Psychiatric Diagnosis

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Julia is a 17 year old first year college student who is living on her own, away from parental supervision, for the first time. She is an accomplished student and athlete who has a full scholarship for track and field. Her continued scholarship depends on continued good performance times for her track meets. Gaining the fresh 15 is very common for first year college students. When her coach recommended that she lose a few pounds to enhance her performance time she found herself wanting to lose more weight and was unable to bring herself to stop her weight loss at a healthy weight. She became withdrawn and her mother decided it was best to get in contact with her coach to ensure that she received an evaluation. Eating disorders can be characterized by many factors, primarily including a continual disturbance of eating habits that result in health issues, both on a mental and physical level. The most common disorders seen in patients are anorexia nervosa, bulimia, binge-eating, and food intake disorders.

Based on the DSM-5 manual I would diagnose Julia with an eating disorder. Anorexia Nervosa can be defined as purposeful starvation and excessive loss of weight. Julia fits all of the symptoms for this disorder. One of the major symptom is being at least 85% of the recommended body weight. The patient’s weight has fluctuated from 145 at the beginning of the semester to less than 100. She also exhibits an intense fear of weight gain. Her mental attitude is that of food avoidance, to the point that she has become antisocial and will not participate in activities that involve school mates and eating. This applied to her family during the holiday break as well. She would tell her family that she was eating at the mall or a friend’s house to avoid eating in front of them.

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I would also diagnose Julia with an adjustment disorder, based on the DSM-5 manual. An adjustment disorder can be characterized by the presence of behavioral or emotional stressors within the three month onset of the stressor occurring. The adjustment disorder can cause a beyond normal reaction to the stressor. Julia is a first year college student who never has lived on her own before. She has always been an exceptional student, participated in school athletics, and never gave her parents any trouble. She is on her own for the first time in her life and responsible for taking care of herself. She is going to college on a full scholarship for track and field, which requires her to maintain a specific grade point average. She seems overwhelmed by the demands of both her academics and her track and field requirements. Symptoms from adjustment disorder can be so great in some patients that they can cause an impairment in daily functioning. In Julia’s case, in combination with the eating disorder, immediate treatment would be recommended to avoid any further physical or emotional distress. To obtain diagnosis the use of the DSM-5 is very important as it is the primary handbook used by professionals. It lists descriptions and symptoms that are necessary in accurately diagnosing mental disorders. According to Yalch, “This system connects clinical practice to basic science, enhances the clinical utility and empirical validity of the DSM–5, and appears to provide a solid pathway for the transformation of personality diagnosis.”

Cognitive-Behavioral Therapy, also known as CBT, is a goal orientated therapy that is designed to help the patient change the behaviors that are causing issues. It is typically a hands on process and takes a quick approach to problem solving. Helping the patient see what is causing the behavior empowers them to change for the better. Aaron Beck is considered to be the pioneer in the cognitive-behavioral therapy field. Born in 1921, he is widely known for his

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research in psychopathology, psychotherapy and suicide prevention. He is a professor emeritus at the University of Pennsylvania and his developed theories regarding clinical depression are still widely used today. In Julia’s case the cognitive factors would be the constant scrutinizing of her weight, her negative body image and belief in having to maintain perfectionism at all times. The behavioral aspect would be her dietary restrictions, body and social avoidance and constant self-harm caused by the eating disorder. Due to her comorbidity, or having multiple disorders, the cognitive-behavioral therapy will also take a hands on approach with her adjustment disorder. By removing, or alleviating the stressor, it will help both disorders.

Humanistic therapy is a therapy that is centered on the relationship between therapist and patient. It studies not just the mind but the patient as a whole. This can also be referred to as phenomenological, or from the view point of the patient’s individual experience. Humanism gained popularity as a form of rejection against the behaviorist perspective, which is primarily stimulus versus response based behavior, and research using animals. According to Hansen, “Psychological humanism emerged as a reaction to the reductionist orientation of psychoanalysis and behaviorism. Early humanists emphasized treating the client as a whole person and were therefore antagonized to the prevailing theories of the psychology that reduced people to mechanistic collections of psychic parts or discrete behaviors, such as behaviorism. For humanists, a reductionist mind-set is an obstacle to apprehending the true experience of the other person, a process that is essential for effective psychotherapy.”

