Identifying Information Name: Age/Sex: Address: Birth date: Civil Status: Educational Attainment:

"Lara" 19 1/2 years old Female Vista Verde Imus, Cavite April 9, 1990 Single 4th year Nursing student

II. Presenting Complaint "Lara" has been presenting maladaptive eating behavior for almost a year. She keeps her weight in control by restricting on foods, counting calories and running 5 times a week for 1 hour. She secretly engages herself with bingeing, vomiting and excessive exercise. III. Case Background "Lara" is a 19 1/2 year old female presenting with maladaptive eating behavior. She is 5 feet 5 inches tall and weighs 115 lbs. with a small to medium frame size. "Lara" was born in Imus, Cavite City. She is the only daughter of three children and has two brothers, ages 21 and 15. According to the client, she rarely eats a normal meal and mostly will consume a small amount of food during social gatherings. However, whenever she feels stressed or frustrated from her duty at the hospital, she would consume large amount of foods secretly, which she says is not normal for her daily intake to release stress. But following her overeating, she would feel anxious and guilty over her behavior and lack of control . She would then stick her finger down her throat to be able to vomit. Her preoccupation with weight and body image started way back in high school in large part of her mother's consistent concern. It then elevated when she was 18 years old and a 3rd year college student in EAC when she gained almost 125 lbs. According to her, weight, appearance and overall self-worth was an issue that troubled her mother most of her life and was determined to prevent that from happening to her. Whenever they go shopping for clothes or during family dinner, her mother would say harsh criticisms about her body and weight and at other times, making her weigh herself in front of her mother when she says that she doesn't think that she had gained any weight. In addition, her relatives would also say jokes about the amount of food that her mother serves to her during occasions. The client recalled an instance of August 2009 wherein she lost some weight and was down to about 110 lbs because of her restriction with eating. But she admits that she finds herself craving cakes and cookies, and other "forbidden" foods. But the moment that this forbidden foods passed through her mouth, she would start to feel guilty and would criticize herself. Following this, she would secretly engage herself in vomiting. At present, "Lara" has been doing some modeling job and photo shoots for freelance photographers since her boyfriend is a part-time model himself. Her present Body Mass Index is 19.1, which is considered to be normal for her age. And she has never been diagnosed nor hospitalized for her maladaptive eating behavior.

IV. Progress of the Case Session 1: January 23, 2010 Before the first session was conducted at the client’s house in Cavite, the interviewer first gathered relevant information about the client’s condition through her boyfriend Eric and her close friend Nisan. The interviewer was already familiar with these people even before the session began. Rapport was already established and data regarding the client’s case were easily given and noted. It was revealed in the interview that “Lara” (the client) was open about her behavior and would confide this issues with her boyfriend and her friends as well. She is aware that she has a problem and in fact wants to ask for help but humiliation stops her to do so. According to Nisan (her friend), even though Lara seems as a happy-go-lucky person she lacks self-esteem when it comes to presenting herself to people. She dreams of becoming a model and she is very thankful that Eric (her boyfriend) helped her to be a part-time model. Session 2: January 24, 2010 Initial interview was conducted at the client’s house in Vista Verde Imus, Cavite. Since the interviewer and the client know each other even before the session, it wasn’t difficult to establish rapport. The interviewer first assured that all information given by the client will be confidential and that data gathered will be used for research purposes only. When the interview started, the client was properly groomed and was able to maintain her personal hygiene. She was completely at ease and was able to make good social contact with the interviewer. She showed interest and cooperation during the interview. She speaks both Tagalog and English with a medium volume of voice which the interviewer can understand her clearly. When asked about her condition, she readily admits that she knows that her eating behavior is not normal because she had taken up Psychiatric Nursing, so she knows what is Bulimia Nervosa. After the observation and interview, the interviewer decided to end the session since all relevant information were already gathered. The interviewer scheduled a battery of psychological tests for Lara. She agreed right away and decided to meet the interviewer on February 2, 2010. Session 3: February 2, 2010 The background of the client’s case was completed based on the gathered information from the client and people close to her. A battery of psychological test was utilized for further assessment of the client’s case. Draw-A-Person Test February 2, 2010 Sachs Sentence Completion Test February 2, 2010 In summary, test results showed that the client clearly rejects and depreciates her mother while also feeling rejected by her family. Based on the interview, the client's family especially her mother is very critical with her weight and appearance. They would make criticisms and jokes about her weight during dinner or family gatherings. It also showed that she is able to establish meaningful relationship with friends and the opposite sex. Based on the interview from the client and her friends, she is honest about her eating behavior and wants to ask for help especially from her friends. In addition, she is thankful

