Model Answer
0 min readIntroduction
Eating disorders are serious mental illnesses characterized by disturbances in eating behaviors and related thoughts and emotions. These disorders can have significant physical and psychological consequences, particularly during adolescence. Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder are the most common types. Early diagnosis and comprehensive treatment are crucial for improving outcomes and preventing long-term health complications. The case presented strongly suggests a specific eating disorder, requiring a systematic approach to diagnosis and management.
(i) Most Likely Diagnosis: Anorexia Nervosa
Based on the clinical presentation – severe weight loss, amenorrhea for 7 months, and a heightened concern about body image in an 18-year-old unmarried female – the most likely diagnosis is Anorexia Nervosa, Restricting Type. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for Anorexia Nervosa include persistent restriction of energy intake leading to significantly low body weight, intense fear of gaining weight or becoming fat, and disturbance in the way one’s body weight or shape is experienced. Amenorrhea (absence of menstruation) is a common physiological consequence of severe weight loss and low body fat in females. The patient’s preoccupation with body image further supports this diagnosis.
(ii) Management
Management of Anorexia Nervosa is complex and requires a multidisciplinary approach involving medical doctors, psychiatrists, psychologists, dietitians, and family members. The goals of treatment are to restore weight, address psychological issues, and prevent relapse.
A. Medical Stabilization
- Assessment of Medical Complications: A thorough medical evaluation is essential to identify and address any life-threatening complications resulting from malnutrition. This includes assessing electrolyte imbalances (potassium, sodium, magnesium), cardiac function (ECG monitoring for arrhythmias), renal function, and bone density (due to risk of osteoporosis).
- Hospitalization: Hospitalization may be necessary if the patient is severely underweight (BMI <15 kg/m2), medically unstable (e.g., bradycardia, hypotension, electrolyte disturbances), or at high risk of suicide.
- Refeeding Syndrome Prevention: Refeeding syndrome is a potentially fatal complication that can occur when severely malnourished individuals are rapidly refed. It is characterized by shifts in electrolytes and fluid balance. Refeeding should be initiated slowly and carefully, with close monitoring of electrolytes.
B. Nutritional Rehabilitation
- Dietary Counseling: A registered dietitian should develop an individualized meal plan to gradually restore weight to a healthy range. The initial caloric intake should be conservative to avoid refeeding syndrome.
- Monitoring Weight Gain: Weight gain should be monitored regularly, with a target of 0.5-1 kg per week.
- Addressing Food Fears and Rituals: Nutritional counseling should also address the patient’s distorted beliefs about food and body weight, as well as any restrictive eating behaviors or food rituals.
C. Psychological Therapy
- Cognitive Behavioral Therapy (CBT): CBT is a first-line psychological treatment for Anorexia Nervosa. It helps patients identify and challenge maladaptive thoughts and behaviors related to food, body image, and weight.
- Family Therapy: Family therapy is particularly important for adolescent patients. It helps family members understand the illness and develop strategies to support the patient’s recovery. The Maudsley Approach to family therapy is a well-established method.
- Psychodynamic Therapy: This can explore underlying emotional conflicts and attachment issues that may contribute to the eating disorder.
- Group Therapy: Group therapy can provide a supportive environment for patients to share their experiences and learn from others.
D. Pharmacological Interventions
While there is no specific medication for Anorexia Nervosa, antidepressants (specifically SSRIs) may be used to treat co-occurring depression or anxiety. However, their efficacy in treating the core symptoms of Anorexia Nervosa is limited.
E. Long-Term Follow-Up
Long-term follow-up is essential to prevent relapse. This includes continued nutritional counseling, psychological therapy, and medical monitoring. Patients should be educated about the signs and symptoms of relapse and encouraged to seek help if they experience them.
Conclusion
Anorexia Nervosa is a serious and potentially life-threatening illness requiring a comprehensive and multidisciplinary treatment approach. Successful management involves medical stabilization, nutritional rehabilitation, and psychological therapy, with a strong emphasis on addressing the underlying psychological factors contributing to the disorder. Long-term follow-up is crucial for preventing relapse and ensuring sustained recovery. Early intervention and a collaborative approach involving the patient, family, and healthcare professionals are key to improving outcomes.
Answer Length
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