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Differential Diagnosis in a Patient: Anorexia Nervosa Case Study

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Updated: Jun 24th, 2022

Introduction

Julia displays clear signs of an eating disorder, most likely, anorexia nervosa. Among the symptoms that justify the primary diagnosis are excessive dieting, abnormally low body mass index (BMI), and anxiety about food and eating (American Psychiatric Association, 2013). From Julia’s and her roommate’s stories, it becomes apparent that throughout recent years, the patient has adopted unhealthy dietary habits such as reducing daily calorie intake and avoiding taking food in places where she could be scrutinized by others.

Moreover, Julia seems to have a distorted body image: even though she is underweight, so far, she has not been satisfied with the results of dieting and would like to continue. Objective nutrition facts such as the importance of the healthy balance of proteins, fats, and carbohydrates elude the patient completely. Julia’s obsession with dieting replaced her other interests and priorities. After being a devoted athlete, the girl took an indefinite hiatus from practice. The disorder took its toll on her academic achievements and motivation: she started to skip classes and struggled with assignments.

Differential Diagnosis

When deciding to diagnose a patient with a disorder as severe as anorexia nervosa, a professional should double-check and eliminate all other options based on the nationally recognized psychiatric standards. “DSM-5: Handbook of differential diagnosis” prescribes a therapist to take several steps before making conclusions. The first step is to avoid malingering and make sure that a patient is not pretending to be sick (First, 2013).

In Julia’s case, a professional has first-hand information from the girl’s roommate who has been observing her behavior for quite some time. Julia’s and the roommate’s stories are not contradictory; hence, it is safe to say that Julia is not lying.

Next, drug or substance abuse should be ruled out based on gathering information and conducting a physical examination (First, 2013). In the roommate’s story, Julia’s habits regarding substance intake are not mentioned. Moreover, the girl does not have any diseases that could trigger weight loss such as stomach upsets. Further, it is essential to determine the specific primary disorder. Since Julia’s destructive behavior is strongly related to food habits, one may contend that she suffers from an eating disorder. Out of all eating disorders described in DSM-5, her symptoms match those of anorexia nervosa.

It appears to be reasonable to assess the validity of the diagnosis using a sociocultural perspective. A therapist might want to determine which social groups Julia belongs to and whether these specific cohorts are at risk of developing an eating disorder.

First, female gender and young age may be predisposing factors (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). Second, living in the United States of America, she might have adopted the Western standards of beauty that glorify thinness. A study by Zipfel et al. (2015) showed that eating disorders are more prevalent in Western countries. Some other social factors might include stress from relocation and separation from the family when Julia started college.

Modern medicine and psychiatry offer a variety of options for treating anorexia nervosa. According to Zipfel et al., one of the evidence-based approaches is cognitive-behavioral therapy. From a cognitive-behavioral perspective, Julia’s disorder is an established set of unhealthy patterns that need to be addressed first. Thus, the girl and her family should work on correcting her nutrition habits and ensuring weight gain. Only after returning to a normal physical state can Julia work on her negative thoughts and body image. On the contrary, what is considered not evidence-based or effective in the case of anorexia nervosa is medication (Goff, 2016). It is argued that the complexity of the disorder does not allow for relying on pills.

The underlying reasons for anorexia nervosa can be easily misinterpreted since there seems to be a lot of myths and misconceptions about this eating disorder. From a fairly outdated and wrong historical perspective, Julia’s illness could be seen as strife for purity and chastity. For instance, in Christianity, many saints were famous and praised for their austerity and refusal to enjoy earthly delights such as food. Instead, they were committed to serving the Lord even though it meant changing their lifestyle radically.

Hence, Julia could be seen as someone who was doing soul-searching and experiencing spiritual growth. Another explanation from a historical perspective could be that Julia is possessed by demons, which accounts for her bizarre behavior and intrusive thoughts. It is easy to see how applying these perspectives would be not only useless but also dangerous.

Conclusion

As for theoretical orientations recognized by modern psychiatry, a strict behaviorist approach could be inappropriate. Anorexia nervosa is a disease that affects both body and mind, and it suffices not only to examine the actions of a patient without paying attention to their adopted though paradigms. The psychodynamic orientation seeking to find the roots of a disorder in child-parent conflicts and childhood traumas maybe not quite useful if misapplied. Exposing underlying reasons may be of great importance; however, merely concentrating on past events does not change the lived reality.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Publishing.

First, M. B. (2013). DSM-5: Handbook of differential diagnosis. Washington, DC: American Psychiatric Publishing.

Goff H. (2016). A Review of: Evidence based treatment for eating disorders: Children, adolescents, and adults (Eating disorders in the 21st century), 2nd ed., edited by Ida Dancyger and Victor Fornari and The Oxford handbook of child and adolescent eating disorders: Developmental perspectives, edited by James Lock. Journal of Child and Adolescent Psychopharmacology, 26(1), 84–87.

Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: Aetiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111.

Zipfel, S., Wild, B., Groß, G., Friederich, H. C., Teufel, M., Schellberg, D…. Burgmer, M. (2014). Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): Randomised controlled trial. The Lancet, 383(9912), 127-137.

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