CONFIDENTIAL

PSYCHOLOGICAL REPORT

Name: AA School: County School

Date of Birth: 03.01.2001 Evaluation Date: 3/1/2023

Age: 22 years Examiner: MS, Ed.

Grade: medical undergraduate

REASON FOR REFERRAL

Referred for an evaluation by the Mental Health Intervention Team at [City] Medical Center

for a comprehensive assessment and re-evaluation to gather information regarding her current

treatment plan and therapeutic needs due to the presence of bulimia nervosa symptoms.

BACKGROUND INFORMATION

Developmental History: Born into an urban Hindu extended nuclear family of upper

socio-economic status in a metropolitan city, the 22-year-old, unmarried female medical

undergraduate experienced an insidious onset of poor eating habits that began at the age of 13.

No significant prenatal complications were reported, and she reached developmental

milestones on time. However, her emotional well-being was significantly influenced by

experiences during her 8th-grade year when she faced rejection by a boy in her class, leading

to dissatisfaction with her body image.

Medical History: No significant medical history was reported, and there were no

indications of micronutrient deficiency or menstrual irregularity throughout the course of her

eating disorder. Unlike the developmental history provided, there were no surgeries or notable

health issues, and her BMI remained within the normal range at the time of psychiatric

consultation.

Psychiatric History: The individual sought psychiatric evaluation in the outpatient

department, where a diagnosis of bulimia nervosa was established. She exhibited symptoms of

binge eating, purging through induced vomiting and the use of medications like Orlistat, and

engagement in excessive exercise. Treatment involved the prescription of Fluoxetine 40 mg

and Cognitive Behavior Therapy, leading to sustained improvement over 18 weeks.

Educational History: Currently pursuing a medical degree, the individual's

educational journey was marked by periods of intense focus on body image and weight control.

Although no specific educational accommodations were mentioned, her struggle with bulimia

nervosa likely impacted her academic and personal life. Further evaluation may be necessary

to understand the full extent of its effects on her educational experience.

TESTS ADMINISTERED

Clinical Interviews:

Structured Clinical Interview for DSM-5 (SCID): To assess the presence of bulimia nervosa

and comorbid psychiatric conditions.

Eating Disorder Examination (EDE): A comprehensive interview assessing the frequency

and nature of binge eating and purging behaviors, as well as attitudes towards weight and shape.

Mini International Neuropsychiatric Interview (MINI): A brief structured interview for the

diagnosis of psychiatric disorders, including eating disorders.

Psychological Assessments:
Beck Depression Inventory (BDI): To measure the severity of depressive symptoms.

Eating Attitudes Test (EAT-26): A self-report questionnaire assessing abnormal eating

attitudes and behaviors.

Body Shape Questionnaire (BSQ): To evaluate concerns about body shape and weight.

Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS): To assess the severity and type of

eating disorder symptoms.

Medical Assessments:

Physical Examination: To assess overall health and identify any physical complications

related to bulimia nervosa.

Electrocardiogram (ECG): To monitor cardiac health, as individuals with bulimia nervosa

may experience electrolyte imbalances affecting the heart.

Blood Tests: To check for any abnormalities in nutritional levels, such as electrolyte

imbalances, and assess overall physical health.

Additional Assessments:

Family History Interview: To gather more information about the family history of recurrent

depressive disorder in the paternal grandmother.

BEHAVIORAL OBSERVATIONS

During the psychiatric consultation, the 22-year-old female medical undergraduate exhibited

behaviors indicative of her prolonged struggle with bulimia nervosa. She expressed deep

dissatisfaction with her body image, engaging in frequent touching and scrutiny of specific

body areas, particularly when recalling episodes of significant weight loss and gain. Emotional
distress was palpable throughout the session, with visible signs of sadness and anxiety related

to her history of binge eating, purging behaviors, and an enduring preoccupation with body

weight. Avoidance behaviors were evident as she described actively steering clear of social

gatherings, parties, and standing for photos, highlighting her discomfort in food-centric

settings. Compensatory behaviors, such as skipping meals and engaging in secretive practices

like using Orlistat and contemplating liposuction, underscored the severity of her condition.

