Eating Ms Duval Attempts example essay topic

Background and Reason for Visit: The patient, Nancy Lee Duval, is a 23 year old female who was admitted to a program for eating disorders at a research facility for eating disorders. Ms. Duval was admitted after writing a letter of request describing her eating patterns. Ms. Duval attended college, however was unable to graduate and dropped out midway through at age 21. There are no reports of previous psychotherapy, however Ms. Duval mentioned several instances of going to the infirmary because of dehydration. Ms. Duval is the second of four children and the only girl.

Ms. Duval reports difficulties between her parents and her brothers and her parents. There are some indications that Ms. Duval's father may have a history of alcoholism. The other family members have no history of psychological treatment. It is reported that Ms. Duval's family refuses to support her efforts in obtaining psychological treatment. Case Formulation: Ms. Duval reports that her eating problems began at the age of 14, however did not become severe until the past three to four years. When Ms. Duval began college she reports that she began using laxatives to lose weight.

Her condition worsened and after two years she was using 250-300 laxatives at one time. She would not eat for days and then consume large quantities of food and then purge to prevent weight gain. She reports, at times she would not drink water for days in fear of gaining weight. She began to exhibit symptoms such as hair loss, loose teeth, fatigue, amenorrhea, and weakness to the point of not being able to walk.

Subsequently, she stopped using laxatives however began exercising for hours each day. Although Ms. Duval attempted to exercise, at times she would become so weak and dizzy she could not. More recently Ms. Duval read an article on anorexia nervosa and was inspired to become healthy again. She studied nutrition and was able to force herself to eat a health balanced diet. Ms. Duval currently eats a rigid diet with the least amount of calories. She reports that she can not eat sweets, fatty foods, or pastas without becoming sick.

Her lowest weight at height 5'6" was 88 lbs and she is currently 105-115 lbs. Ms. Duval wrote a letter to the research facility in search of professional help into the understanding and nature of her eating patterns. Ms. Duval's symptoms and behaviors portray the use of several defense mechanisms. Ms. Duval's use of turning against the self is evident by her destructive eating patterns. The nature of her defense may stem from her relationship with her mother and father.

It was reported that her parents often had disagreements and most likely did not have a satisfactory relationship. Subsequently perhaps the parents in search of emotional support, were over involved in Ms. Duval's life, sharing her experiences as their own. In efforts to gain control of the relationship and of her life, she turned her feelings of being powerless and ineffective towards herself. Her parents intrusive relationship with Ms. Duval created a feeling of the self as separate from the body. As a result, Ms. Duval took control of her eating behaviors in attempts to develop a sense of her self, the body, and its effectiveness. Similarly, the use of undoing is evident by her using her eating behaviors as a way to abolish or control her past experiences or unacceptable thoughts.

Perhaps because of the relationship and dynamics in her family she was "used" rather than seen as a person of her own with feelings, wants, and needs. This can give rise to many feels of which may be deemed unacceptable such as anger, sadness, rage, hurt, ineffectiveness, meaningless, and depression. By using eating or not eating Ms. Duval attempts to get ride of her feelings, unacceptable feelings or thoughts, and mask her past experiences. In addition, it is possible that Ms. Duval feels guilt or shame in her achievements due to her role in the family.

It may be that she was experienced by the parents as the "good child" or the one who they tried to experience their own life through. As a result, her need to be the best and achieve great things may be followed by guilt or shame in her shortcomings. Ms. Duval's eating patterns may be an attempts to erase those feelings and become someone or something that is special and unique. In addition, Ms. Duval exhibits behaviors of denial. Her battle with her weight and her inability to see the significance that it has in her life highlights this defense. Initially, Ms. Duval did not believe she had a problem and was in denial of being underweight.

Although Ms. Duval has shown growth in this defense mechanism and has been able to seek out treatment it is also important to remember that most people with an eating disorder recover and have a relapse. Her ability now to see her problem may be followed by full denial of her situation. It is apparent that Ms. Duval still struggles with her denial in that she can not understand her cognitive distortions. Her ridged eating habits, her feeling of hatred, and being frightened portray parts of her denial. Similar to denial, Ms. Duval used aspects of rationalization in order to support her eating habits. She reports thinking " I can face people when I lose only a few more pounds".

While denial is more of a primitive defense it is likely that initially this defense was used more as opposed to her current status. Currently it is likely that she uses more of rationalization than denial in order to explain her rigid diet and the decisions she makes regarding her eating patterns. In addition, she may rationalize not finishing school in order to "get healthy" when really she fears social situations, being evaluated by others, not being able to achieve all A's (i.e. not being perfect), or her possible failure at becoming unique and special through graduating from college. While at the height of her illness, Ms. Duval isolated herself from friends, boys, school, and the public. She was unable to make decisions and concentrate.

