Boragay Heart O.

BSPSYCH 2-1
Case Analysis (Eating and Sleep-wake Disorder)

#1
This morning I had a half of a grapefruit for breakfast, and some coffee—no sugar or cream. For
lunch, I had an apple and a diet soda. For dinner, I had some plain white rice and a
salad with just some lemon squeezed over it. So I was feeling really good about myself, really
virtuous. That is, until Jackie came over, and completely messed up my day. She
brought over a movie to watch, which was fine. But then she insisted on ordering a pizza. I told
her I didn’t want any, that I wasn’t hungry (which was a lie, because I was starving).
But she ordered it anyway. The pizza arrived, and I thought I could be good and not have any.
But it was just sitting there on the table, and I couldn’t think of anything except having
some. I couldn’t concentrate on the movie. I kept smelling the pizza and feeling the emptiness in
my stomach. Like a weakling, I reached out and got one piece, a small piece. It was
ice cold by then, and kind of greasy, but I didn’t care. I ate that piece in about 5 seconds flat.
Then I had another piece. And another. I stopped after four pieces.
But I still couldn’t pay attention to the movie. All I could think about was what a pig I was for
eating that pizza, and how I’ll never lose the 10 pounds I need to lose to fit into size 2
jeans. Jackie’s gone now, and I still keep thinking about how ugly and fat I am, and how I have
no willpower. I didn’t deserve to have that pizza tonight, because I haven’t lost
enough weight this month. I’m going to have to skip breakfast and lunch tomorrow, and exercise
for a couple of hours, to make up for being a complete pig tonight.

List of Symptoms:
• Starving but she kept on insisting that she wasn’t hungry.
• Ate one piece of pizza in about 5 seconds flat.
• Binges eat a four-slice of pizza.
• Uncontrollable eating/no willpower.
• Kept on thinking what a pig she was for eating those pizzas.
• And how ugly and fat she is.
• She is going to skip breakfast and lunch tomorrow and will also exercise for a couple of
hours to compensate for eating a large amount of food tonight.

DSM-5 Diagnosis Criteria

• Criteria A2 – Shows lack of control and willpower when eating the pizza.
• Criteria B – Fasting (Will skip breakfast and lunch tomorrow) and excessive exercising.
• Criteria C – It doesn’t indicate how often the binge eating episode and the inappropriate
compensatory behavior occur.
• Criteria D – Shows excessive concern about her appearance, shape, and weight.

Diagnosis: Bulimia Nervosa

Triggering Events: Her friend Jackie came over and bought a pizza that trigger more of her
hunger.

Biopsychosocial Cause:
• Psychological Cause – Weight concern, and too much self-evaluation concerning her
appearance and size.

Best Possible Treatment:

• CBT-E (Cognitive behavioral therapy enhanced) – It will help to educate the client about
the physiological consequences that will happen if he/she always has inappropriate
compensatory behavior (Fasting). It can also help to alter the dysfunctional thoughts of
the client about her/his, weight, body shape, and eating.
• Prozac – it will help the client to reduce the frequency of binge eating. But I think in this
case it’s not completely necessary to take this medication since starvation is one of the
causes that her binge eating happens if the client doesn’t starve herself, I think it will not
result in that kind of behavior.

#2
I would spread my paper out in front of me, set the yogurt aside, check my watch. I’d read the
same sentence over and over, to prove that I could sit in front of food without snarfing
it up, to prove it was no big deal. When five minutes had passed, I would start to skim my
yogurt. . . . You take the edge of your spoon and run it over the top of the yogurt, being
careful to get only the melted part. Then let the yogurt drip off until there’s only a sheen of it on
the spoon.
Lick it—wait, be careful, you have to only lick a teeny bit at a time, the sheen should last at least
four or five licks, and you have to lick the back of the spoon first, then turn the spoon
over and lick the front, with the tip of your tongue. Then set the yogurt aside again. Read a full
page, but don’t look at the yogurt to check the melt progression.
Repeat. Repeat. Do not take a mouthful, do not eat any of the yogurt unless it’s melted. Do not
fantasize about toppings, crumbled Oreos, or chocolate sauce. Do not fantasize about
a sandwich. A sandwich would be so complicated.

