CASE FORMULATIONBackground of the Case:
“Lara” is a 19 ½ year-old female studying BS Nursing at Emilio AguinaldoCollege. She is 5 feet 5 inches tall and weighs 112 lbs. with a small to medium framesize. She is the only daughter of three children and has two brothers, ages 21 and 15.
“Lara” is a 19 ½ year-old female presenting with bulimia nervosa. The bulimiastarted in high school but her concern with weight started a few years before that. Her symptoms of bingeing, purging and excessive exercising started when she was 15years old and a senior student in Imus Institute in Cavite. In the beginning, she kept her weight in control by restricting on foods (no rice or any foods rich in carbohydrates),counting calories and running 7 times a week for 2 hours. Her daily intake is as follows:no breakfast, no lunch, snack (fruits), heavy dinner, and bingeing all night. She throwsup once before she goes to bed.
Some investigators have attempted to associate cycles of bingeing and purgingwith genetic factors and various neurotransmitters in the development of bulimianervosa. Neurotransmitters, including serotonin, play a role in appetite, satiation, foodselection, and eating pattern, all of which may be disrupted for clients with bulimianervosa. Additionally, the appetite-inducing neuropeptide Y and peptide YY have beenfound to be elevated in clients with bulimia nervosa. Cholecystokinin, which is ahormone associated with the experience of satiety and discontinuation of eatingbehavior, has been found to be low in some clients with bulimia nervosa. The disruptionof these neuronal systems may be implicated in bulimia nervosa.
Lara manifests Bulimia Nervosa. According to her, her view of herself is alwaysin terms of what she’s not, what she hasn't accomplished which she says are a sum of her failures, instead of a sum of success. She is a high achiever and is known as the girlwho could do everything and was most likely to succeed. People around her always tellher how lucky she was but she never really saw herself to be lucky. Cognitive theoristsview bulimia nervosa as a disorder of thinking, in that distortions are the basis of behaviors such as binge eating and purging. Thoughts, feelings and behavior areclosely linked, often in the form of vicious circles. People with eating disorders judgethemselves largely, or even exclusively, in terms of their shape and weight and their ability to control them. As a result, their lives become focused on their shape, weight,and eating with dietary control, thinness and weight loss being actively pursued whileovereating, ”fatness”, and weight gain are arduously avoided.
Lara’s concern over with weight was a sum of other people’s influences, mostnotably her mother’s. According to her, weight, appearance and overall self-worth wasan issue that troubled her mother most her life and so her mother was determined toprevent that from happening to her. Whenever they go shopping for clothes or duringdinner, her mother would say harsh criticisms like “You are a pretty girl and youshouldn’t be walking around with thighs like that”. Her extended family would say jokesabout the portion of food her mother used to give to her during occasions like” Thatamount of food would fit a thimble”. Families of patients with bulimia nervosa are