The first article that I researched regarding validity for the eating disorder diagnosis was about eating the risk factors of the disorder during adolescence. According to Rohde, “3 A cross-sectional retrospective epidemiological study suggested that approximately 7.5% of young

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women meet criteria for a DSM-IV-TR4 eating disorder of anorexia nervosa, bulimia nervosa, or binge eating disorder (BED).” Julia, at seventeen years of age, is at the right age to develop an eating disorder. Anorexia Nervosa is typically onset in young females between the ages of sixteen and twenty two. As the female body matures and advances in age it is normal for body mass index to increase. Julia is an athlete and her performance depends on proper weight management. She has a preconceived notion of what her body size should be and it is not mentally healthy. She also suffers from poor body image and esteem issues, which are risk factors.

The second article that I read was in regard to the prevalence of mental health issues in university students. It examines the pressures that college students face with the adjustment to being out of the nest. This definitely relates to Julia as she is a first year college student with many pressures to maintain her grades and track scholarship. With the transition to university life many young people are more likely to become vulnerable to mental health issues, including adjustment disorder and eating disorders, like Julia is currently dealing with. According to the article there has been a large shift over the last decade in cases from University health centers shifting from developmental issues to psychological issues. According to Saleem, “Gallagher, Sysko, and Zhang (2001) conducted a national survey of 274 Counseling Center institutions. The directors of the Counseling Centers were reported that the psychological problems were increasing both in number and severity in students over the last five years. The report also showed that overall 85% of the university students display severe type of psychological issues. In which 71% students have learning problems, 38% eating disorder, 45 % alcohol problems, sexual assault concerns on campus 33%, and drug use 49%. Overall, approximately 16% of

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counseling center clients had severe psychological problems.”

Evidence based treatments are treatments that have a basis of strong scientific evidence, according to approaches and techniques already in practice. There has been research to prove a standard cause and effect. On the other hand, non-evidence based treatment may still be considered experimental and has no scientific merit or track record to make it accountable. For Julia, evidence based treatment with the use of enhanced cognitive-behavioral therapy would be recommended. It is a short term therapy, typically around 20 weeks, that helps the patient to establish structured, stable therapy that focuses on the problematic issue specific to the eating disorder. The therapy will help her tackle her body issues and what is stopping her from maintaining healthy body image and eating habits. Julia will also need to have intense psychological counseling to help her manage her stress resulting from school and adjusting to university life. Family therapy would also be a good idea if the parents are willing to participate. This would help everyone be on the same page with treatment and having open communication.

Cognitive remediation therapy (CRT) is a widely recognized treatment for eating disorders. CRT was originally used as a form of therapy for patients suffering from severe brain injuries and trauma. The therapy aim is to help reduce dysfunctional thinking and the perfectionist attitude that is often prevalent in patients with eating disorders. According to Van Passel, “In CRT for AN, patients carry out cognitive excercies and are encouraged to reflect on their typical, maladaptive daily-life strategies, and to consider and practice helpful alternatives, for instance by adopting more global van Passel et al. BMC Psychiatry (2016) 16:393 Page 2 of 14 ‘bigger-picture’ thinking strategies and more goal directed behaviors.” Both CRT and CBT

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therapies aim is for symptom reduction making a definite success rate difficult to pinpoint; however, both therapies have shown to be very successful treatment options.

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Annotated Bibliography

Lynn, Z., Matthew, S., & Cheryl, N. (2017). Case Conceptualization: Improving Understanding and Treatment with the Temporal/Contextual Model. Journal Of Mental Health Counseling, 39(3), 181-194

This article explores case conceptualization as a treatment option for eating disorders. The conceptualization aids in how the treatment proceeds, almost like a blueprint of the process. The process utilizes a scientific model, the Temporal/Contextual Model, and is uses formula based on the individual patient to help produce the most effective treatment results.

De Jong, M., Korrelboom, K., van der Meer, I., Deen, M., Hoek, H. W., & Spinhoven, P. (2016). Effectiveness of enhanced cognitive behavioral therapy (CBT-E) for eating disorders: study protocol for a randomized controlled trial. Trials, 171-12.