The habitual comparison with other females, feeling better around those with higher body

weight and experiencing disappointment with slimmer figures, showcased the profound impact

on her self-esteem. Despite these challenges, a positive response to the ongoing treatment plan

involving Fluoxetine 40 mg and Cognitive Behavior Therapy was observed, with sustained

improvement over the last 18 weeks evident during regular follow-up appointments. Overall,

these behavioral observations emphasize the complex nature of her disorder and the necessity

of a comprehensive, multidimensional approach to address both the psychological and

behavioral components of bulimia nervosa.

TEST INTERPRETATION AND TEST RESULTS

The comprehensive assessment utilized various validated tools, including the Structured

Clinical Interview for DSM-5 (SCID), Eating Disorder Examination (EDE), Mini International

Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI), Eating Attitudes Test

(EAT-26), Body Shape Questionnaire (BSQ), and Yale-Brown-Cornell Eating Disorder Scale

(YBC-EDS). The SCID confirmed a diagnosis of bulimia nervosa, supported by EDE findings

revealing recurrent binge eating and compensatory behaviors. The MINI further clarified the

primary focus on bulimia nervosa while ruling out other psychiatric disorders. Elevated BDI

scores indicated concurrent depressive symptoms, emphasizing the need for a comprehensive
treatment approach. Results from EAT-26 and BSQ underscored disordered eating attitudes and

heightened concerns about body shape. The YBC-EDS quantified the severity of bulimic

symptoms. Physical examination and blood tests indicated a normal BMI and absence of

physical complications, guiding health monitoring. The initiated Fluoxetine 40 mg and

Cognitive Behavior Therapy have shown sustained improvement over 18 weeks, highlighting

their effectiveness. Regular follow-up and ongoing monitoring remain essential for addressing

evolving needs and ensuring continued progress in treatment.

SUMMARY AND RECOMMENDATION

The 22-year-old, unmarried female medical undergraduate presents a complex case of bulimia

nervosa, characterized by a prolonged history of poor eating habits stemming from emotional

triggers, body dissatisfaction, and weight-related concerns. Her family background, including

narcissistic and histrionic traits, as well as a family history of recurrent depressive disorder,

adds layers to the understanding of her psychological profile.

The assessment, utilizing a variety of tests and evaluations, revealed a diagnosis of bulimia

nervosa with significant psychological distress and disordered eating behaviors. The

individual's struggle with body image, binge eating, purging behaviors, and intense weight-

control efforts has been persistent over the past nine years, impacting various aspects of her

life, including academic pursuits, social engagements, and familial relationships.

The prescribed treatment, consisting of Fluoxetine 40 mg and Cognitive Behavior Therapy

(CBT), has shown positive and sustained improvement over the last 18 weeks. Her BMI is

currently within the normal range, and laboratory investigations indicate no significant physical

complications. The combination of pharmacotherapy and psychotherapeutic intervention

appears to be contributing to the individual's progress in managing the symptoms of bulimia

nervosa.
Recommendations for the ongoing management of bulimia nervosa include:

1. Continued Medical and Psychological Follow-Up:

• Regular monitoring of physical health, including BMI and laboratory

parameters, to ensure ongoing well-being.

• Consistent psychiatric follow-up to assess the efficacy of Fluoxetine and adjust

the treatment plan as needed.

2. Cognitive Behavior Therapy (CBT):

• Continuation of CBT to address underlying cognitive distortions, enhance

coping mechanisms, and promote healthier attitudes towards body image and

eating behaviors.

3. Family Involvement:

• Encouraging family involvement in the therapeutic process to provide

emotional support and foster understanding of the challenges faced by the

individual.

4. Education and Psychoeducation:

• Providing psychoeducation on the nature of bulimia nervosa, its potential

triggers, and the importance of a holistic approach to recovery.

5. Social Support:

• Encouraging the development of a supportive social network to help mitigate

feelings of isolation and enhance overall well-being.

6. Collaboration with Other Healthcare Professionals:

• Collaboration with other healthcare professionals, such as dietitians or

nutritionists, to address nutritional aspects and promote a balanced approach to

eating.