A CASE STUDY – TRACY

A PRESENTATION FOR MALADAPTIVE BEHAVIOUR

CIE-1
BY-
• AAYUSHI JAIN
• SNEHAL CHAUDHARY
 CASE STUDY OF
• 22 year old
• Junior in college
• 5’6’’ height
• Weighed 61 kg
• Scored 3.2 GPA
academically
• Lived by herself
 PRESENT PROBLEM:
 Academic performance was slipping.

 Planning and organization were not among her strengths. She

attended classes only sporadically and regularly found herself
staying up all night to finish writing papers or to prepare for tests.
 depressed mood and pattern of increasing social isolation

 She couldn’t understand why these men found her attractive

 Tracy had pervasive concerns about her appearance and strong, negative
feelings about her body.
 Wanted to lose 7 kg, indulged in binge eating and purging cycle.
 For the past 2 years, she had been going on private eating binges in
which she consumed very large quantities of food and then forced
herself to throw up
 These episodes currently happened three to four times per week. At its
worst, this binge/purge cycle had occurred 8 to 10 times per week.
 Took diet pills and laxatives on regular basis.

 Tracy’s notion of an appropriate diet bordered on the concept of

starvation.
 HER BINGE AND PURGE
CYCLE:
• Did not eat whole day
• Felt hunger pains throughout the day
• Starving by 8 pm
• Indulged in binging
• Would eat – A whole Chicken, mashed
potatoes, 2 large pizzas, cookies, chips
and wine
• Whenever felt full, threw up and ate
again
• Cycle lasted- 3-4 hours
 AFTER EFFECTS OF THE
CYCLE:
• Mood would go from bad to worse
• Felt awful and disgusted about herself
• Felt guilty over inability to control and
eating so much
• engaged in casual sexual relations
that contributed to her already
ample feelings of guilt, confusion,
and lack of control
• Her stomach hurt and she felt physical
pains
 AFTER EFFECTS OF
THE CYCLE:
PHYSICAL

• Enamel erosion
• Calloused knuckles
• Sore throat
• Coughing blood due to hurt
esophagus
• Drinking problem
SOCIAL HISTORY
 Parents got divorced when Tracy was 2 years old

 Mother remarried father got Tracy’s custody

 Father was never around, Tracy felt lack of affection

 Her nanny was also aloof

 Frozen meals and watching TV a daily routine

 When Tracy was 13, mother came back in her life.

 She was beautiful and friendly, spent time with Tracy and gave her much needed love

 After sometimes she became rigid about Tracy’s diet and very critical of her body image

 Tracy had to compete with her half sister for her mother’s affection
 Tracy moved back and forth between her mother’s and father’s house where very different type
of meal was served
 Tracy’s self image downgraded and made friends with “wild” kids

 Got into a relationship at age 16 with Jerome.

 ONSET OF THE DISORDER:
 Tracy’s parents did not like Jerome and she became

more isolated from them

 At age 17 she dropped out of high school and moved in

with Jerome to California

 Her relationship was going downwards and depressing.
 Tracy’s binge eating and purging evolved gradually while she was living with Jerome in California.
As she became more seriously depressed, she often ate snack foods to make herself feel better.
 Within 2 months, she had gained eight more pounds and in attempt to loose weight she went on
diets.
 One day, after eating two large bags of pretzels, Tracy began to feel nauseated. Rather than
waiting to find out whether she would vomit spontaneously, she decided to go to the bathroom
and stick her fingers down her throat. The process itself was upsetting, but she felt much
better after it was over. Then it dawned on her: Maybe self induced vomiting was a way to
avoid gaining weight.
 Initially threw up twice a week

 Frequency started to increase

 She returned home and got a part time job and completed college

 Problems escalated and physical signs of her private deeds started to show
which made her more embarrassed.
 She started to suffer academically which in turn stressed her

