- Explanation of Psychological Concepts
- Julia appears to be suffering from chronic depression otherwise known as dysthymia. As the narration unravels, it becomes clear that the girl also shows signs of anorexia nervosa – a mental disorder distinguished by an unhealthy low weight and destructive dietary patterns.
- Potential Disorders and Matching Symptoms
- Julia’s symptoms match those of persistent depressive disorder (dysthymia) DSM-5 300.4 (F34.1) and anorexia nervosa DSM-5 307.1 (F50.01) (F50.02). Such symptoms as low appetite, poor eating, insomnia, fatigue, and poor concentration justify the first diagnosis (Reynold & Kamphaus, 2013). As for the second diagnosis, distorted body image, excessive dieting, and weight loss explain the choice (American Psychiatric Association, 2013). DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) serves as the principal authority for diagnosis in the field of psychiatry.
- The Likelihood of Comorbidity
- In the case of Anorexia nervosa, comorbidity is considered the norm (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). It is safe to assume that Julia suffers both from the said eating disorder and persistent depressive disorder, and the two illnesses aggravate each other.
- Theoretical Orientations and Perspectives on Anorexia Nervosa
- Within the framework of the cognitive-behavioral approach, Julia’s illness may be described as a set of behavioral patterns. In psychoanalysis, resistance to food is linked to resistance to psychological and sexual maturation. From the historical perspective, such behavior could also be praised for the purity and “holiness.”
- Risk Factors: Age and Gender
- There has been found evidence that young and adolescent women are more susceptible to anorexia nervosa. Since Julia is a college-aged girl, she is at risk.
- Social Factors
- Among other factors is stress at school or work and critical comments about weight, shape, and eating habits (Machado, Gonçalves, Martins, Hoek, & Machado, 2014). Anorexia nervosa has also been found more prevalent in western countries due to the idealization of thinner bodies (Zipfel et al., 2015).
- Psychological Factors
- From the anamnesis, it is seen that Julia experienced parental pressure to succeed. Like many other people with anorexia nervosa, Julia showed signs of perfectionism.
- Biological Factors
- As for biological factors, anorexia nervosa is considered to be familial, and its heritability range is rather high – from 28% to 74% (Zipfel et al., 2015). There is not enough information about Julia’s sexuality; however, if she is bisexual, she is at risk (Shearer et al., 2015).
- Treatment for Anorexia Nervosa: Evidence-Based Practices
- Evidence-based practices for treating this mental disorder are primarily behavioral (Goff, 2016). First, a patient should change dietary habits and maintain a healthy weight. Addressing destructive thinking patterns is only possible when a patient is back to normal physically (Zipfel et al., 2014). Another evidence-based practice would be family-based therapy with the involvement of all the relatives whose opinions matter to the girl (Madden et al., 2015).
- Treatment for Anorexia Nervosa: Non-Evidence-Based Practices
- Non-evidence-based practices would include medication: no medications have been yet approved for treating anorexia nervosa (Goff, 2016). Julia could also try positive affirmations and coping strategies such as self-convincing.
- Treatment for Depression: Evidence-Based Practices
- Julia should retake her sports classes as physical activity was found to be relieving for depressed patients (Hallgren et al., 2015). Cognitive-behavioral therapy may also be of great use in treating chronic depression (Gautam, Jain, Gautam, Vahia, & Grover, 2017).
- Treatment for Depression: Non-Evidence Based Practices
- As in the case of anorexia nervosa, Julia could try to adopt positive thinking. She could check if daily affirmations work for her and stabilize her mood.
- Predicted Treatment Outcome
- Success in treating anorexia nervosa and depression is highly individualized, and the likelihood can only be predicted on a case-by-case basis. Julia shows mindfulness and awareness of the problem, so the expected outcome is positive.
DSM-5 serves as the principal authority for diagnosis in the field of psychiatry. Hence, further evaluation of the patient’s symptoms will be based on the theoretical framework provided in this guidebook. If the framework of DSM-5 is applied to Julia’s case, it is possible to point out numerous symptoms that justify the diagnosis of anorexia nervosa. First, her weight loss is self-induced and not caused by any other factors such as serious diseases.
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The patient shows clear signs of the body dysmorphic disorder: despite the significant weight loss, Julia is not satisfied with the result and plans to continue dieting. Lastly, both Julia and her roommate describe her avoidant behavioral patterns such as making excuses for not eating enough.
The humanistic approach outlines nuances deemed as negligible in behavioral therapy and seeks to establish underlying motives. Thus, Julia’s experiences show the need for self-actualization, as she matures. She may be devaluing her former life priorities such as studies and sports, especially if they were imposed by the family. The patient seems to be trying to take control of her life by controlling her body, even in the most radical ways. Humanistic therapy in Julia’s case will be based on respect, empathy, and comprehension of her motives.
American Psychiatric Association. (2013). Feeding and eating disorders. Web.
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice Guidelines for the management of Depression. Indian Journal of Psychiatry, 59(Suppl 1), S34-S50.
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.
Hallgren, M., Kraepelien, M., Lindefors, N., Zeebari, Z., Kaldo, V., & Forsell, Y. (2015). Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: Randomised controlled trial. The British Journal of Psychiatry, 207(3), 227-234.
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le Grange, D…. Touyz, S. (2015). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychological Medicine, 45(2), 415-427.
Machado, B. C., Gonçalves, S. F., Martins, C., Hoek, H. W., & Machado, P. P. (2014). Risk factors and antecedent life events in the development of anorexia nervosa: A Portuguese case‐control study. European Eating Disorders Review, 22(4), 243-251.
Shearer, A., Russon, J., Herres, J., Atte, T., Kodish, T., & Diamond, G. (2015). The relationship between disordered eating and sexuality amongst adolescents and young adults. Eating Behaviors, 19, 115-119.
Reynold, C. R., & Kamphaus, R. W. (2013). Persistent depressive disorder (Dysthymia). 300.4 (F34.1). Web.
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.