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In: Other Topics

Submitted By Grene
Words 731
Pages 3
C. W.
Female, 17

As with many eating disorders, C. W. anorexic eating patterns started gradually. When she initially joined the cheering squad in high school she began to compare to compare herself to the other girls and concluded that her problems revolved around weight. Her parents began to notice secretive eating patterns and started to worry about her. Not until C. W. fainted in school and the school nurse notified the parents did C.W. come to the attention of professional help. By the time she was seen, C.W. showed a symptom picture typical of anorexia nervosa; her emaciated physical appearance, concerns about being fat and missing four or five menstrual periods. Despite a limited food intake, C.W. loved to cook for others and took an interest in food recipes. Unfortunately, she did not eat any of the food she prepared for others.
Despite C.W.'s serious loss of weight and preoccupation with food, the competency-based assessment uncovers a number of parallel strengths in her story. Her parents are concerned about her and involved in her life. She is a good student. Counseling was not a new experience for her. Despite feeling demeaned by a prior counselor, C.W. came to see the current therapist and appeared to be engaged and willing to discuss her eating patterns. In fact, when she changed the subject C.W. responded cooperatively to the therapist's attempt to redirect her to the problem at hand. C.W. is in good general health (despite her eating patterns) and shows no symptoms to support the presence of another mental disorder such as schizophrenia, major depressive disorder, or panic disorder. Though C.W. loves to look at cookbooks and experiment with recipes, she does not particularly obsess to the point of supporting the diagnosis of obsessive compulsive disorder.

Diagnostic Criteria

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health, significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICP-10-CM code depends on the subtype (see below). Specify whether: (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentation in which weight loss is accomplished primarily by dieting, fasting, and/or excessive exercise. (F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Specify if: In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criteria B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met. In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time. Specify current severity: The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect chemical symptoms, the degree of function and disability and the need for supervision. Mild: BMI ≥ 17 kg/m2 Moderate: BMI 16-16.99 kg/m2 Severe: BMI 15-15.99 kg/m2 Extreme: BMI < 15 kg/m2

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