Identifying Information Name: Age/Sex: Address: Birthdate: Civil Status: Religion: “Lara” 19 ½ years old Female Imus, Cavite April 9, 1990 Single Roman Catholic 4th year college student

Educational Attainment: II. Presenting Complaint Bulimia Nervosa III. Case Background

“Lara” is a 19 ½ year old female presenting with symptoms of Bulimia Nervosa. She is 5 feet 5 inches tall and weighs 112 lbs. with a small to medium frame size. She is the only daughter of three children and has two brothers, ages 21 and 15. The bulimia started 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 15 years 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 throws up once before she goes to bed. According to her, her view of herself is always in 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 girl who could do everything and was most likely to succeed. People around her always tell her how lucky she was but she never really saw herself to be lucky. Lara’s concern over with weight was a sum of other people’s influences, most notably her mother’s. According to her, weight, appearance and overall self-worth was an issue that troubled her mother most her life and so her mother was determined to prevent that from happening to her. Whenever they go shopping for clothes or during

dinner, her mother would say harsh criticisms like “You are a pretty girl and you shouldn’t be walking around with thighs like that”. Her extended family would say jokes about the portion of food her mother used to give to her during occasions like” That amount of food would fit a thimble”. After eating a large amount of food in during dinner, she feels guilty about it and is disgusted with what she did and so she throws up before she goes to bed. This started the cycle of bingeing and purging to control her weight. IV. Observation 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 and in doing the tests. She was able to establish rapport with the interviewer. She speaks fluently in English with a medium volume of voice which the interviewer can understand what she was saying. She was attentive to the interview and in taking the test. Though she showed a general tendency to be over critical with herself when asked about how she sees herself (weight, body image, self-concept). V. Psychological Test and Interpretation Draw-A-Person Test Sachs Sentence Completion Test February 2, 2010 February 2, 2010

In summary, test results showed that the client clearly rejects and depreciates her mother while also feeling rejected by her own family. Based on the interview, the client’s family especially her mother is very critical with her weight and keeps on pressuring her to be thin. They would make harsh criticisms and jokes about her weight during dinner or family gatherings. She has no control over her impulsive behavior ion terms of eating and vomiting. According to her, when dinner is served she simply cannot stop to eat though she already feels full. She can’t control either the need to vomit/purge it before going to bed. She is overly concerned with her appearance especially with her body shape. According to her, she worries about how others see her and is always concern of looking attractive.

VI. Analysis

Lara’s assessment using the Draw-a-Person Test and Sachs Sentence Completion Test provided a basis for understanding the client’s unconscious feelings towards herself and others especially with her family. The client feels pressured to conform with her mother’s desire to look good and stay thin. She cannot handle the criticisms coming from her mother and family about her weight. She admits of being a high-achiever and is always concern with her appearance. She has never been overweight but because of other people’s influences especially her mother’s comments about her body, it clearly affected her self-esteem and how she sees herself now. After eating a large amount of food, she feels guilty about it and is disgusted with what she did and so she throws up before she goes to bed. This started the cycle of bingeing and purging to control her weight. It made her to be self-critical with her body shape and weight and it lead to having Bulimia Nervosa. VII. Diagnostic Impression Axis I Axis II Axis III Axis IV 307.51 Bulimia Nervosa None None Psychosocial problem: problems with primary support group (family); criticisms from her mother about her body shape and weight; jokes coming from her relatives Axis V Current Global Assessment of Functioning: 60 ( Behavior has considerable difficulty in social functioning and has occasional impulsive behavior with eating and vomiting but generally can function well in other areas like school)

Differential Diagnosis Rule in Rule out

Bulimia Nervosa Anorexia Nervosa Binge-Eating/Purging Type Eating Disorder NOS

Anorexia Nervosa Binge-Eating/Purging Type Eating Disorder NOS

Anorexia Nervosa Binge-Eating/Purging Type was disregard because the client didn’t meet the criteria for this disorder. The client still has regular menses and the binge-eating occurs for a discrete period of time (during dinner) and vomiting occurs after a large amount of food has been eaten. The client also has a normal weight unlike with individuals with Anorexia Nervosa who are underweight of body weight is less than 85% of that expected. The client’s BMI is 18.6 which is a normal weight for her age.

Eating Disorder NOS was also disregard because the client didn’t meet the criteria wherein there is repeated chewing and spitting out, but not swallowing large amounts of food and with the binge-eating disorder. The client is clearly fixated on body shape and weight that why she engages both with bingeeating (eating large amounts of food during dinner) and purging (throwing up before going bed) to control her weight. She laso controls her weight by counting calories, restricting on certain foods (no rice or food rich in carbohydrates) and excessive exercise.

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