FAR EASTERN UNIVERSITY - MANILA

Institute of Arts and Sciences | Department of Psychology | Undergraduate Studies

PSY 1207 | Abnormal Psychology

PSYCHOLOGICAL CASE STUDY/ANALYSIS

A. TITLE:
Case studies in Abnormal Psychology, 11th Edition
Eating Disorder: Anorexia Nervosa

B. REFERAL QUESTION:
At work, the patient's significant change in appearance has been noticed. At home, the patient's
parents are conscious noticing the odd eating patterns and extreme weight loss. The patient also
shows irascible behaviour when her eating habits are brought up.

C. CASE BACKGROUND:
Patients with anorexia nervosa restrict their caloric intake in accordance to their energy
requirements by eating fewer calories, engaging in excessive exercise, and/or eliminating meals
through the use of laxatives and vomiting. They are extremely underweight, yet they have
incorrect ideas about how their bodies should look. They may have issues as a result of vomiting
meals and becoming underweight. A history, physical examination, and lab testing are used to
make diagnoses and rule out other conditions that might be the source of the patient's weight
management.

Joan was a 38‐year‐old woman with a good job and family life. She lived with her second
husband, Mitch; her 16‐year‐old son, Charlie, from her first marriage; and her husband’s 18‐
year‐ old daughter from a previous marriage. Joan was employed as a secretary at a university,
and Mitch was a temporary federal employee. Joan was 5′3″ and weighed approximately 125
pounds. Although she was concerned about her weight, her current attitudes and behaviours
were much healthier than they had been a few years earlier, when she had been diagnosed with
anorexia nervosa. Joan had struggled with a serious eating disorder between the ages of 29 and
34. She was eventually hospitalized for 30 days. The treatment she received during that hospital
stay finally helped her overcome her eating disorder. Four years later, her condition continued
to be much improved.

In that the patient's eating issues started at the age of 29 years old, her situation was unusual. Her
parents over-protected her when her sibling passed away. She had a return to childhood when she
returned home following her divorce. However, by forbidding her from working, Patient's parents
may have added to her sense of inadequacy and ineffectiveness. Patient's parents diligently met
all of her demands.

D. DIAGNOSIS AND FINDINGS:

Diagnosis: Eating Disorder: Anorexia Nervosa
Subtype: Persistent Binge-eating/Purging type

Following what is written on the DSM-5-TR (2022, pp. 382), the patient meets most of the
criteria which categorizes her to having PTSD. The most prominent ones are as follows:

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 FAR EASTERN UNIVERSITY - MANILA
Institute of Arts and Sciences | Department of Psychology | Undergraduate Studies
PSY 1207 | Abnormal Psychology

a. She underwent a significant, self-inflicted weight reduction; she had a strong fear of
gaining weight; and she was unable to identify her real size or the gravity of her situation.
b. In addition to her severe restricted food intake. 
c. She also went through many of the physical side symptoms of fasting, including lanugo
(downy hair growth), lack of menstruation, skin changes, constipation, hypotension, fluid
retention, stomach aches.
Specify whether:
I. Binge-eating/Purging type:
Joan swung back to and forth between somewhat healthy eating behaviours’, intense
restriction, and binging and purging, making her life feel like a roller coaster. To get rid
of the meal, Joan took between 20 and 30 laxatives. She occasionally forced herself to
throw up by downing a toothbrush, yet she personally prefer to use laxatives. She binged once
or twice some weeks but not others. She simply ate a small amount of fruit and drank a
few beverages mostly on days in between binges. For the following 5 years, Joan's
eating issues persisted.
Specify if:
II. In full remission:
In the course of the treatment, Patient was able to adjust her eating habits and her
opinions on weight reduction and physical beauty as a result of this unsettling event.
With Mitch's help and the support of her family, she was able to keep a regular meal
schedule and eventually mustered the determination to leave the hospital after 30 days. In
just 6 more months of treatment, the patient is able to achieve an additional 15 pounds.
Specify severity:
III. Severe: BMI 15-15.99 kg/m2
For the course of 5 years, Patient’s eating issues persisted. During this time, with her
height 5’3 weight varied between 90 and 105 pounds. Patient would occasionally
consume a large quantity of food and afterwards try to get rid of the extra calories by
vomiting and using laxatives, in addition to existing rigorous dietary restrictions. She also
went through a variety of medical implications from symptoms of fasting, including
lanugo (downy hair growth), lack of menstruation, skin changes, constipation, low-blood
pressure, fluid retention, stomach aches.

DIFFERENT PERSPECTIVE RELATED TO THE CASE:

E. BIOLOGICAL PERSPECTIVE:
It originated as a weight loss strategy, with the decrease in brain storage caused by dietary
restriction significantly decreasing serotonin levels. As malnutrition worsens, the brain responds
by increasing the number of serotonin receptors (Tryptophan) in order to make better use of the
available serotonin, which is related with an increase in dopamine production. When serotonin
fluctuates, it promotes anxiety, hyperactivity, depression, and behavioural impulsivity.

 Patient's exhibits symptoms have anorexia nervosa such as increased activity patterns,

restlessness, prolonged exercise, and intense control over their nutrition, weight, and external
appearance with great pleasure.

