Sophia Esperanza Ramirez

Anorexia Nervosa, Self-Mutilation Behavior

Michael Devera, Tyler Gregory, Ashley Lynch, Daniela Ramirez

https://www.youtube.co
m/watch?v=5mP5RveA
_tk&t=4s
Family Background and Demographics
Gender: Female

Age: 14

Diagnosis: Anorexia Nervosa, Self-mutilation behaviors

Personality: Perfectionist, introvert, low-self esteem. Sophia often

succumbs to peer pressure and is easily swayed in order to fit in with her
peers. As a freshman, she feels a considerable amount of stress from
starting a new school.

Lifestyle: Sophia is a freshman at Hermitage High School. She typically

maintains perfect attendance and always strives for honor roll. She
became a cheerleader in middle school and decided to continue the sport
when transitioning to high school. Sophia’s mom, Angela, blames
cheerleading for her obsession with her weight and appearance. Says she
was constantly afraid of being heavy or ugly and never fully understood
why.

Sophia is the only child to parents Roberto and Angela. Roberto

abandoned the family when sophia was 5. Since his departure, the family
has struggled financially. Angela strives to give Sophia the best life
possible, so she has to be working away from home most of the time.
Summary For Current Diagnosis
Patient presented to the ER with a BMI of 15.6 after her mother found her unconscious
one evening. Patient was observed to have multiple scarring on both thighs above the
clothing line where it is not easily visible. Patient stated that she has had menarche but
her period stopped approximately 3 months ago.

Patient reports intense fear of gaining weight and reports to stay away from foods that
she deems “good and bad”.

She reports being a perfectionist and will continue an activity for hours until she is
satisfied. Food rituals are reported and the patient admits that her silverware has to be
placed at certain angles at the table.

Prior to eating, the patient will slice her food up until it is unrecognizable. Upon eating,
the patient will microbite and admits to hiding food.

Contributing Factors: Patient reports that she often uses social media. She often watches
material on dieting and weight loss. A contributing factor is her participation as a
cheerleader. Patient reports peer pressure from her teammates to lose weight. The
mother is a possible contributor to her daughter's disorder because she sells medications
associated with dieting and is obsessed with fitness.
 Just days before entering in-patient treatment at the Center for Discovery, Sophia
was seen in the E.R. after collapsing at home. There, she admitted to starving
herself for the past 8 months. She presented in the following state:

Healing the Body

- BMI: 15.6
- Scarring on upper thighs, beneath the clothing line
- Menarche stopped approximately 6 months ago
- Skin: pale for race, dry, cool to touch
- Hair: thin, dull, dry
- Dehydration, poor skin turgor
- Overall weakness and malaise
- Vital signs
For Sophia, treatment must begin with getting her healthy - Height: 60 inches
- Weight: 80 lbs
again!
- Temperature: 98.6
- Blood Pressure: 100/60
- Medications
- Pulse: 110 bpm
- Clonazepam (Anxiety)
- Lorazepam (Anxiety) - Respiratory rate: 22
- Buspirone (Anxiety)
- Docusate Sodium (Constipation)
- Polyethylene Glycol (Constipation)
- Fluoxetine (Depression)
- Sertraline (Depression)
- Duloxetine(Depression)
- Various Vitamin supplements

- Strict re-feeding with supplements

- Monitoring I/O, fluids and electrolytes during re-feeding
- Regulation of physical activity
- Wound care/ promote healing for any recent self-injurious
behaviors
Tour of this amazing
Facility
Holistic Treatment Plan
Anorexia Nervosa

Residential Eating Disorder Treatment:

- Sophia has a history of SH and anorexia, confounded by her mother
not being home
- Angela does not feel she has the resources to fully support Sophia in
an outpatient setting
- Angela also fears that school and cheerleading have made Sophia’s
condition worse and are contributing to further harm
- She feels being away from triggers and not being home alone will
help to improve her condition
Residential Anorexia Nervosa Treatment
In this setting, patients can expect a highly regimented
schedule:
0800: Wake up, bathing/ ADL routine
- medication administration
0900: Clients conviene in the central milieu; clients with meal
preparation privileges begin to prepare their breakfast
0930: Consumption of meal in the community setting
- planned in conjunction with the therapist
Dietary habits observed and corrected
- Constructive coping strategies developed
- Bathroom use prohibited to discourage behaviors
- client is expected to be forthcoming about
If meal is not completed, nutritional supplement is given
(not punitive, just a means to correct nutritional
deficiencies)
1000: Remainder of food is noted and reported to treatment
team
1000: Individual therapy sessions and therapeutic groups begin
- Occur throughout the day
- Level of authorized movement occurs throughout the
day as well
A similar schedule is followed for the remaining meals of the
day.
On a weekly basis, a client majority
chosen restaurant will be selected and the
clients will be taken there accompanied
by the dietician and counseling staff. The
clients will eat foods that they have
determined as challenges and become
more acclimated to the presence of
difficult foods in a social setting.
In an effort to encourage autonomy
and self accountability, unsupervised
outings for those deemed eligible, will be
and client. Because this activity is
designed to build self accountability, the
indiscretions should they occur while off
property.
Routine visitation by psychiatrist and
medical doctor can be expected on a
weekly basis and nursing staff is available
during daytime operation hours.
Counseling staff is present 24 hours, and
if needed, transportation to a nearby
medical facility is available.
The facility is voluntary. If for any
reason the patient wishes to discontinue
treatment, they can sign an AMA and
leave at their discretion.
Holistic Treatment Plan
Self-Mutilation Behaviors

