A Case Study on Eating Disorders and Depression
Kayleigh Turner
Liberty University
PSYC 620: Intervention and Behavior Support
Dr. Phillips
March 3, 2024
A Case Study on Eating Disorders and Depression
Mckinley, a 22-year-old college student has been on a strict diet that does not seem to stop. She
has never been overweight before and she has not secured any type of happiness from her new diet.
Mckinley’s dieting behaviors have made her more withdrawn, depressed, and anxious. Mckinley started
to exercise excessively to the point where people around her started to notice. While at school, she
stopped eating with her friends and spent most of her free time in her bedroom. Mckinley weighs out
her food to make sure she knows exactly how little she is eating, but to ensure that it is just enough to
keep her going. Mckinley has struggled with body dysmorphia ever since she started high school. She
began comparing herself to other girls and eventually started to feel fat, even though she was not. Due
to this, Mckinley began to hate herself and the way that she looked. She frequently talks down to herself
and is constantly degrading herself and her body image compared to her peers.
The longer that Mckinley has been doing this the worse she has become physically. She has
started to experience stomach pains, constipation, and fatigue, and even her hair has thinned out. All of
these symptoms she has been experiencing have made her mood fluctuate again, in full circle, has made
her withdrawn from her loved ones around her.
Clinical History
Mckinley comes from a divorced family with one older sister. Her parents went through a nasty divorce
while she was just starting out in high school. During this divorce, she and her older sister were always
put in the middle between their mother and father.
Her older sister was a senior in high school while Mckinley was starting out as a freshman.
Mckinley’s older sister hung out with all of the popular kids in school, went to all the football games,
dated the best guys, and went to all the best parties. Due to this, Mckinley’s grades began to slip, and
she started to not care about school or how she was doing academically. Whereas, in the past, Mckinley
never got any grade lower than a B and always was so intrigued to learn more from her teachers.
Occupational History
In high school, Mckinley worked at a retail store as a cashier. In her retail job, she was exposed
to many different fashion trends throughout her time in high school. While working here it also gave her
exposure to other girls she felt looked so much “better” than her at the time. Once she graduated and
went to college, Mckinley began to work part-time at the local tanning salon in her college town. Again,
working at this job gave her access to see “perfect girls” who were tan and always looked put together.
Every time she went to work she would compare herself to all of the girls who came into tan her entire
shift.
Family Psychiatric History
Mckinley’s mother suffers from these similar symptoms that Mckinley has been experiencing for
a few years now. Her mother’s symptoms first started in the eighth grade when she realized that girls
her age were starting to change and act older due to the fact that they were about to go into high
school. The reason Mckinley’s mother noticed this is because she was far from that. She still wore
clothes that made her look like a child, she was interested in school rather than being interested in boys
like the other girls, and she was completely fine with staying home on the weekends rather than going
out to parties constantly. These symptoms followed her mother with going through the divorce with
Mckinley’s father. Mckinley’s father ultimately cheated on her mother which led to the divorce. This has
created more sadness and comparative behaviors in her mother’s life. Due to all of this, Mckinley’s
mother has been put on medication in order to help her cope with these life situations as well as she has
attended therapy following the divorce.
Patient Psychiatric History
When Mckinley started to feel these emotions and physical changes, she went to her mother to
let her know that she would like to speak with a therapist. Throughout high school, Mckinley
occasionally saw a therapist and while it helped a little bit, she still experienced her specific eating
behaviors that affected her weight and health. However, once Mckinley went to college and was away
from home, going to school, and working part-time she stopped going to therapy. By doing this, it has
made all of Mckinley’s symptoms much worse.
Family and Social Relationships
Mckinley has had one serious boyfriend throughout her life. They met when she first started
going to college. At first, their relationship was going perfect, he would open doors for her, bring her
flowers randomly, and always wanted to be with her. However, the longer that they were together he
started to pick up on the symptoms that Mckinley was experiencing. He started to notice how she would
rarely ever eat in front of him and when she did eat it was in extremely small amounts. He noticed that
she became closed off towards her friends and family and never wanted to do anything in groups like
bowling or movie nights, instead she would always want to stay at home or even lay in her bed.
Mckinley’s boyfriend noticed her mood changing throughout the course of their relationship. On certain
days she would be extremely happy and just like the Mckinley she was when they first started dating,
but on other days she would have no emotion, seemed irritated, and was very sluggish. Mckinley started
to become extremely insecure in their relationship and her boyfriend started to even notice how
insecure she was within herself. She started to compare herself to all of her boyfriend’s friends who
were women, which started to irritate her boyfriend. It got so bad that eventually Mckinley’s boyfriend
could not take it anymore and ended up breaking up with her. This ultimately led Mckinley down an
even worse pattern of behavior that she has been experiencing since early high school. As for her
friends, with her being so distant and standing off towards them she started to lose friends from high
school. Eventually, her high school friends stopped asking her to go to dinner, go to the mall, or just to a
movie night. Once Mckinley got to college it was a little bit easier to make friends, but she has still never
really had close relationships due to her behavior of being distant, withdrawn, moody, and obsessive
over the way that she looked compared to her friends.