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 FAR EASTERN UNIVERSITY - MANILA
Institute of Arts and Sciences | Department of Psychology | Undergraduate Studies
PSY 1207 | Abnormal Psychology

The brain also releases stress hormones known as corticotrophin-releasing hormone, mainly
in the hypothalamus. Because it triggers the production of adrenocorticotropic hormone from
the pituitary gland, corticotrophin-releasing hormone is also known by this name. The circulation
then carries adrenocorticotropic hormone to the adrenal cortex, where it triggers the release of
the stress-hormone cortisol. In this event, cortisol, acting as a glucocorticoid, enhances
gluconeogenesis, muffles resistive response, and promotes fat and protein absorption (de Weerth,
2017).
 This may be a factor in all of the symptoms the patient has whenever she experiences a
distressing episode related to her urge to fulfil self-imposed hunger and weight control.

F. PSYCHODYNAMIC PERSPECTIVE:
The patient had social discomfort, anxiety, and insecurity as a teenager continually towards being
an adult, Patient are lack strong relationships with others, and as a mother, they are more likely
to find it challenging to read her own child's social cues. As a result, the patient may experience
lack of emotional awareness, or alexithymia, which makes it difficult for them to adequately
describe their feelings.
G. BEHAVIORAL PERSPECTIVE:
Whether the patient engages in self-starvation, purging, alcohol use, dysfunctional sexual activity,
or other actions that are frequently characterized as obsessional, compliant, and emotionally
guarded, the behaviour of the patient may be viewed as abnormality-focused. In addition to a
restriction of interests, there is frequently an intensification of prior personality features including
increased anger, avoidance, and social disengagement.

H. COGNITIVE PERSPECTIVE:
When the patient's disorder initially appeared, (1) she mistook her internal urges and sensations
for a sign of strength, (2) believed she had no control over her life, and sought out extreme
control over her eating, her body size, and her outward appearance, feeling enormous pride in
having done so. Consequently, (3) incorrect ideas about what a body should appear like. As a
result, patients frequently only examined their own bodies. (4) The patient displays a dismissive
attitude while agreeing to join an eating disorders support group and even attending some
outpatient therapy sessions, largely in an effort to please her friends.

I. TREATMENT OR INTERVENTION PLANS:

1. Joan's treatment and intervention included some of these strategies. Under hospitalization, weight
restoration is required in order to both treat her starving symptoms and face her dreaded body
size. Along with Nutritional counselling this involves the following: Planning meals, keeping
track of your dietary choices. Once, there is an improvement in her physical condition.
2. Focusing on her mental state, clinical psychologists who intervened with the patient’s case used a
variety of psychotherapy approaches, with cognitive behavioural therapy (CBT) or a mix of CBT
and psychodynamic techniques being used most frequently to get her weight back to a healthy
level. Joan was treated individually rather than in a family therapy setting since she was older and
lived independently. Direct challenges were made to Joan's perspectives about the outside world
and herself. Such technique is as follows:

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 FAR EASTERN UNIVERSITY - MANILA
Institute of Arts and Sciences | Department of Psychology | Undergraduate Studies
PSY 1207 | Abnormal Psychology

3. To challenge the patient's conceptions of herself and her body and to spot harmful habits and
ideas that are impeding the course of therapy, cognitive restructuring will be endorsed. Several
exercises and tasks are utilized in cognitive remediation therapy (CRT) to assist overcome the
restrictive thought processes that are frequently linked to patient's anorexia nervosa. In
conjunction with the use of mindfulness in acceptance and commitment therapy (ACT).
4. As therapy progressing, Dialectical Behavioural Therapy (DBT) can be helpful for treating eating
disorders because it enables patient to handle conflict and stress better while gaining more control
over their negative thoughts and emotions. Coping strategies are formed to manage undesired
emotions like urges and distractions as well as to prevent negative thoughts from forming in order
to deal with overwhelming triggers and sensations. Relapse prevention attempts to help patients
put their newly acquired abilities to use in developing a relapse and recovery plan. Patients get
better at identifying relapse triggers as they get more used to the procedures they are taught.
Therefore, increase her confidence.

J. REFERENCES:
 Abnormal Psychology. (2017). Worth Publishers.
 American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders,
Text Revision Dsm-5-tr (5th Ed.). Amer Psychiatric Pub Inc.
 Oltmanns, T. F., & Martin, M. T. (2019). Case Studies in Abnormal Psychology (11th Ed.). Wiley.
 De Weerth, C. (2017). Do bacteria shape our development? Crosstalk between intestinal
microbiota and HPA axis. Neuroscience; Biobehavioral Reviews, 83, 458–471.
https://doi.org/10.1016/j.neubiorev.2017.09.016
 Eating Disorder Hope. (2022, July 29). Types of Treatment for Eating Disorders.
https://www.eatingdisorderhope.com/treatment-for-eating-disorders/types-of-treatments
 Haleem, D. J. (2012). Serotonin neurotransmission in anorexia nervosa. Behavioural
Pharmacology, 23(5 and 6), 478–495. https://doi.org/10.1097/fbp.0b013e328357440d