She felt as if she could not see anyone until she "lost a few more pounds". In addition she used the defense of isolation to isolate feeling from knowing. In the past, Ms. Duval performed her eating rituals or patterns without awareness of the feelings associated with it. While it can be assumed that her bouts of binging and purging were attached to heightened emotions, her periods of food restriction were not. She was unable to feel or understand the ways in which her actions and beliefs were detrimental to her life. It is likely that Ms. Duval has anorexia nervosa, binge purging type based on the reported symptoms, the behaviors, defense mechanisms, and the marked distress it has caused in her life.

Ms. Duval has reportedly been obsessed with her weight from an early age however, it did not become a problem until about the age of 17 or 18, the average age onset of the illness. Ms. Duval is unable to maintain a minimum body weight for her height, even currently when she has begun to eat a healthy regimen. In addition, Ms. Duval did not menstruated for 2 years. Although Ms. Duval does not meet the criteria of serious denial of low weight her marked symptoms and behaviors currently and in the past qualify her for the diagnosis. In addition, Ms. Duval is not currently healthy and considered to be in remission of her illness thus requiring the diagnosis. It is requested the Ms. Duval receives a complete medical exam due to the nature of her illness.

Treatment should begin by restoration of eating in attempts to gain weight. Ms. Duval has already made progress in this area, however she reports eating as few calories as possible and still maintaining an abnormally low weight for her height. Once this has been accomplished, the next step is psychodynamic psychotherapy. It is likely that treatment will be long term as the underlying conflicts, object relations, and defense mechanisms must be addressed to fully conquer the illness. The technique of supportive-expressive therapy should be used to help Ms. Duval understand her feelings, what they mean to her, that they are normal and acceptable, her decisions are her own and are validated.

These key concepts are important in the beginning of treatment. Ms. Duval likely suffers from an underdeveloped ego and building up her ego will be essential to progressive therapy and examining her cognitive distortions. It is suggested that family therapy occur however Ms. Duval's parents have stated they do not support her in seeking psychological treatment and family therapy is thus unlikely. It is possible that Ms. Duval suffers from depression, as she reports feelings of depression earlier in life, and should be explored in the therapeutic process. In addition, due the nature of her illness the possibility of obsessive-compulsive disorder or personality should be explored as well. It is of interest the dyadic relationship between Ms. Duval and her mother.

Typically the relationship between the mother and child early in development has often led to the development of anorexia nervosa. Ms. Duval did not report on her relationship and thus it would be essential to explore this topic in therapy. It can be hypothesized the during the anal stages when the Ms. Duval was attempting to go out on her own while looking for the reassurance and support from her mother, she did not get it. Ms. Duval's mother did not give her the reassurance and acceptance of her own independence that she needed.

Ms. Duval was unable to form as sense of her own self or sense of her own body separate from her mothers. She was not made to feel that she was acceptable, special, or unique as an independent being thus making Ms. Duval feel inadequate, ineffective, and but a mere extension of her mother. Perhaps in her attempts to feel unique or special and be validated as that, she used her eating habits to achieve this. From an object relations point of view, it may be seen that Ms. Duval viewed her mother as "all bad" and because she was an extension of her mother she to must be bad and in attempts to "kill" the bad parts she deprived her body.

In addition, the role that men play in her life is interesting in that her social anxiety is increased around them. Her anxiety was so severe at one point that she had to change to an all girls school. It is interesting that her social anxiety is more so around men then women. Perhaps her low self-esteem and the feeling of not being attractive plays a large part. In addition it may be hypothesized that because her dad sought out his daughter for emotional support but did not give it, Ms. Duval may not want to be around men or attempt to have a relationship with men in fear of they will not look at her as a person with feelings, wants, and needs but rather as an object for support. In her attempts to develop a sense of herself and her body she avoids the very thing that makes her feel the least human.

Diagnosis: Axis I: 307.1 Anorexia Nervosa, Binge-Eating / Purging Type Axis II: V 71.09 No Diagnosis Axis : None Axis IV: Relationship difficulties between parents Axis V: GAF = 41 Questions For Further Implications: 1. Do you ever feel sad, helpless, depressed? How often? Do you have difficulty sleeping, enjoying activities?

(This can help assess whether she has depression) 2. How do you feel about your current weight when compared to your lowest weight and your ideal weight? What are your thoughts about gaining weight? (This can help assess cognitive distortions and level of functioning) 3. Can you talk about your relationship with your mother and your feelings about her? (This will give insight to the dyadic relationship and how that is a part of her illness) 4.

Can you talk about your social anxieties? Do you have any close friends, someone you confide in? How do you feel about dropping out of school? (This can also give insight to the nature of her illness as to how it relates to her personally).