Both eating disorders and somatic symptom disorders involve a mind-body relationship. However, those living with somatic disorders tend to be highly sensitized to their body experiences in a different way than those with eating disorders. While eating disorders can cause individuals to lose their interoceptive awareness of the body, those with somatic disorders tend to have a magnified awareness, often coupled with preoccupation and a high level of anxiety that is deemed to be excessive to the cause.
These spectrums of illness require that social workers take an early-intervention, multidisciplinary, and biopsychosocial approach to treatment to be successful in supporting recovery. Both require knowledge and extensive communication with medical providers and other specialists. That priority for interdisciplinary knowledge and teamwork increases in importance given the mortality rates of eating disorders and the mind-body factors in both.
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This week you analyze the impact of living with an eating disorder and the problems (nutritional, medical, social, and psychological) in the recovery process. You also consider current societal influences that impact the onset, recognition, and recovery process for eating disorders and somatic symptom disorders.
Through this week’s Learning Resources, you become aware not only of the prevalence of factors involved in the treatment of eating disorders, but also the societal, medical, and cultural influences that help individuals develop and sustain the unhealthy behaviors related to an eating disorder. These behaviors have drastic impacts on health. In clinical practice, social workers need to know about the resources available to clients living with an eating disorder and be comfortable developing interdisciplinary, individualized treatment plans for recovery that incorporate medical and other specialists.
For this Discussion, you focus on guiding clients through treatment and recovery.
To prepare: Review the Learning Resources on experiences of living with an eating disorder, as well as social and cultural influences on the disorder. Read the Case of O.
Post a 300- to 500-word response in which you address the following: Provide the full DSM-5 diagnosis for O. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months. Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis. Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services. Explain how you would use the client’s family to support recovery. Include specific behavioral examples. Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan. Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder. Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You do need to include an APA reference for the treatment approach and any other resources you use to support your response.
The Case of O PATIENT SUMMARY—O
DEMOGRAPHIC DATA: This was an emergency, voluntary admission for this 28-year-old single white female. This was her fourth psychiatric hospitalization. O lives with a 24-yearold female roommate in New York City. She has a bachelor’s degree in art history and is employed by a major New York museum. O is of Jewish ancestry. CHIEF COMPLAINT: “My therapist said I was decompensating because I broke my leg, and I was despondent.” HISTORY OF PRESENT ILLNESS: O reported that she began an Optifast diet and, although she was supposed to be eating 600 calories a day, she was only eating between 200 and 400 calories a day. She also admitted to purging and frequent use of laxatives. O reported her weight was being monitored, and she had lab work done to be sure she remained healthy. In 3 months, O lost approximately 80 pounds. O reported that she has a very stressful job. She stated that approximately one month prior to admission, she started to “decompensate” and had difficulty maintaining control at work. She had several altercations with coworkers. One week prior to admission, O reported that her NA sponsor “said something nasty, and I lost it.” According to her mother, the sponsor made a reference to O being overweight. O reported that she was angry and “hit everything I knew I could—but that did not help.” She then kicked a brick wall, fracturing her right leg. O also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend. O complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. She believed the police had her under surveillance. O also complained of a fear of dirt, taking time to frequently bathe and brush her teeth. O reported she was emotionally abused as a child and suffered from post-traumatic stress disorder, but she denied a history of flashbacks or nightmares. She also complained of panic attacks and reported that she controlled them by taking Klonopin, but there was no clear information about this. She reported a history of bulimia since the age of 17. O also reported a history of drug and alcohol use, but she stated that she has been clean and sober for two years. PAST PSYCHIATRIC HISTORY: O’s mother reported that O saw a clinical social worker briefly when O was 10 years old. O reported that she was hospitalized at a New York hospital 3 years ago for 3 months. Six months after that, O took an overdose of Halcion and was treated at the same hospital, and then was transferred to a state hospital. After discharge in the next month, O attended a partial hospitalization program for drugs and