of having Eric (her boyfriend) in her life and made her fulfill her dreams of becoming a part-time model. In terms of personality, she has no control over her impulsive behavior with regards of her binge-eating and vomiting. According to her, whenever she feels stressed or frustrated from her duty at the hospital, she would consume large amount of foods high in fat and carbohydrates to release stress. Following her overeating, she would feel anxious and guilty over her behavior and lack of control. She would then secretly engage herself to vomit because she feels afraid that all those calories would make her gain weight. In addition, it also showed that she is overly concerned with her appearance especially with her body shape. According to her, she is concerned with her shape and weight as aspects of looking good and always worries about how others see her. Session 4: February 5, 2010 The interviewer arrived at Emilio Aguinaldo College to meet up with the client. The interviewer discussed the results of the psychological test taken by the client and asked further questions or confirmations about it. The client wasn't surprised with the results of her test. She admitted that she has problems with her eating patterns but she is willing to ask for help especially from her friends. She showed a tendency of blaming her mother for being so critical with her weight. Before the session ended, the interviewer asked the client to answer a quiz as part of their activity entitled The Eating Attitudes Test (EAT-26). The client scored a total of 56 on the EAT-26. Based upon her responses to this eating attitude test, her scores are similar to others who have an eating disorder or at risk for developing an eating disorder. Based from the client's responses on the interview and the test, it shows that she is actively dieting and have an active preoccupation with food that is often associated with bulimia nervosa. She also has difficulty with self-control over eating and vomiting. V. Analysis The client (Lara), was assessed using two (2) Projective Test such as Draw-A-Person Test and Sachs Sentence Completion Test and an activity entitled the Eating Attitude Test. After the interpretation of the tests and analysis of the case through interviews and observations with the client and her friends, it was confirmed that the diagnostic criteria in the DSM IV-TR for Bulimia Nervosa was met. Evidences from the client's personal background influenced the cause and onset of Bulimia Nervosa. Her mother and relatives persistent criticisms and jokes about her weight and shape greatly affected and influenced the client's view of herself at present. Her preoccupation with shape and weight as aspects of looking good is in fact her defense because she has low self-esteem that rooted from the criticisms of significant others. She is afraid of gaining weight and judges herself largely in terms of her shape and weight and her ability to control them. VI. Diagnostic Impression Axis I 307.51 Bulimia Nervosa Axis II None Axis III None Axis IV Psychosocial problem: problems with primary support group (family); criticisms from her mother about her body shape and weight; jokes from her relatives

Axis V

Current Global Assessment of Functioning: 70 (Has occasional impulsive behavior with binge-eating, vomiting and excessive exercise but is generally functioning well in other areas e.g school; is able to establish meaningful relationship with her friends and the opposite sex)

VII. Prognosis Good Prognosis The client is aware of her maladaptive eating behavior (ego dystonic) and is willing to ask for help. There is a good chance of partial recovery of Lara's condition. If the client can learn how to deal with her problems of self-image and body weight she can go on to lead a normal and productive life. But they should give attention to the mother-daughter relationship of the client and her mother which can influence the recovery of Lara. VIII. Recommendation The purpose of this psychological testing was to provide assistance for "Lara" as well as to her parents on what they can do to help her. Recommendation for "Lara's" future plans are as follows: • "Lara" should get professional help coming from a clinical psychologist, dietician or nutritionist to facilitate and address her current condition and give proper attention for her treatment. • "Lara" should seek therapy especially family therapy to address her feeling towards her mother and relatives. • "Lara's" family should avoid making harsh criticisms and jokes regarding her weight and body shape. They should instead make her feel loved and cared for by her family.

Caban, Jareen T. Psychology major