Psycological_Disorder_Analysis

Psychological Disorder Analysis PSY/240 Marla is a 42 year old female who is experiencing trouble sleeping, inability to concentrate, sees herself as fat and ugly and as of lately feeling jumpy all of the time. It is now affecting her work and personal life. She is noticing she is becoming agitated because she cannot lose any more weight, lonesome because she cannot go out with her family due to not being able to eat and purge herself, misunderstood by all and feeling more hopeless. She acknowledges she has good days and some bad days. She states she finds comfort in food but then once she eats she feels fat and gross. She admits to binging and then purging. She thinks of food all day and dreams of eating. She eats secretly all day then purges at least two times a day. She states she had been very heavy as a child and young adult and that she had tried many different diets throughout her life, none of which had brought off the weight till she began to purge herself. She states she was in her early 30’s when she started purging herself. Interviewing Marla is the next step of my process to diagnose her. To keep Marla relaxed I am going to proceed with my interview in a friendly nature to which she is responding to very well. “Marla, I need to ask you some questions. I will understand if you feel that I am prying, but the questions I will ask will help me figure out your problem as in, what is your diagnosis, where did it develop from, how it does affect you, and how we will treat it'” Marla, shifts in her seat many times while I spoke, I note that she is still feeling uneasy. She acknowledges she understands and is agreeable. “Ok, here we go. We will start with your childhood. Can you tell me about what type of person your father was and how was your relationship to him'” Marla smiles, “My father was a very nice man but rarely home. He worked much of the time. I never saw him much unless I stayed up late at night to catch him before he went to bed. I would stay up long enough for my father to eat his supper and I would get milk and cookies.” “Do you feel that the late night snacks had a hand in to your weight problem'” She begins looking downward at her clasped hands in her lap. “I think now that my late night snack began my weight problem but I also ate a lot. My family was big eaters.” Making a note that Marla’s family history with food was excessive. “What about your mother' Tell me about her and your relationship with her'”Marla smiles weakly. “She was always cooking and cleaning. She took in laundry to help bring in money. Our home always smelled like starch. She never talked much to me unless she had to until we sat down for our meals. It was family times she said. She passed away when I was eight. She was always making cookies, and big meals. She died from a heart attack because she was overweight and had high blood pressure. ” I write down that Marla’s family let food be a center piece for them. I note that Marla’s mother had high blood pressure which was likely from high sodium intake and being overweight. I see the sadness in Marla now; I note that her mother’s death has left an emotional scar which may have donated to her eating problem. “Do you have any brothers or sisters'” She shook her head yes and stated she no longer have contact with them because she is afraid one will judge her for purging. “Ok everyone has one big memory from his or her childhood. Some has more than one. I actually have two. One was good, which was when my brother bought me a puppy, and the other was bad. I fell while running down our road and busted both knees. It hurt very badly.” Marla is listening intently, no longer shifting in her seat. “What is your most memorable event as a child'” Marla expression tells me she is thinking back to her childhood. “Oh I have a bad one and a good one too. Once when I was 9, I was left home alone for two days. I was so scared. I had no clue where my father was, and no other family to call. We lived in a bad neighborhood so I was afraid to go outside for anything. There was only some crackers to eat and water to drink. I was so relieved when my father came home. He started to drink after my mom past away. That was the only time though he ever left me home alone like that. But when he came home he fixed us a large supper and we sat and eat till we were stuffed. After that we always had big meals and we talked about my mom, as in how much we missed her or the fun we had.” I note that Marla bad memory was abandonment. She was left alone with no supervision, no proper food, and her mother was dead. A serious problem for a young child. Marla smiles, “My good memory is when my father and mother worked together with me on a tree house in our backyard. It was good because we all were happy and no one was mad or upset. We all camped out in it when it was finished.” “I loved camping when I was a child it was so fun”. I try to keep Marla from becoming upset from thinking of her mother. “Do you have memories that are good of school'” She smiles, “I was a good student in school. I did not have friends like everyone else, I knew I was going to school to learn, not make friends. I won many spelling bees and awards in school till I got in high school. I was picked on a lot. I wasn’t popular; I was the dork, the fat dork. I tried to fit in