Life Stressors and Future Goals
With Mckinley being in college and about to graduate as well, one of the biggest life stressors
for her right now is what her life is going to look like after college. She has been concerned about where
she is going to live, what job she is going to have, and how to become a full-on adult in the real world
compared to her life now in college. Another stressor within Mckinley’s life is her parents. Their
relationship and issues have taken a significant toll on Mckinley with her always feeling as if she is in the
middle. They are constantly talking bad about one another to her making her feel as if she needs to take
sides. Mckinley struggles with not wanting to disappoint the other parent if she has a great relationship
with each of them. This has begun to lead to a significant stressor in her life, even with her being away
at college.
While Mckinley has been in college, she has been working towards getting her bachelor’s degree
in interior design. Her dream is to work with decorating homes for people. She has always loved
different home trends and would love to give back to the people around her. She hopes to move to a
different state in order to experience different people and start over in a new area, just like she did in
college.
Living Arrangements
Mckinley currently lives on her own in an apartment right outside of her college campus. She
used to live in a house with three other roommates, but once her symptoms started to increase it was
harder for her to be in the house. She always felt out of place when she lived with the other girls like she
never truly belonged. She even would compare herself to the girls she was living with, wishing she
looked more like them, and would try to lose weight in order to do so. Mckinley felt it was in her best
interest to move out and live on her own in hopes that some of these feelings would go away. However,
this only secluded Mckinley even more. All she could think about were the girls around her and how
prettier and skinnier they were compared to her in her eyes.
Diagnoses
Depressive Disorder
Depressive disorder can be described as the presence of sad, empty, or irritable mood that is
accompanied by related changes that significantly affect the individual’s capacity to function in their
day-to-day life (Barlow, 2021). After reviewing Mckinley’s case and speaking with her she exhibits
several symptoms that make her eligible for the criteria of Major Depressive Disorder. According to the
DSM-V, a patient needs to exhibit five (or more) symptoms within two weeks. Mckinley meets the
following criteria according to the DSM-V: A. Depressive mood most of the day and nearly every day B.
Markedly diminished interest or pleasure in all or most activities for most of the day almost every day C.
Decrease or increase in appetite nearly every day D. Fatigue or loss of energy nearly every day and lastly,
E. Feelings of worthless nearly every day (American Psychiatric Association, 2013).
Mckinley exhibits the first criterion due to the fact that she has a pretty constant feeling of
sadness or as if she is empty. She tends to feel this way when she looks in the mirror as well as when she
sees other women who she compares herself to. The second criterion is exhibited by Mckinley since she
has been struggling with being withdrawn from her family and friends. She rarely ever wants to hang out
with the people around her. She also has recently shown less interest in school given her constant
feeling of sadness. The third criterion is expressed by Mckinley’s decrease in her appetite with rarely
eating and when she does eat she is eating extremely small amounts. When all Mckinley wants to do is
stay in bed and sleep constantly she is exhibiting her fourth criterion for major depressive disorder
according to the DSM-V. Nearly every day Mckinley compares herself to individuals around her whether
it be during class, working at the tanning salon, or even with her friends or the people she lives with.
This ultimately reveals her fifth criterion in order to diagnose her with major depressive disorder.
Mckinley meets the criterion of two weeks given that she has been portraying these emotions and
behaviors for several years at this point.
Eating Disorder – Anorexia Nervosa
An eating disorder can be described as a persistent disturbance of eating or eating-related
behavior that results in the altered consumption or absorption of food that significantly impairs
psychosocial functioning or physical health (Barlow, 2021). After reviewing Mckinley’s case and speaking
with her she exhibits several symptoms that make her eligible for the criteria of an eating disorder
specifically anorexia nervosa. According to the DSM-V, Mckinley meets the following criteria for
anorexia nervosa: A. Restriction of energy intake relative to requirements leading to significantly low
body weight B. Intense fear of gaining weight or becoming fat even though one is significantly low in
weight C. Disturbance in the way in which one’s body weight or shape on self-evaluation with lack of
recognition of the severity of how low the body weight currently is. Along with this, it can be specified
that Mckinley exhibits the F50.01 Restricting type of anorexia nervosa which is: During the last 3 months
the individual presents weight loss through dieting, fasting, or excessive exercise (American Psychiatric
Association, 2013).
