bulimia nervosa

Order Description

Ami is a 25-year-old, single Hindu female who has lived in a major metropolitan Northeastern City in the United States since studying undergraduate. Prior to arriving to the United Sates, she lived in an urban area of New Delhi, India with an extended family of a high socioeconomic status. She has a family history of depression on paternal grandmother’s side. When she was younger, Ami always wanted to be a movie star or a dancer. During her 8th class, she developed liking for a boy in her class who rejected her by calling her fat. She started to develop a dissatisfaction with her body image even when her weight was normal. She considered herself fat in the mirror and started looking for means to reduce weight. She felt her weight interfered with her achieving a career in acting or dancing. With gradually increasing concerns over growing fat, she started skipping meals and eventually would have only one meal and salads. Over another 7-month period, she lost up to 11 lbs. and looked thin, although she would consider it inadequate weight loss and view herself as herself as flabby in front of the mirror, despite the facts that others remarked that her clothes were loose. Sometime around this time, she also developed an intense liking for the high calorie foods. She would binge on them 5-6 times a month and would regret her actions afterwards. She tried to induce vomiting also once or twice. She started exercising on a Stairmaster and a tread mill for 1-1½ h in order to compensate weight gain. This pattern continued although she gave up working out in order to focus more on medical school and she gained about 14-15 lbs. She would be distressed with it. She restarted dieting sporadically, having increased craving for the high calorie foods and binging, which would be more when she would deny food in parties. Though she knew that her Body Mass Index (BMI) was well within normal range, she started taking one tablet of Orlistat daily secretly along with skipping meals and rejoining a fitness center in order to reduce her weight even more. She sold her jewelry without to undergo liposuction. She did not inform any family members of this. During last 5 years, she would compare herself with every female she met or read about on social media. She felt when she was around obese females. She could not spend an hour without fear of becoming obese. In recent times, she would avoid parties, going out with friends, standing for photos, and would spend hours in the gym. At the time of consultation with you the PMHNP in an out-patient department, her BMI was 18.5. 1. What are likely this patient’s diagnosis? 2. What comorbid personality disorders might exist? 3. What are familial, cultural, and social theories associated with the development of this disorder? 4. What are the neuropsychiatric abnormalities or neuronal problems associated with Ami’s disorder? What hormones and neurotransmitters? 5. How will you treat this patient? 6. What medications? Support your choices? 7. Is this an easy case? 8. How does culture influence clinical presentation of symptoms?





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