question 1.2 Societal Pressures


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