Mckinley demonstrates criterion A due to the fact that she restricts the food that goes into her
body. She is very selective and careful with specifically how much she takes in. Due to this, Mckinley has
experienced significant low body weight that looks less than minimally normal. Criterion B is portrayed
given that Mckinley is always fearing how she looks in the mirror and also the way her body looks
compared to other girls her age. She is scared of being “fat” therefore she does not eat in order to stay
the way she thinks she should look. Mckinley exhibits criterion C because she is constantly degrading
herself and the way that she looks. She continuously cannot see that she physically looks unhealthy, she
continues to do extreme diets and restrict herself. To her, it is never enough. Everyone around Mckinley
has expressed concern for her wellbeing, essentially due to how unhealthy she appears, yet Mckinley
cannot see it for herself. In particular, Mckinley can be diagnosed with the F50.01 restricting type for
several reasons. One reason being that her behavior has lasted for the past three months and even
longer. Mckinley has been experiencing these behaviors since she was in high school, and it has
continued with her now. The second reason is that Mckinley has been dieting for a little bit now, trying
to take in as little nutrition as she possibly can. Sometimes, Mckinley will even fast depending on who
she is around at the time. If she is around girls that she starts comparing herself to, then she will not eat
in front of them. Lastly, as stated previously, Mckinley has been exercising excessively within the past
three months compared to what she has done in the past. Mckinley has never really been the type to
exercise, however with being back at college she has been feeling like she needs to now more than ever.
Rationale
The cognitive-behavioral approach is the course of treatment that will include therapy sessions
for Mckinley to develop cognitive-behavioral coping mechanisms in order to help guide her treat her
eating disorder of anorexia nervosa as well as her major depressive disorder. With this treatment, there
are several steps that Mckinley will have to work through her anorexia nervosa. Step 1: Help Mckinley
engage in the treatment and allow for the creation of a summary of what is to be accepted during these
treatment sessions such as addressing weight concerns and showing normal eating habits. Step 2:
Mckinley takes stock to review her process for this treatment as well as prepping for entering step 3.
Step 3: Mckinley will be entering the main section for her treatment. In this step body image, dietary
restrictions, and moods/events/eating will be addressed in order to help Mckinley work through these
barriers. Step 4: This is the final stage of Mckinley’s treatment. This step will focus positively on her
future to where the implemented changes stay as well as a decrease chance for Mckinley to relapse with
her disorders.
Once these have been completed, Mckinley will work through her major depressive disorder.
There are three different phases that Mckinley must go through for this treatment. Phase 1: Similar to
her anorexia nervosa treatment, Mckinley will discuss and review the symptoms that she has been
experiencing. Mckinley will also begin to discuss the goals that she wants to achieve throughout the
whole process as well as the strategies for how it will help guide her to do so. Phase 2: During this
treatment phase, Mckinley will begin to get into the main focus of what is causing her to feel the
emotions that she has been feeling. The goal of these sessions is to work on working out the problem at
hand. Phase 3: This is the last and final stage where Mckinley will be reviewed on her progress and
symptom improvement. By doing this, it allows for reassurance to Mckinley about all that she has
accomplished throughout her sessions.
In a study conducted at the University of Zagreb, researchers examined the association between
psychological resilience and depression with the presence and intensity of anorexia nervosa symptoms
and the nature between them (Beroš et al., 2021). This study is significant to Mckinley’s treatment given
that anorexia is a distorted image of the body. When Mckinley goes through the third step of her first
treatment sessions it will allow for her to gain confidence within herself and her appearance as a whole
for the beautiful person that she is.
In a study conducted at the University of South Alabama, researchers examined the relationship
between food insecurity and eating disorder risk independent of co-occurring anxiety and depression
(Zickgraf et al., 2022). This study is significant to Mckinley’s treatment when it comes to her recognizing
how her weight concerns have fed into her depressive state. According to this study, food insecurity is
commonly associated with many issues such as poor diet, poor physical and mental health, and low
academic performance or disruptions (Zickgraf et al., 2022). All of these are areas that Mckinley needs
to focus to work on within her treatment sessions not only for her anorexia nervosa but for her major
depressive disorder as well.
Anorexia nervosa and major depressive disorder symptoms overlap frequently when it comes to
the behaviors and emotions that an individual may feel throughout their day-to-day activities.
Therefore, Mckinley’s treatment plan will incorporate aspects for treating both with the same treatment
activities or options.
