2021

Case Diagnosis
mental helth and psychopathology 2
ASSIGNMENT 2

NAME: SEHAR KHALID

ENROLLMENT # 01-171182-020
CLASS: BS PSYCHOLOGY 6A
SUBMITTED TO: DR. RIZWANA AMIN
SUMBISSION DATE: 3RD MAY, 2020.
 ASSIGNMENT # 2

Q: On the basis of following case study, answer the given questions: (1)

Ms. L was a gaunt 15-year-old high-school student evaluated at the insistence of her parents,
who were concerned about her weight loss. She was 5 feet 3 inches tall and had reached her
greatest weight, 100 pounds, a year earlier. Shortly thereafter she decided to lose weight to be
more attractive. She felt “chubby” and thought she would be more appealing if she were
thinner. First, she eliminated all carbohydrate-rich foods, and gradually intensified her dieting
until she was eating only a few vegetables a day. She also started a vigorous exercise
program. Within 6 months, she was down to 80 pounds. She then became preoccupied with
food and started collecting recipes from magazines in order to prepare gourmet meals for her
family. She had difficulty sleeping and was irritable and depressed, having several crying
spells every day. Her menses started the previous year, but she had only a few normal
periods.

Ms. L had always had high grades in school and had spent a great deal of time studying. She
had never been active socially and had never dated. She was conscientious and perfectionistic
in everything she undertook. She had never been away from home longer than a week. Her
father was a business manager. Her mother was a housewife who for the past 2 years had a
problem with hypoglycemia and was on a low-carbohydrate diet.

During the interview, Ms. L said she felt fat, even though she weighed 80 pounds, and she
described a fear of losing control and eating so much food that she would become obese. She
did not feel she was ill and thought that hospitalization was unnecessary.

i. Diagnose the client and give rationale for your diagnosis (1+2=3)

Ans: The tentative diagnosis is Anorexia Nervosa, restricting type. It is Anorexia nervosa
because full criteria of Anorexia Nervosa have been met. Elimination of all carbohydrate
rich food and eating only a few vegetables leading to a low body weight of 80 pounds
meets criteria A that is “restriction of energy intake relative to requirements, leading to
significantly low body weight.” Her fear of becoming obese even at the weight of 80
pounds and following a vigorous exercise program and intensified dieting meets criteria B
that is “intense fear of gaining weight or of becoming fat and persistent behavior that
interferes with weight gain, even though at a significantly low weight.” Feeling “fat”
when she is thinner, lack of recognition of being ill and thinking that hospitalization is
unnecessary meets criteria C that is “disturbance in the way in which one’s body weight
or shape is experienced, undue influence of body weight or shape on self-evaluation, or
persistent lack of recognition of the seriousness of the current low body weight.” The
diagnosis is Anorexia Nervosa restricting type because there is no evidence of binge
eating or purging behavior and the client achieved low weight by vigorous exercise and
intense dieting or semi starvation. The client also has amenorrhea or abnormal periods
which is a physiological disturbance as a result of semi starvation. The vigorous exercise
preceding the onset of the disorder and the acceleration of weight loss over the course of
the disorder, semi-starvation and the resultant amenorrhea in this case are the associated
features which support the diagnosis of Anorexia Nervosa. Depressive symptoms like
difficulty sleeping, irritable and depressed mood, crying spells, weight loss, social
withdrawal and diminished interest in sex in the client are associated features supporting
the diagnosis of Anorexia Nervosa, an additional diagnosis of Major Depressive disorder
is not warranted because of the presence of a desire for excessive weight loss and intense
fear of gaining weight which is absent in Major depressive disorder and also the full
criteria for major depressive disorder is not met which validates that it is Anorexia
Nervosa rather than Major Depressive Disorder. Obsessive-compulsive features such as
client’s preoccupation with food and her behavior of collecting recipes from magazines is
an associated feature supporting the diagnosis of Anorexia Nervosa and an additional
diagnosis of OCD is not warranted because in this case, the client has no clear obsessions
and compulsions unrelated to food, all her preoccupations are related to food, and an
additional diagnosis of OCD is given only if the individual has obsessions and
compulsions unrelated to food. Absence of binge eating validates that the diagnosis is
Anorexia Nervosa rather than Bulimia Nervosa. The presence of the fear of gaining
weight and feeling fat even at a low weight validates that the diagnosis is Anorexia
Nervosa rather than Avoidant/restrictive food intake disorder because in
Avoidant/restrictive food intake disorder the individuals do not have a fear of becoming
obese and they do not have a disturbance in the way they experience their body shape and
weight. It is Anorexia Nervosa rather than body Dysmorphic Disorder because in this
case, the distortion is related to body shape and size and, an additional diagnosis of Body
Dysmorphic Disorder is given only if the distortion is unrelated to body shape and size
(e.g., preoccupation that one’s nose is too big). It is Anorexia Nervosa rather than Social
Anxiety Disorder because the client has not reported any social fears. Although, her
mother has hypoglycemia, no personal medical history of the client and substance use is
reported. Therefore, it can be assumed that the client has not used any medications or
drugs, so, it is Anorexia Nervosa rather than substance use disorders. For more authentic
diagnosis, a complete medical assessment and information related to the presence or
absence of substance use is required to differentiate from medical conditions and
substance use disorders which can further help in validating the diagnosis of Anorexia
Nervosa.

ii. Identify the specifier (if any) (1+1=2)

a. By type

Ans: Restricting type.

b. Current severity

Ans: The result of BMI percentile calculation of this client was 14.2 kg/m2 which
is less than 15kg/m2. Therefore, the current severity is Extreme.

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