Psychological disorder

1. Name : Afrah
Roll no: 5051
My topic: Case history
Disorder: Anorexia Nervosa

2. Psychological
disorder
Eating disorder

3.  Mrs. Shushmita, 25 years old, married for 5
years
 from an upper social class Hindu (Marvadi)
family
 Housewife
 Educated up to metric
 Got married at 20 years

4.  Principle symptoms- vomiting, menstrual irregularities, amenorrhea
 Duration- vomiting from a period of 2 years, menstrual irregularities
from 1 year and amenorrhea since 6 month
 Sleep cycle- 2 to 3 hour just
 Appetite- No wants to eat anything
 Weight and Height- 30 kg (excessive loss) and 5.4 ft
 BMI- 15.6
 Effects on social and work life- feeling lazy and not doing properly
their tasks

5.  Previous hospital admissions- Nil
 Response to treatment- Nil
 How well performed in admissions- Nil
 PAST MEDICAL & SUGICAL HISTORY
 Previous hospital admissions- She was evaluated by a gastroenterologist;
an intestinal biopsy was done to rule out malabsorption syndrome.
Gynecological opinion was taken in the background of amenorrhea and
infertility, and was advised endometrial biopsy
 Allergies- Nil

6.  Mother age- 37 and housewife, Father age- 45 and Shopkeeper, Sister’s name-
Shamita and 27 year old, No brother, Sister mental status- Normal , and
Housewife
 Family psychiatric history- No any member has any psychological problem in
past
 Family medical history- Sister had kidney problem in childhood, and her mother
is the patient of high blood pressure
 Current relationships with parents, siblings and other relatives- Avoid
gatherings with family and feel uncomfortable with people

7.  Birth- Normal birth
 Developmentalmilestone- Issue with excessiveweight at 5 year she has 17.4 kg weight
 Early childhood- According to client she was has not good relation with sister and she
feels shy with her sister on any family function because her sister was thin
 School- From 5 years to 16 years, has height phobia, Co-educational system in school,
Got good grades in class, has friendly relation with friends and also an obedient student
 Occupation- Homemaker
 Psychosexual history- At the age of 15 years she was committed towards puberty,
Client reported that she don’t have any guild, she was married at the age of 20 years,
she don’t have any child
 Drugs- Taken sleep pills from 17 years of age
 Forensic history- No

8.  Composition of the household- There are two persons in her house
that’s why she feels alone at home
 Type of house- Nuclear
 Main-bread earner- Husband
 Status of patient- Important because her husband given her
importance in domestic issues and decisions
 Financial difficulties- Nil
 Any debt- No

9.  The patient’s personality before first admission- Before
taken admission client were reported that she was very
shy and feel uncomfortable in family functions and she
always avoid the parties of her husband’s friends
because she think all the people were has focus on her
 Relationships- According to her, her relationship with
close friends were very good but she said that she has
few friends
 Character- Reserved and sensitive
 Mood- Gloomy and changeable
 Religious- Poor religion inclination
 Leisure activities- Thinking and imagination and prefer
to solitude

10.  Appearance and behavior- Dress were tidy, and in manner she was
uncooperative during session, her movement of body showing that she was tense,
and her eye contact was partially maintained
 Talk- In start up her voice tone were low but with the time her tone were
change and now she speaks clearly
 Mood- Depressed, flat and uncomfortable
 Thought- Thoughts were sad and client reported that her thoughts were
changeable and thoughts are associated with like she wants to thin and she wants
that her husband give attention to her
 Perception- No Hallucination and illusions

11.  Orientation- She was not able to guess the exact time but recognize
the pictures of places
 Attention/concentration- She were able good to speak days name
as opposite, but in digits span she were confuse to answer immediately,
but after repeated session, the client opened up to the clinician
 Registration and recall- She were not able to recall immediate
her addressed and also be confused in digits span
 Short term memory- The client’s short term memory were not
good because she was not able to answer about her last anniversary,
menu of last meal and not easily speak her fiends name also
 Long term memory- Good because she remembered her metric
grades, farewell party date, marriage date, day and month

12.  She knows some of meaning of proverbs
 Diagnosis:
 The client was diagnose by Anorexia Nervosa fro the symptoms of
the disorder. And the symptoms include sleepless, loose weight
vomiting and amenorrhea.
 Techniques of insight-oriented psychotherapy and cognitive
behavioral therapy
 treatment usually includes continuous medical care, regular
therapy, nutritional counseling, and sometimes medication.

13.  Mrs. Shushmita she was very worried about her weight at the age of 16
years she started strict diet which adversely affect her health and also her
life. Takes sleeping pills from the age of 17 years. She feels uncomfortable
because she was thin. At the 20 years she got married she stated that her
husband always compares her with thin girls and she wants her
husband’s attention. Because of poor nutrition from last two years she
was suffering from vomiting, irregular menstrual cycle from 1 year, also
diagnose amenorrhea since 6 month for that’s why her weight was
excessively lose from a normal weight. And on the basis of these
symptoms Amnesia Nervosa was diagnosed and she also said that she was
not good for her tasks and homework. And she doesn’t want to eat
anything. Her husband taken her to psychologist and after 1 week was 2
kg.

14.  Mrs. Shamita gradually became cooperative for treatment process.
Supportive psychotherapy was planned that provided a maximum
understanding of the patient perspective. Techniques of insight-oriented
psychotherapy and cognitive behavioral therapy were structured to
address the cognitive distortions. She was subsequently discharged and a
follow up for every 2 weeks was done. Her weight gain at the end of 1
month was 4 kg. At the end of 6 months, there was a weight gain of 15
kg. At the end of 1 year, there was a relapse in symptoms with patient
reported of decreased intake of food and purging tendencies. The
symptoms were addressed through Psychotherapy only. Mrs. Shamita
symptoms remitted. At the end of 2 years, her weight was 55 kg with no
fresh complaints.


15. Axis1- Anorexia Nervosa 307.1 (F50.02)
Axis2- Nil
Axis 3- Intestinal biopsy, anemia
AXIS 4- Nil
AXIS-5- GAF 80% found
 In two years she gain 15 kg weight
 Her weight was 55kg
 No fresh complaints found