CASE FORMULATION Background of the Case: “Lara” is a 19 ½ year-old female studying BS Nursing at Emilio Aguinaldo College.

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. Presenting Problem: “Lara” is a 19 ½ year-old female presenting with bulimia nervosa. 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. Biological Factors: Some investigators have attempted to associate cycles of bingeing and purging with genetic factors and various neurotransmitters in the development of bulimia nervosa. Neurotransmitters, including serotonin, play a role in appetite, satiation, food selection, and eating pattern, all of which may be disrupted for clients with bulimia nervosa. Additionally, the appetite-inducing neuropeptide Y and peptide YY have been found to be elevated in clients with bulimia nervosa. Cholecystokinin, which is a hormone associated with the experience of satiety and discontinuation of eating behavior, has been found to be low in some clients with bulimia nervosa. The disruption of these neuronal systems may be implicated in bulimia nervosa. Psychological Factors: Lara manifests Bulimia Nervosa. 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. Cognitive theorists view 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 are closely linked, often in the form of vicious circles. People with eating disorders judge themselves 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 while overeating, ”fatness”, and weight gain are arduously avoided. Social Factors: 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”. Families of patients with bulimia nervosa are

generally less close and more conflictual and can be describe as neglectful and rejecting. Summary: “Lara” is a 19 ½ year-old female presenting with bulimia nervosa. 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. Her 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 food would fit a thimble”. Case Plan: Cognitive-Behavioral Therapy (CBT) should be considered as the first-line treatment for Lara’s condition. The therapist will implement a number of cognitive and behavioral cycle of bingeing and dieting and alter Lara’s dysfunctional cognitions – that is her beliefs about food, weight, body-image and overall self-concept.

Caban, Jareen T. Psychology Major

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