List of Symptoms:
• Restricting oneself to have the right amount of intake of food.
• Distracting oneself so that he/she wouldn’t eat the food in front of her.
• Trying to prove that she could sit in front of food without snarfing it up.
• There is also a repeated process that the client follows in eating the yogurt.
• Limiting taking a mouthful of food, and fantasizing about different kinds of food

DSM-5 Criteria
 • Criteria A – The client shows a persistent energy intake restriction.
• Criteria B – It doesn’t mention there if the client has an intense fear of gaining weight or
any disturbance in perceiving their own shape and weight. But there is also a possibility
that the client may not acknowledge any fear of gaining weight.
• Criteria C – The client doesn’t show any disturbance or concern about her/his body’s
weight, and size. It is more like just doing or following a process of eating in a restricting
manner.
Specify if:
• Restricting type – The duration and occurrence of the client’s behavior were not also
indicated. But it shows there the client is trying to restrict herself from having a large
amount intake of food. The restriction is too much that it already become
inappropriate.

Note: The client also shows compulsion while eating the yogurt.

Diagnosis: Anorexia Nervosa restricting type, (With the obsessive-compulsive feature since
there is an urge to behave a certain way on having the food.)

Biopsychosocial Cause:
• Psychological Cause – one of the possible causes might be the obsessive-
compulsive trait that the client has.

Best Possible Treatment:

• CBT-E (Cognitive behavioral therapy enhanced) – This kind of therapy, might
help to address the eating process and disorder of the client. And can also help the
client to alter and normalize her eating pattern and behavior.

#3
“The day after New Year’s Day I got my check cashed. I usually eat to celebrate the occasion,
so I knew it might happen. On the way to the bank, I steeled myself against it. I kept reminding
myself of the treatment and about my New Year’s resolution about dieting. . . . “Then I got the
check cashed. And I kept out a hundred. And everything just seemed to go blank. I don’t know
what it was. All of my good intentions just seemed to fade away. They just didn’t seem to mean
anything anymore. I just said, ‘What the hell,’ and started eating,
and what I did then was an absolute sin.”
He described starting in a grocery store where he bought a cake, several pieces of pie, and
boxes of cookies. Then he drove through heavy midtown traffic with one hand, pulling
food out of the bag with the other hand and eating as fast as he could. After consuming all of his
groceries, he set out on a furtive round of restaurants, staying only a short time in
each and eating only small amounts. Although in constant dread of discovery, he had no idea
what “sin” he felt he was committing. He knew only that it was not pleasurable. “I didn’t
enjoy it at all. It just happened. It’s like a part of me just blacked out. And when that happened
there was nothing there except the food and me, all alone.” Finally, he went into a
delicatessen, bought another $20 worth of food, and drove home, eating all the way, “until my
gut ached.”

List of Symptoms:
• Dietary restraint
• Loss of self-control from eating
• Bought cake, several pieces of pie, and boxes of cookies. And while driving he use
his other hand to eat the food as fast as he could
• After consuming all of those, he set on a furtive round of restaurants, staying in a
short amount of time, and eating only a small amount of food.
• He felt like he committed a sin.
• He didn’t enjoy it at all. A part of him blacked out, and it all just happened.
• He went into a delicatessen, and still both another $20 worth of food, and eat it all
the way home until his gut ached.

DSM-5 Criteria
• Criteria A1 – Does not indicate how long he ate, but he consumes a large amount of
food in a short span of time. Eating a cake, several pieces of pie, and boxes of cookies
are too much compared to the normal amount of food that people would eat.
• Criteria A2 – He lost control and couldn’t refrain himself from eating, especially when he
started eating.
• Criteria B
1. He ate as fast as he could
2. He eat while driving back home until his gut ached.
5. He feels guilty like he committed a sin after he consume a lot of food.
• Criteria C – Shows distress while binge eating, for him it was not pleasurable, and he
didn’t enjoy it.
• Criteria D – Does not indicate the occurrence of his binge eating episodes.
• Criteria E – He does not show or even thought about doing compensatory behavior for
having too much intake of food.

Diagnosis: Binge-eating disorder

Biopsychosocial Cause:
• Psychological Cause – Dietary restraint might be the cause since the client mention
that it is his new year’s resolution.

Best Possible Treatment:

• Prozac – an effective treatment for eating disorders, and it will help to reduce the
frequency of binge-eating disorders.
• CBT-E (Cognitive behavioral therapy enhanced) – will help him cope with the issues that
trigger his eating disorder. And it will give him a better sense of control over his behavior
and the regulation of his eating pattern.