 She was not willing to accept that she had eating disorder and was not
enthusiastic about therapy when his father insisted to enrol into one.
 Her goal to enter into therapy was , to get better academically.
DIAGNOSIS:
BULIMIA
NERVOSA
DIAGNOSTIC CRITERIA
ACCORDING TO DSM 5
• Recurrent • Recurrent • The binge • self-
episodes of inappropria eating and evaluation
binge te inappropriate that is unduly
eating compensat compensatory influenced by
behaviors must
ory occur, on
body shape
behaviours average, at least and weight
to prevent once per week
weight gain for 3 months
 Bulimia can occur either by itself, as in Tracy’s case, or as an accompanying symptom of
anorexia nervosa
 The frequency of binges and vomiting in these patients, however, is less than was true for
Tracy.
 Several serious physical complications may result from bulimia (Mehler, 2011). Tracy
experienced several of these problems
 Bulimia also is comorbid with several other diagnoses, including depression, personality
disorders (especially borderline personality disorder), anxiety disorders, and substance-use
disorders
 Menstrual irregularity is also common.
ETIOLOGY:
BULIMIA NERVOSA IS UNDOUBTEDLY THE PRODUCT OF A
COMPLEX INTERACTION AMONG BIOLOGICAL,
PSYCHOLOGICAL, AND SOCIAL FACTORS.

THESE INCLUDE VARIOUS SORTS OF ANTECEDENT

CONDITIONS AND PREDISPOSITIONS TO THE DISORDER, SUCH
AS NEGATIVE SELF EVALUATIONS AND FEAR OF GAINING
WEIGHT.

IN THE PRESENCE OF THESE VULNERABILITY FACTORS, THE

STRESS OF DIETING OFTEN TRIGGERS THE FULL-BLOWN
SYMPTOMS OF THE DISORDER AND SETS OFF A CASCADE OF
RELATED BIOLOGICAL REACTIONS
 BIOLOGICAL BASIS:
Importance of genetics

Neurologically importance of the neurotransmitter SERATONIN. 

Drugs that block serotonin receptors increased binge eating.

Low level of serotonin associated with both Depression and Impulsivity

patients with bulimia have comorbidity with depression

PSYCHOLOGICAL FACTORS
AND RISK:
Fear of being Fat

progression toward thinness as the ideal shape

Cultural effect on women

being overweight or having overweight parents are risk factors for bulimia

Being teased by peers/ Family

A distorted view of the size of one’s body is another risk factor

disorder is a combination of extreme weight concerns and dieting practices

TREATMENT:
 Many patients with eating disorders do not seek treatment for their disorder because they do
not believe that anything is wrong
 When patients with bulimia do enter therapy, they are treated with both biological and
psychological treatments.
 It has been treated with antidepressant medication, especially SSRIs
 The major psychological intervention, as was the case with Tracy, is cognitive-behaviour
therapy
 For some patients, the optimal treatment may involve a combination of both drugs and CBT.
 Unfortunately, only about half of bulimic patients improve significantly during treatment. One
year after the end of treatment, only one-third are maintaining their treatment gains
TRACY’S TREATMENT:
 Tracy’s individual therapist referred her to a group for people suffering from
bulimia nervosa.
 The group included Tracy and four other women who also suffered from bulimia
 Led by a clinical psychologist who specialized in the treatment of eating disorders,
they met once a week for 10 weeks and followed a prearranged sequence of topics
 The cognitive elements of the program are aimed at factors such as low self-esteem
and extreme concern about body size and shape. The behavioural elements are
designed to alter maladaptive patterns of eating.
 Week 2: Week 4:
Week 1: Week 3: Thoughts,
Perfectionism and
Cues and Feelings, and
Self-Monitoring All-or-Nothing
Consequences Behaviours
Thinking

Week 8:
Week 7:
Week 5: Week 6: Problem Solving
Dieting and Other
Assertive Behaviour Body Image and Stress
Causal Factors
Reduction

Week 9:
Week 10:
Healthy Exercise
Coping with future
and Relapse
events
Prevention