Treatment Protocol
Eating Disorder – Anorexia Nervosa
Stage 1: This beginning session will take about 4 hours long and will last for 2 sessions. This stage
has four goals to accomplish with Mckinley. Mckinley will be engaged with starting treatment in order to
help with her anorexia nervosa. It can be extremely hard for a person who experiences these disorders
to be willing to seek help in overcoming them, therefore this step is essential to the process. In order to
engage Mckinley in this process, it will take explaining of the treatment and why it is being done. During
this stage, Mckinley will self-reflect on what she has been experiencing and highlighting the main
mechanisms that need to be addressed throughout her treatment. Stage 2: This stage will continue for
20 sessions. Mckinley will create her “self-monitoring chart”. This chart is essential to the progress
because it will track everything that Mckinley eats, drinks, and what is going on at the time. This will
allow Mckinley to become aware of the nature of her eating problem. The self-monitoring chart will be
completed every day and will be discussed during each session. Mckinley will review her progress from
her last session. Her treatment will then be reassessed to see if any changes need to be made. Stage 3:
During each of the twenty sessions, Mckinley will begin addressing her key mechanisms of evaluation of
weight and shape, dietary restrictions, and her mood-related changes. During this session, Mckinley’s
body checking, self-evaluation, “feeling fat”, and mood changes will be addressed and examined. Stage
4: This will be Mckinley’s final two sessions that will essentially go over the positive changes and the full
progress that she has made with her anorexia nervosa. She will review her information from the first
two sessions and compare it to how she feels now after completing the full twenty sessions. This will
allow for reassurance and a way for Mckinley to feel accomplished in all of her hard work. After this,
Mckinley will make a list to hold herself accountable for what she will continue to do to better herself
with self-esteem, getting better nutrition into her system, and how she is currently feeling throughout
the day.
Major Depressive Disorder
Phase 1: During the first three sessions, Mckinley will begin to review the symptoms that she has
been experiencing. An example of this would be her sadness when she begins to compare herself to
other girls around her or her loneliness and loss of interest when all Mckinley wants to do is lay in bed
all day long. Once this has been accomplished, Mckinley will begin to discuss, focus on, and write down
her goals and strategies for her treatment. It is better for Mckinley to write down their overall goals that
way once the treatment has been completed, she will be able to go back and look at their progress.
Phase 2: During sessions four through nine, Mckinley will start off the session by answering how she has
felt since the last session concluded. This will help gain knowledge of the progress from session to
session. During these sessions, Mckinley will “Role Play” potential interactions that she may have with
the people around her. This will allow Mckinley to figure out how to overcome her behaviors and
emotions depending on different situations. It is beneficial to role play because it acts as a practice to
overcome when these situations happen in real life. Mckinley will also use the self-monitoring chart in
order to track her emotions throughout the week from session to session. This will allow her to see the
progress she is making as she is going through the treatment. Mckinley is already completing this for her
anorexia nervosa treatment, therefore it will become easier for her to follow this chart for both
treatment protocols. Phase 3: During sessions ten through twelve, Mckinley will be reviewed on the
progress that she has made throughout the entirety of the treatment protocol. Mckinley’s self-esteem
during these sessions should look completely different compared to how she felt during the initial three
sessions of her treatment. To conclude her treatment, Mckinley will be told that while life constantly
throws stressors and situations that may cause relapse, this is a constant battle, but ultimately she has
been given coping mechanisms in order to help her navigate her way through challenges that may come
her way.
Discussion
Mckinley sought to seek help regarding her behaviors and emotions that she has been
expressing for a while now. Her symptoms have gotten worse with her nutrition, self-evaluation of
weight, comparison to other girls, excessive exercise, and her emotional moods. She has been very
withdrawn from the people around her and has come to the realization that something needs to
change. Mckinley’s anorexia nervosa was first addressed given that that has the most impact on her
physical health. In order for Mckinley to fully tackle her major depressive disorder she needed to be
physically well or on the mend. Mckinley monitored her eating, drinking, and feelings throughout the
sessions which allowed for the realization of progress with her getting better. Additionally, Mckinley
used similar treatments when it came to her major depressive disorder. As stated before, anorexia
nervosa and major depressive disorder exhibit similar symptoms and go hand in hand making it easy to
use treatments that overlap, such as the self-monitoring chart.
Mckinley completed both treatments extremely well, coming out on top and winning over her
disorders. While these are continuous battles that Mckinley is going to face throughout her life, she now
has the tools and coping mechanisms to help guide and support her when it is essential.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). https://doi.org/10.1176/appi.books.9780890425596
Barlow, D. H. (2021). Clinical handbook of psychological disorders: A step-by-step treatment
manual, 6th ed. New York, NY: The Guilford Press
Beroš, K., Brajković, L., Kopilaš, V., (2021). Psychological resilience and depression in women with
anorexia nervosa. Mediterranean Journal of Clinical Psychology, 9(1).
http://doi.org/10.6092/2282-1619/mjcp-2662
Zickgraf, H. F., Hazzard, V. M., & O’Connor, S. M. (2022). Food insecurity is associated with eating
disorders independent of depression and anxiety: Findings from the 2020–2021 Healthy Minds
Study. International Journal of Eating Disorders, 55(3), 354–361.
https://doi.org/10.1002/eat.23668
