M05 Writing Case Study 1: Brandy

Maximo Green

PSYC205 Abnormal Psychology

Professor Dan W. Baggs

February 27, 2023

Case Study: Brandy

Brandy is a 19-year-old Caucasian female who stands at 5’5” and weighs 116 lbs.

Brandy is a patient who is insecure about her weight, and how she thinks others may perceive

her. She believes that she is fat, and is certain the other people view her as disgusting. Her

insecurity has led her to follow very strict diets and the habit of throwing up after eating to lose

weight. It is also of note that she has isolated herself from her friendships and she has been

depressed since she believes the others won’t like her because of her weight. The patient presents

symptoms and signs such as cessation of menstrual periods, misuse of laxative or purging, binge

eating, dental problems as well as mood disorders or anxiety disorders.

Symptoms and diagnosis

The patient has said that she experiences what seems to be a state of constant depression

which has come about due to her negative views about her own weight. The patient's way of

living has also interfered with her social life, mainly with her friends. Brandy has mentioned that

whenever her friends express concern about her eating habits, she tends to become agitated, and

then distances herself from her friends. This isolation may also be a main factor in her constant

depression. Anxiety disorders and mood disorders are characteristic symptoms of anorexia

nervosa and bulimia nervosa. Brandy has also developed dental issues, which are a result of her

purging.

Purging, self-starvation, and induced vomiting can result in a deficiency of vitamin D,

iron, and especially calcium. Stomach acid permanently erodes the protective enamel of the

teeth, which can ultimately lead to severe tooth sensitivity when it comes to eating food. The
stomach acid will then break away at the calcium in the teeth, causing tooth discoloration, and

then decay (Bhandari, 2022). The patient has also developed a cessation with her menstrual

periods (amenorrhea).

This is a warning sign that the body is not in proper function due to little or no nutrition,

however it is not a constant factor since it does not happen in all cases. These symptoms are

present in eating disorders such as anorexia nervosa and bulimia nervosa (Barlow, 2016). Also,

patients that could have bulimia nervosa tend to be ashamed of their eating problems and attempt

to hide them. According to the DSM-5 official and diagnostic criteria, the patient presents a clear

example of bulimia nervosa.

Differential Diagnosis

Even though the patient shows symptoms present in bulimia nervosa, there is a possibility

that she also suffers from anorexia nervosa. Both disorders carry similar symptoms, and it's

entirely possible that a patient can show symptoms of both disorders.The DSM-5 Disorder

criteria of anorexia nervosa are symptoms such as depression, anxiety, and intense panic

(Barlow, 2016). Another similar symptom is the cessation of menstrual periods. According to the

clinical history of the patient, Brandy has also explained amenorrhea to be within the list of

physical symptoms.

If we were to make this diagnosis, we’d have to consider predominant symptoms in said

patient to diagnose the possibility of an additional diagnosis, seeing as there are subtypes to

anorexia nervosa. The DSM-5 has specified anorexia nervosa in two subtypes: the restricting

type and binge-eating–purging type. For example, Brandy has had negative thoughts about her

appearance, and believes that she is overweight. This is a shared symptom between bulimia, and

thus could fit in as an additional diagnosis if needed. According to the symptoms documented,
Brandy could suffer from the subtype of binge-eating–purging type (Bulimia Nervosa, 2018).

This additional diagnosis is strengthened by the fact that the patient has been practicing the act of

purging after eating to lose weight.

Treatment for Bulimia Nervosa

Treating bulimia is something that falls under both conventional medicine, and

psychology, because it is a disorder that not only attacks the body, but the mind as well.

According to Harvard Health Publishing, the American Psychiatric Association (APA)

guidelines suggest that a treatment consisting of both psychotherapy and nutritional counseling is

administered. (Harvard Health Publishing, 2009). CBT (cognitive behavioral therapy) can be

effective when it comes to talking about behavior, while learning to solve problems and manage

a patient's symptoms. Another option is an eating disorder clinic, which is specifically designed

to help people learn to manage eating disorders.

Weekly individual and group programs are good steps that one can take to help treat the

disorder. Nutritional therapy has also proven very effective when it comes to battling an eating

disorder. With nutrition therapy, a registered dietitian will help you develop meal plans, find

what’s best to eat and what to avoid, and create better feelings about food in general. When it

comes to prescribing medication, “According to the American Addiction Centers, the

antidepressant Prozac is the only bulimia nervosa medication approved by the Food and Drug

Administration (FDA)”(Juby, 2021)

Prognosis

When it comes to the patient, it is safe to say that a treatment that includes both psychotherapy,

legitimate nutritional counseling, and medication can show improvement over a period of time.
Despite her views about her weight, a weight of 116 lbs at 5’5” is considered ideal on the BMI

scale. Fortunately, there were no records of sexual abuse on Brandy.

References

Barlow D. H., Durand M. V., & Hofmann S. G. (2016). Essentials of Abnormal Psychology (8th

ed.). Cengage.

Bhandari, S. (2022, August 31). Effects of Bulimia on the Body.

https://www.webmd.com/mental-health/eating-disorders/bulimia-nervosa/bulimia-effects-body

Harvard Health Publishing. (2009). Treating bulimia nervosa. Harvard Health.

https://www.health.harvard.edu/newsletter_article/Treating-bulimia-nervosa.