The effectiveness of CBT-E therapy for eating disorders it the primary focus for this article. It explores the continued validity of the treatment and options for patients who made need different therapies. The cost effectiveness compared to other treatment approaches were also examined.

Ballard, J., & Crane, D. R. (2015). Eating Disorders Treatment Patterns by Age. Eating Disorders, 23(3), 262-274

This article suggests that while CBT is the still the most common treatment for eating disorders, that other options may be considered based on age. Family therapy may be a

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cost effective option for patients whose eating disorder are influenced by the family dynamic. This would hold merit as it is taking into consideration the core of the issue and using it in a form of treatment.

Wagner, R., MacCaughelty, C., Rufino, K., Pack, T., Poplack, J., George, K., & Ruscitti, C. (2016). Effectivenes of a track-based model for treating eating disorders in a general psychiatric hospital. Bulletin Of The Menninger Clinic, 80(1), 49-59. 

This article examines track-based models for treatment patients with severe eating disorders that require inpatient hospitalization. According to the article, the APA has reported that patients with a body weight of less than 85% than the recommended weight will benefit from inpatient treatment in a specialty facility. This has been attributed to the fact that the staff in specialty hospitals have specific training to make them better understand the treatment that they are providing to the patient. This increases the potential success of the program.

Milano, W., De Rosa, M., Milano, L., Riccio, A., Sanseverino, B., & Capasso, A. (2013). The Pharmacological Options in the Treatment of Eating Disorders. ISRN Pharmacology, 1-5.

This article examines the use of prescription medication, mainly antipsychotics, in the treatment of eating disorders. This treatment is primarily used for patients with severe cases that have other disorders, such as schizophrenia. There is scientific basis, as the medication typically shifts focus and to increase appetite and weight gain; however, medication should not be considered as the sole option for treatment.

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References

Ballard, J., & Crane, D. R. (2015). Eating Disorders Treatment Patterns by Age. Eating Disorders, 23(3), 262-274

De Jong, M., Korrelboom, K., van der Meer, I., Deen, M., Hoek, H. W., & Spinhoven, P. (2016). Effectiveness of enhanced cognitive behavioral therapy (CBT-E) for eating disorders: study protocol for a randomized controlled trial. Trials, 171-12.

Lynn, Z., Matthew, S., & Cheryl, N. (2017). Case Conceptualization: Improving Understanding and Treatment with the Temporal/Contextual Model. Journal Of Mental Health Counseling, 39(3), 181-194

Milano, W., De Rosa, M., Milano, L., Riccio, A., Sanseverino, B., & Capasso, A. (2013). The Pharmacological Options in the Treatment of Eating Disorders. ISRN Pharmacology, 1-5.

Hansen, J. T. (2000). Psychoanalysis and Humanism: A Review and Critical Examination of Integrationist Efforts With Some Proposed Resolutions. Journal Of Counseling & Development, 78(1), 21-28.

Rohde, P., Stice, E., & Marti, C. N. (2015). Development and predictive effects of eating disorder risk factors during adolescence: Implications for prevention efforts. International Journal Of Eating Disorders, 48(2), 187-198.

Saleem, S., Mahmood, Z., & Naz, M. (2013). Mental Health Problems in University Students: A Prevalence Study. FWU Journal Of Social Sciences, 7(2), 124-130.

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Van Passel, B., Danner, U., Dingemans, A., van Furth, E., Sternheim, L., van Elburg, A., & ... Cath, D. (2016). Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial. BMC Psychiatry, 161-14.

Wagner, R., MacCaughelty, C., Rufino, K., Pack, T., Poplack, J., George, K., & Ruscitti, C. (2016). Effectivenes of a track-based model for treating eating disorders in a general psychiatric hospital. Bulletin Of The Menninger Clinic, 80(1), 49-59. 

Yalch, M. M., & Hopwood, C. J. (2016). Convergent, discriminant, and criterion validity of DSM–5 traits. Personality Disorders: Theory, Research, And Treatment, 7(4), 394-404.