Discussion The Complexity of Eating Disorder Recovery in the Digital Age

Through this week’s Learning Resources, you become aware not only of the prevalence of factors involved in the treatment of eating disorders, but also the societal, medical, and cultural influences that help individuals develop and sustain the unhealthy behaviors related to an eating disorder. These behaviors have drastic impacts on health. In clinical practice, social workers need to know about the resources available to clients living with an eating disorder and be comfortable developing interdisciplinary, individualized treatment plans for recovery that incorporate medical and other specialists.

For this Discussion, you focus on guiding clients through treatment and recovery.

To prepare: Review the Learning Resources on experiences of living with an eating disorder, as well as social and cultural influences on the disorder. Read the case provided by your instructor for this week’s Discussion. By Day 3

Post a 300- to 500-word response in which you address the following: Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months. Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis. Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services. Explain how you would use the client’s family to support recovery. Include specific behavioral examples. Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan. Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder.  

  Required Readings American Psychiatric Association. (2013g). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm10 Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5(20), 1–12. doi:10.1186/s40337-017-0145-3 Lewis, B., & Nicholls, D. (2016). Behavioural eating disorders. Paediatrics and Child Health, 26(12), 519–526. doi:10.1016/j.paed.2016.08.005 American Psychiatric Association. (2013p). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09 Brown, P., Lyson, M., & Jenkins, T. (2011). From diagnosis to social diagnosis. Social Science & Medicine, 73(6), 939–943. doi:10.1016/j.socscimed.2011.05.031 Kaltura Media Uploader (HTML) Required Media Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018d). Psychopathology and diagnosis for social work practice podcast: Feeding and eating disorder and somatic symptom disorders [Audio podcast]. Baltimore, MD: Author.
TEDx Talks. (2016b, June 29). Starving for the good: An anorexic’s search for meaning and perfection | Elisabeth Huh | TedxUChicago [Video file]. Retrieved from https://www.youtube.com/watch?v=GxI0ewBJdMo TEDx Talks. (2013b, October 21). An epidemic of beauty sickness | Renee Engeln | TedxUConn 2013 [Video file]. Retrieved from https://youtu.be/63XsokRPV_Y TED Conferences, LLC (Producer). (2016). What happens when you have a disease doctors can’t diagnose [Video file]. Retrieved from https://www.ted.com/talks/jen_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose Optional Resources Axelsson, E., Andersson, E., Ljótsson, B., Finn, D. W., & Hedman, E. (2016). The health preoccupation diagnostic interview: Inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder. Cognitive Behaviour Therapy, 45 (4), 259–269. doi:10.1080/16506073.2016.1161663 Marzilli, E., Cerniglia, L., & Cimino, S. (2018). A narrative review of binge eating disorder in adolescence: Prevalence, impact, and psychological treatment strategies. Adolescent Health, Medicine and Therapeutics, 2018(9), 17–30. doi:10.2147/AHMT.S148050 Vartanian, L. R., Trewartha, T., & Vanman, E. J. (2016). Disgust predicts prejudice and discrimination toward individuals with obesity. Journal of Applied Social Psychology, 46(6), 369–375. doi:10.1111/jasp.12370 Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: This is the same document introduced in Week 1. Optional Media Sagey, L., & Blair, R. (Producers). (n.d.). Anorexia: What therapists and parents need to know [Video file]. Retrieved March 22, 2018, from http://www.psychotherapy.net.ezp.waldenulibrary.org/stream/waldenu/video?vid=386

The Case Study is below

The Case of Diamond

Intake Date: August 2019

DEMOGRAPHIC DATA: This was a voluntary intake for this 28-years-old single African American female. Diamond lives with a 24-years-old female roommate in New York City. She has a bachelor’s degree in Art History and is employed by a major New York museum. Diamond was born and raised in Virginia and moved to New York 4 years ago for employment. 

CHIEF COMPLAINT: “My roommate suggested I go to therapy. I do not agree. I can handle my life, but she threatened to move out and I cannot afford the apartment by myself.” 

HISTORY OF PRESENT ILLNESS: Diamond admitted to purging and frequent use of laxatives to try and keep her weight down. Diamond reported her weight was being monitored by a nutritionist and she had lab work done to be sure she remained healthy. Diamond reports that she was much heavier as a teenager and wants to confirm she doesn’t get like that again. 

Diamond reported that she has a very stressful job. She stated that approximately one month ago she started to have difficulty concentrating at work. She had several altercations with coworkers as well. Several weeks ago Diamond reported that a coworker “said something nasty and I lost it.” Diamond reported that she was angry and “hit everything I knew I could—but that did not help.” Diamond also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend. 

Diamond complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. This was another reason her roommate wanted her to seek treatment. Diamond reported she was emotionally abused as a child and suffered from post-traumatic stress disorder, but she denied a history of flashbacks or nightmares or any avoidance of the person who she says emotionally abused her. 

Diamond noted that at times over the past year she has very strange experiences of being overwhelmed with fear. At these times she begins sweating, has chest pains and chills, and thinks she is going crazy. It concerns her terribly that these may happen at inappropriate times. Reluctantly, Diamond admitted to bingeing several times per month since she was 17-years-old. 

PAST PSYCHIATRIC HISTORY: Diamond denies any history of psychiatric problems in the past. Diamond admits to using alcohol periodically but rarely to excess. 

MEDICAL HISTORY: Diamond is allergic to penicillin and has a lactose intolerance. She wears glasses for reading. 

PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Diamond’s parents were married when her mother was 19-years-old, and Diamond was born the following year. Two years later, Diamond’s sister was born. Diamond reports her mother stated Diamond’s personality changed; she became stubborn and difficult. Diamond’s mother said that Diamond began biting, having temper tantrums, and has been moody since then. Diamond states she “adores her father” because he was never the disciplinarian. When Diamond was 12-years-old, her parents separated for 2 weeks. Diamond reported her mother quit college after Diamond’s birth and returned to college after her sister’s birth. She said her father worked all the time, and there was a housekeeper who cared for the children. 

Diamond reports that when she was in high school, her maternal aunt, who was dying of cancer, came to live with the family and this was very stressful for the family. During those years, Diamond told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Diamond had a temper tantrum and there was no further investigation. 

Diamond reports she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Diamond stated that in college she had a 3.8 GPA and was on the Dean’s list. Diamond is currently applying for admission to graduate school and has taken some courses toward her master’s degree. 

Currently, Diamond is friendly with her roommate but does not have many other friends. “I don’t trust anybody.” Diamond states that when she lived in Connecticut during college, she had many friends. 

Diamond worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, Diamond has been employed by a museum. Diamond reports she currently has financial problems due to living in New York. 

MENTAL STATUS EXAMINATION: Diamond presented as a slightly overweight, somewhat disheveled, African-American female. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Diamond’s speech was pressured, and she spoke in a loud voice. At times, her thinking was logical; and at other times, it was illogical. Diamond denied hallucinations but complained of hearing policemen outside her sometimes. She denied homicidal ideation. She initially admitted to suicidal ideation but then denied it. 

Diamond was oriented to person, place, and time. Her fund of knowledge was excellent. Diamond was able to calculate serial sevens easily and accurately. Diamond repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Diamond was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate. Diamond’s three wishes were: “To be skinny, to have a big house where I can take in all the stray cats, and for a million more wishes.” When asked how she sees herself in 5 years, Diamond replied, “Hopefully graduating from graduate school.” If Diamond could change something about herself, she would “make myself thin.”