Individuals with eating disorders have a higher likelihood of developing other

mental health disorders
- The Center for Discovery has treatment options for those experiencing co-
occuring disorders, such as self harm
- Self-harm is characterized by the purposeful actions of causing physical harm to oneself without
the intention of committing suicide. This behavior is more common in teenagers and adolescents
and occurs due to severe underlying emotional pain and a lack of healthy coping skills.
- It is absolutely essential that the eating disorder and any other co-occurring
disorders are simultaneously addressed and treated in order for the individual
to fully recover
- This is why there is such an important need for a thorough initial assessment of clients.
Healing the Mind & Spirit

Cognitive Behavioral Therapy

- concentrates on patterns of abnormal thinking and distorted beliefs that are the underlying causes for irrational
emotions and thought patterns.
- helps eliminate negative aspects and develop positive coping skills by fixing abnormal thought processes.

Dialectical Behavior Therapy

- Provides clients with new skills to manage painful emotions and decrease conflict in relationships.
- Encourages change, but also promotes acceptance.
- Mindfulness
- Emotional regulation
- Interpersonal effectiveness
- Distress tolerance

Family Therapy

Body Awareness
Mindfulness

-With eating disorders, emotional perceptions and regulation becomes

difficult. With time and repetition, the patient can begin to view their
disorder as their only means of coping with stressful situations.

-Techniques such as meditation, breathing exercises, and guided

imagery can be utilized to constructively cope with stressors.

-By being mindful, the patient can gradually become aware that
although they cannot control their emotions, they can control what
they do about them in a positive way.
Stress Reduction
- Filter Social Media
- Subscribing to body positive or recovery focused groups,
organizations, clubs

Positive coping mechanisms:

- Walking/Healthy exercise; physical activity
- Drawing/journaling/reading
- Music, singing, playing instrument
Support System

- Multidisciplinary team of dedicated healthcare professionals

- Peers undergoing similar treatment
- Members of support group
- During treatment and after discharge home
- Family (Sophia’s Mother)
- Participation in family therapy, involved in treatment and recovery
- Open and honest w/ employer; excused for any missed work due to Sophia’s health
- School
- Teachers, Guidance Counselor, Cheer Coach
- Friends
Discharge Planning
Discharge from the Center for Discovery to home with intensive outpatient
treatment
- Goals of this treatment: at least 9 hours of individualized or group
therapy per week
- Weekend programs allow for more flexibility and transition from
inpatient care to recovery at home.
- The goal of IOP is to allow clients to shift the majority of their time
back to their life outside treatment, utilizing IOP to continue the work
on those areas where they need additional therapy or skills practice.
Recovery

- Physical Recovery
- Behavioral Recovery
- Psychological Recovery

- Recovery is a long and difficult process, and it’s common for people to return to eating disordered
behaviors, especially during times of stress.
- Acceptance, Accountability, Structure, Commitment, Sense of Self
- The best way to deal with relapse is to accept the possibility that it might happen, soon or in the
distant future, and make a plan to help manage it.
- Identify triggers, warning signs, and support
Continuous Process
- Spirituality
- Find purpose; do things that help you find spirit, hope, and connection. It's too easy to get distracted by work, media, and material
things. What really matters is love and life.
- Service
- Volunteer, get outside of self, and help others with eating disorders.
- Fun
- Make plans for the weekend! Allow yourself to have fun. Staying home and isolating is a breeding ground for an eating disorder.
- Creativity
- Do something where you feel you shine—but allow yourself to suck at it too. Let go of perfection.
- Emotional Needs
- Usually we are using an eating disorder to fill a need. Find out what your "hunger" is really about and then find a way to get the need
met.
- Feelings
- Separate eating disorder behaviors from stress. Be willing to feel all feelings, even when they feel awful. Feelings won’t kill you, but an
eating disorder might. Be willing to sit with discomfort by taking one minute at a time. Breathe, don’t run. Running from our feelings just
takes us in a circle right back where we started.
Life Long Recovery
https://www.nationaleatingdisorders.org
References

Use our interactive map to find a treatment provider near you. (2021, July 29). Retrieved from
https://www.nationaleatingdisorders.org/

Center for Discovery. (2017, May 3). Residential Eating Disorder Treatment Program Overview. Alexandria, VA [Video]. YouTube.

https://www.youtube.com/watch?v=oljbnnIyLvA

https://www.youtube.com/watch?v=5mP5RveA_tk