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case formulation
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Background and Reason for Visit: The patient, Nancy Lee Duval, is a 23 year old female who was admitted to a program for eating disorders at a research facility for eating disorders. Ms. Duval was admitted after writing a letter of request describing her eating patterns. Ms. Duval attended college, however was unable to graduate and dropped out midway through at age 21. There are no reports of previous psychotherapy, however Ms. Duval mentioned several instances of going to the infirmary because of dehydration. Ms. Duval is the second of four children and the only girl. Ms. Duval reports difficulties between her parents and her brothers and her parents. There are some indications that Ms. Duval’s father may have a history of alcoholism. The other family members have no history of psychological treatment. It is reported that Ms. Duval’s family refuses to support her efforts in obtaining psychological treatment. Case Formulation: Ms. Duval reports that her eating problems began at the age of 14, however did not become severe until the past three to four years. When Ms. Duval began college she reports that she began using laxatives to lose weight. Her condition worsened and after two years she was using 250-300 laxatives at one time. She would not eat for days and then consume large quantities of food and then purge to prevent weight gain. She reports, at times she would not drink water for days in fear of gaining weight. She began to exhibit symptoms such as hair loss, loose teeth, fatigue, amenorrhea, and weakness to the point of not being able to walk. Subsequently, she stopped using laxatives however began exercising for hours each day. Although Ms. Duval attempted to exercise, at times she would become so weak and dizzy she could not. More recently Ms. Duval read an article on anorexia nervosa and was inspired to become healthy again. She studied nutrition and was able to force herself to eat a health balanced diet. Ms. Duval currently eats a rigid diet with the least amount of calories. She reports that she can not eat sweets, fatty foods, or pastas without becoming sick. Her lowest weight at height 5'6" was 88lbs and she is currently 105-115lbs. Ms. Duval wrote a letter to the research facility in search of professional help into the understanding and nature of her eating patterns. Ms. Duval’s symptoms and behaviors portray the use of several defense mechanisms. Ms. Duval’s use of turning against the self is evident by her destructive eating patterns. The nature of her defense may stem from her relationship with her mother and father. It was reported that her parents often had disagreements and most likely did not have a satisfactory relationship. Subsequently perhaps the parents in search of emotional support, were over involved in Ms. Duval’s life, sharing her experiences as their own. In efforts to gain control of the relationship and of her life, she turned her feelings of being powerless and ineffective towards herself. Her parents intrusive relationship with Ms. Duval created a feeling of the self as separate from the body.
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