alcohol every day for 5 weeks. She also saw a psychiatrist for 2 years. Two years after that, O saw a clinical social worker and psychiatrist and continues to the present with them. O admitted to using marijuana, cocaine, opiates, and hallucinogens in the past. She denied IV drug use but admitted to “skin popping” cocaine. O has abused alcohol in the past. According to her mother, O has also abused prescription medications in the past. O reported that she has been sober for the past 2 years and attends AA and NA meetings regularly. MEDICAL HISTORY: At 17 years old, O suffered from bulimia with bingeing, purging, and the use of laxatives. She reported she had not purged for 3 years until she began the Optifast diet 3 months ago. Although O is currently not bingeing, she admitted to purging and using laxatives. O is allergic to penicillin and has a lactose intolerance. She wears glasses for reading. PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: O’s parents were married when her mother was 19 years old, and O was born the following year. O’s mother described O as a wonderful, even-tempered, and happy baby. Two years later, O’s sister was born; mother stated O’s personality changed; she became stubborn and difficult. O’s mother said that O began biting and having temper tantrums and has been moody since then. O’s mother stated her marriage was conflicted because she has a communication problem with her husband and he was “never an active parent.” O’s mother reported that O “adores her father” because he is not the disciplinarian. O frequently caused conflict between her parents. When O was 12 years old, her parents separated for 2 weeks. O reported her mother quit college after O’s birth and returned to college after her sister’s birth. She said her father worked all the time, and there was a housekeeper who cared for the children. O reported that the family moved to Arizona when O was in sixth grade, where she began using marijuana that she reported stealing from her parents. The family returned to New York when O was in seventh grade. O’s mother reported that when O was in high school, her maternal aunt, who was dying of cancer, came to live with the family and that this was very stressful for O. During those years, O told the school counselor that her mother was abusive, and school officials visited the family. During the visit, O had a temper tantrum and there was no further investigation. O reported she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. O stated that in college she had a 3.8 GPA and was on the Dean’s list. O is currently applying for admission to graduate school and has taken some courses toward her master’s degree. O was always an athlete (soccer) in school, and according to her mother, she was a champion. O reported that in high school, most of her friends were athletes. She stated that she had one close friend. Currently, O is friendly with her roommate but does not have any other friends. “I don’t trust anybody.” O’s mother reported that when O lived in Connecticut during college, O had many friends and was active in NA and AA. O’s mother stated that she was surprised when O returned to New York. O agreed that she was happy living in Connecticut and felt returning to Queens was “a stupid mistake.” O hoped to return to Connecticut in the future. O’s mother reported that when O returned to New York, she at first moved in with her parents. Conflict increased in the household, and O’s parents began marital therapy. O’s mother stated that she and her husband became united and finally asked O to move out. O’s mother stated that within 6 weeks of moving out, O was doing well and seemed happy. O’s mother felt O has difficulty accepting adult responsibilities and felt O needed to separate from her parents. O’s mother stated that they do not want O to return home to live, but O stated that she wants to return home. O’s mother reported O worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, O has been employed by a museum. O reported that she currently has financial problems because of money owed to her therapist and the hospital in New York. MENTAL STATUS EXAMINATION: O presented as an overweight, somewhat disheveled, white female who had a cast on her right leg. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. In subsequent interviews, her affect was full range and her mood very liable. O’s speech was pressured and often circumstantial or tangential, and she spoke in a loud voice. At times her thinking was logical, and at other times it was illogical. O denied hallucinations but complained of hearing policemen outside her door prior to admission. She denied homicidal ideation and initially admitted to suicidal ideation but in subsequent interviews denied this. O was oriented to person, place, and time. Her fund of knowledge was excellent. O was able to calculate serial sevens easily and accurately. O repeated 7 digits forward and 3 in reverse. Her recent and remote memory were intact, and she recalled 3 items after five minutes. O was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment were appropriate. O’s three wishes were: “To be skinny, to have a big house where I can take in all the stray cats, and for a million more wishes.” When asked how she sees herself in 5 years, O replied, “Hopefully graduating from graduate school.” If O could change something about herself, she would “make myself thin.”