after a while by failing classes so I wouldn’t seem to be such a dork. I tried to dress cool but fat does not look good in some cloths. It didn’t help. So I would push through the day at school, keeping to myself, and then get home fast as possible. When someone was nice to me at school I was afraid they were just up to something, and I was usually right.” I wrote down how she was treated in school. She was put through peer pressure; not having friends shows a social conflict. “Marla, now, the fun part. Girl gossip.” I laugh a little bit and Marla smiles more. “I think I have the greatest husband at times because he will pick me wildflowers for no reason. He’s a sweetheart. But then again there is times he makes me mad. He won’t clean up after his self.” Marla giggles and looks down at her hands again, still with a smile. “Do you have a husband or boyfriend' If yes, can you tell me about your relationships or can you tell me about any past romantic relationships you have had'” Marla begins to frown. “I once had a boyfriend but it didn’t work out. He said I was too worried about being fat and I was too jealous. I saw how he looked at the skinny women.” I note she admitted to being jealous of the skinny women and that her relationship had failed because of her obsession with her weight. “Marla can you tell me what makes you happy right now'” She shrugs and looks down at her hands again, “I love food, so I can only think of foods that make me happy.” “Marla can you tell me what makes you upset in your life as of now'” She states that food makes her happy and the purging does not. She does not like the fact that is all she ever gets done. I note that Marla is not happy with eating and purging. “Marla I am almost done now. I want to know about dreams you have. Do you fantasize about something or someone'” Marla is shifting in her seat once again. “I feel more tired of lately, but when I sleep I dream about food and being skinny. I have had the same dream for years now, of becoming skinny, and having a wonderful husband.” I note that Marla dreams of food as well. “Marla, can you see down the road from now' Do you see yourself getting better, living a normal life and perhaps having a family'” Marla shifted again in her seat, “I don’t know what I am going to be like down the road from now. I maybe better with help. I want to be better but I don’t know how. I don’t know if anyone can help me. I want to be a healthy weight and not have to purge myself to do so.” I note how she wants to end the cycle of eating and purging. This is positive. I note that she does not think anyone can help her. “Marla, I want you to now think of me as a friend and I want to help you. I am going to set you up with the best care possible to help you get past your problem.” Marla smiles, “So I do have a problem'” “Yes, you are suffering from bulimia nervosa which is an eating disorder. It will take time and work to overcome this, but we can do this and you can maintain a healthy weight which you will feel better. You’re a beautiful woman with a great future ahead. Until your next appointment I want you to try to eat three times a day and instead of purging I want you to take a walk with your family. If one speaks of your problem tell them about it and that you are now getting help. They will support you.” Marla is smiling and agrees. Marla’s eating problem stemmed from her childhood. Her family life was centered on food. She has found comfort in food so she eat. Eating obsessively lead her to weight gain. As a student she dealt with peer pressure and was tormented by other because of her ability to make good grades and because of her weight. She consoled herself with food. As Marla became an adult she could not hold a relationship because of fixation on her weight. She entered her 30’s and began to purge after binge eating. She is now seeking help. To treat Marla’s eating disorder I will order lab work to check her blood pressure and heart health. Mentally she is not showing any severe mental illness. She can think and function normally except when it comes to food and her weight. Possible underlying depression maybe adding to her problem since she had to deal with her mother’s death at a young age, peer pressure and rejections in society and personal relationships. First step is getting Marla exams completed by a team that consist of her physician, nutritionist, and a therapist. They can help Marla develop a care plan that will be tailored to her needs. One short term goal will be to return Marla to a normal, regular eating pattern and to address any form of malnutrition she may have. A long term plan will be to not relapse. Associated psychological and social issues will be address at this point. Marla may be prescribed a medication to reduce the obsession compulsive behavior to eliminate the cycle of binging and purging. She may also be suffering from depression in which medication can help relieve. Tricycle antidepressant can reduce both behavior problems of binging and purging. I think that Psychotherapy can be helpful as well. Marla can have positive results from cognitive behavioral therapy to help her redirect her thought from food to something healthier such as exercise. Interpersonal therapy will help her explore the role of personal relationships in getting and keeping a healthy eating perspective.