CPE5601 Diagnosis in Counselling

Obsessive-Compulsive Disorders
(OCD)
Disediakan : Siti Musliha Binti Darus (GS54587)
Pensyarah : Dr. Wan Marzuki Bin Wan Jaafar
 Types of
Feeding and Eating Disorders
1. Pica
2. Rumination Disorder
3. Avoidant/Restrictive Food Intake
Disorder
4. Anorexia Nervosa
5. Bulimia Nervosa
6. Binge-Eating Disorder
 Pica
Diagnostic Criteria

A. Persistent eating of nonnutritive, nonfood substances over a period of at

least 1 month.
B. The eating of nonnutritive, nonfood substances is inappropriate to the
developmental level of the individual.
C. The eating behavior is not part of a culturally supported or socially
normative practice.
D. If the eating behavior occurs in the context of another mental disorder (e.g.,
intellectual disability [intellectual developmental disorder], autism spectrum
disorder, schizophrenia) or medical condition (including pregnancy), it is
sufficiently severe to warrant additional clinical attention.
 Prevalence
• intellectual disability

Risk & Prognostic Factor

• Neglect
• lack of supervision
• developmental delay
 Functional Consequences

ingesting something
poisonous, or something
that becomes poisonous cause intestinal blockages
when consumed in large
quantities.

poses serious risks to your

gastrointestinal health
 Treatment
1. Non-pharmacological
 Applied behaviour therapy (ABT)
 applied with those with intellectual disabilities and behavioural
problems
 teaches new behaviour by rewarding and reinforcing positive
behaviour and punishing undesired behaviour
2. Pharmacological
 medicines, supplements, or vitamins Treating malnutrition and
nutrient deficiencies (Iron supplements for anemia)

(Matson, et al., 2013)

 Case
Mrs H, a 35 year old female, married with an eight month old male baby,
studied till degree, currently not working, belonging to middle socio-economic
status family, with no family history and no past history of any psychiatric
illness or neurodevelopmental delay. She presented to the psychiatry
outpatient department with complaints of consuming paper and cardboard
whenever she was alone from the past 2 months. The onset of her
symptomatology was eight months into her post-partum period, was of an
insidious onset and progressive nature. Every time she unpacked toys for her
child, she would repeatedly smell the cardboard boxes and had an intense
liking for the same. When alone at home, she felt like tasting those cardboard
papers and ate a few pieces. There were no negative consequences the first
time she ate a few pieces which further reinforced her interest. Gradually over
the course of a week, she also started chewing on the ends of pencils and ice-
cream sticks. On certain days she would end up consuming two to three A4
size sheets bit by bit.
(Goerge et al., 2017)
On further detailed evaluation she reported of low mood consistently
for the past 2 months because she felt constrained to her home as
she was unable to go for work like she used to previously. She did not
feel that it was irrational to consume the paper items and did not find
it distressful. She also revealed the truth that this habit of eating
cardboard and paper gave her a sense of relaxation and helped her
forget her worries. She was diagnosed with Pica secondary to severe
depression without psychotic symptoms. Patient was advised
behavioral modification. Her psychosocial stressors were addressed
and patient was taught relaxation techniques. Patient reported
improvement in her low mood and depressive symptoms on further
follow-ups in the next two weeks. Hamilton Depression Rating Scale
for Depression applied after 2 weeks was found to be 11. She was
abstinent from consumption of paper during this time and for the
next two months. She also admitted that she is not having the desire
to eat those unwanted substances anymore. She was advised for
further follow-ups and educated about treatment adherence
 Bulimia Nervosa
Diagnostic Criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of
the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of
food that is definitely larger than what most individuals would eat in a similar
period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one
cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as
self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or
excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at
least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
 Functional Consequences
• lead to electrolyte and chemical imbalances in the body

Prevalence
• common is in females, with an approximately 10:1
female-to-male ratio
 Risk & Prognostic Factor

• individual has weight concerns, low self-esteem,

depressive symptoms, social anxiety disorder, and
overanxious disorder of childhood
11
 Treatment Plan
Non-pharmacologic Therapy

• cognitive behavioural therapy (CBT)

• Family approaches

Pharmacologic
• appetite suppressants
• antidepressants

(Kruger and Kennedy, 2000)

 Case
Sage is a 26-year-old doctoral candidate in English literature at the local university. She
is in good standing in her program and has plans to enter the job market in the fall. In
your intake, she tells you she thinks she is “fat” and has been self-conscious about her
body since the sixth grade, at which time she began menstruating and developing
breasts earlier than the other girls in her class. She was teased for needing a bra and
remembers feeling “chubby, too big, and just wanting to be small like younger sister.”
She started dieting in the seventh grade, following strict rules for weeks (e.g., she
recalls the grapefruit only diet), then transitioning into what she called “bad” weeks. 
During these times, she would stock up on candy bars and other snack foods and eat
them, often in her bedroom late at night. Her parents became concerned and tried to
strictly limit her dieting.  This led to eating “normal” during the day and binging on
those candy bars she kept hidden in her bedroom at night if she felt sad, scared, or
mad. She grew into a habit of eating to feel better – relief that was only temporary, as
she would feel ashamed about what she had done and resolve to not do it again.
 In college, her pattern of emotional eating continued, which felt more
distressing to her because of the pressure to look “as pretty and thin as the
other girls.” In spring of her freshman year she experimented with throwing
up after the late-night eating and found that, at least in the minutes that
followed, she felt like she had much more control and believed this would
help her to prevent the weight gain she so dreaded. She fell into a vicious
cycle of late-night binges (typically consuming about 7 candy bars in 15
minutes, during which times Sage described feeling very out of control)
followed by making herself throw up. In college, she engaged in these binge-
purge episodes about 6 nights/week. At present, she is having a harder time
hiding the episodes because she lives with her boyfriend; she estimates that
they occur about 4 nights per week. The times when she feels the most
compelled to binge and purge are when she has a major presentation coming
up in her doctoral program and when she gets in a fight with her boyfriend.
Her BMI is in the normal range, but she says she needs to lose weight. She
wants to stop binging and purging because she does not want her boyfriend
to find out, but she is also afraid that if she stops, she will gain weight.
 References
• American Psychiatric Association(2013). Diagnostic and Statistical Manual of
Mental Disorders 5th edition. Washington, DC London, England.
• Kruger, S., & Kennedy, S.H. (2000). Pharmacotherapy of anorexia nervosa, bulimia
nervosa and binge-eating disorder. J Psychiatry Neurosci, 25, 497-508.
• Matson, J. L., Hattier, M. A., Belva, B., & Matson, M. L. (2013). Pica in persons
with developmental disabilities: Approaches to treatment. Research in developmental
disabilities, 34(9), 2564-2571.
• George, M., Maheshwari, S., Ram, D., Raman, R., Sathyanarayana, Rao, T.S.,
(2017). A Case Report of a Female Patient with Pica. Annals of Clinical Case
Reports. 2, 1332.
TERIMA KASIH / THANK YOU
www.upm.edu.my