Discussion: The Complexity of Eating Disorder Recovery in the Digital Age

The Case of Tiana

Intake Date: August 2019

DEMOGRAPHIC DATA: This was a voluntary intake for this 16-year-old single

African American female. Tiana lives with her family in New York City, where

she was born. She is currently in the 10th grade. Her dad works in the garment

district and her mom works for a major hotel as the front desk manager. Tiana has

an older brother and sister and one younger brother.

CHIEF COMPLAINT: “My mom wanted me to go to therapy. She thinks I

should be more social like my older sister was at this age. I do not agree. I can

handle my life. I am doing fine. My grades are good.”

HISTORY OF PRESENT ILLNESS: Tiana admitted to throwing up when she

overeats several times per week. She finds herself eating a lot of sweets when she

is under stress and is concerned about gaining weight. She found websites on the

Internet describing ways to keep her weight down. Tiana reports that she was

much heavier when younger and wants to confirm she doesn’t get like that again.

Her fear of gaining weight contributes to her not engaging in social interaction

with others. If her peers see what she eats, they may judge her so she chooses not

to socialize a lot.

Tiana reported that she is stressed in school trying to get good grades. She doesn’t

want to socialize, it makes her anxious and she needs to focus on her school. She

has attempted to attend school activities, but they just brought up a lot of anxiety

with all the students looking at each other. She thinks her behavior and anxiety

would be prominent. She did not mind attending parties as a young child but once

she got in her teen years, it became uncomfortable. Tiana noted that at times over

the past year she has very strange experiences of being overwhelmed with fear. A

couple of times when she tried to attend a social situation she began sweating and

had chest pains and chills. Reluctantly, Tiana admitted to bingeing to calm her

down from these episodes.

PAST PSYCHIATRIC HISTORY: Tiana denies any history of psychiatric

problems in the past. Tiana denies any alcohol or drug use.

MEDICAL HISTORY: Tiana is allergic to penicillin and has a lactose

intolerance. She wears glasses for reading.

PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Tiana’s parents

were married when her mother was 19-years-old. Tiana’s sister was born the

following year. Two years later, her brother was born. Tiana was born one year

after that, then 4 years later her younger brother was born. Tiana reports her

mother started worrying about her when she began high school. Tiana’s mother

said that Tiana began isolating. Tiana states she “adores her father” because he

was never the disciplinarian.

Tiana reports that when she was in junior high school, her maternal aunt, who was

dying of cancer, came to live with the family and this was very stressful for the

family. Tiana reports she was always an above-average student. She said she was

always very focused on school and wants to get into a good college. She is

concerned that she may move away to college and would have to connect with

people she does not know. This thought builds anxiety in her.

Currently, Tiana is friendly with a student that sits next to her in chemistry class.

She does not talk much about herself since she does not want her classmate to

know of her behaviors. Tiana works during summer vacation in the library. She

does not have to interact with many people in her work so this makes her

comfortable. Tiana also babysits.

MENTAL STATUS EXAMINATION: Tiana presented as a slightly overweight,

somewhat disheveled, African-American female. She was anxious during the

interview. Her facial expression was mobile. Her affect during the initial interview

was constricted and her mood dysphoric. Tiana’s speech was normal. Her thinking

was logical. Tiana denied hallucinations. She denied suicidal and homicidal

ideation.

Tiana was oriented to person, place, and time. Her fund of knowledge was

excellent for her age. Tiana was able to calculate serial sevens easily and

accurately. Tiana repeated 7 digits forward and 3 in reverse. Her recent and remote

memory was intact, and she recalled 3 items after five minutes. Tiana was able to

give appropriate interpretations for 3 of 3 proverbs. Her social and personal

judgment was appropriate. When asked how she sees herself in 5 years, Tiana

replied, “Hopefully graduating from college .” If Tiana could change something

about herself, she would “try to be more comfortable around people.”