Download A young lady who eat a lot - Centre on Behavioral Health

MSBH 7001, 2004/05
Individual Presentation
By Poon Man Kay
Enjoy eating.
Enjoy eating?
I cannot control from
eating!
A young lady who ate
a lot
A 25-year-old clerical worker could not
help her from stopping eating for eight
years.
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When she was 17-year-old, she prepared for the
HKCEE and she terminated the relationship
with her boyfriend.
After that, she considered herself obese.
Her body weight was 56.8 kg with body height
1.55 m. BMI=23.6
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She attempted dieting and exercise to reduce her
body weight.
Without the usage of medication, including
Western or herbal medicine.
Her body weight decreased to 50 kg. BMI=20.8
Very successful! Every lady might envy her.
Then, what happen?
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She could not resist the urge to eat because she
was too hungry. That was “normal”.
She continued with this pattern of eating.
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Gradually, She developed the urge to eat even
thought she was NOT hungry.
She knew that she was in trouble.
She tried to resist the urge to eat, but she could
not tolerate the discomfort generated.
Eating a lot could bring her joy of eating and
help her from relieve stress and loneliness.
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Gradually, she found that eating was disgusting as she
ate two to three lunch sets in one setting, completed
within one hour (binge eating).
She worried she would be obese after eating.
“Luckily”, she was very clever that she could
compensate the weight gain by exercise and repeated
regurgitation.
Urge
binge eating
purging, exercise
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Repeated regurgitation made her too weak to
perform exercise (due to electrolyte imbalance,
dehydration).
She was under the control of the urge to eat. No
social activity, but only eating alone!
Her life fixed onto food. Nutrient was NOT her
consideration.
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Self-control of not to eat failed repeatedly.
She was frustrated. She felt hopeless and helpless. She
considered herself as total personal failure.
She explained her condition to her family and family
physician. She felt nobody understand her. As a result,
her problem could not be solved.
One day, her chance of “recovery” came! (in fact, it
should be remission).
What was it?
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She was referred to Centre of Behavioral
Health.
The diagnosis was Bulimia nervosa (BN),
purging type (DSM-IV-TR).
Differential diagnosis: Anorexia nervosa, major
depressive disorder, anxiety disorders.
Bulimia Nervosa
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Adapted DSM Criteria:
A. Recurrent episodes of binge eating: (1) Eating, in a discrete
period of time, an amount of food that is definitely larger than
most people would eat during a similar period of time and under
similar circumstances. (2) A sense of lack of control during the
episode.
B. Inappropriate behavior to compensate.
C. Eating and compensation at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and
weight.
E. Not due to anorexia nervosa.
Two types: purging and non-purging type.
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She was invited to attend the PC in Action.
The interview was targeted on the aspects of eating
behavior, loneliness, assertion, expectation from others,
interpersonal relationship, low self-esteem, low selfimage, and her fragile and weak self.
To normalize her eating condition. It was a eating
control problem, not a disease (i.e. to save her face, to
decrease her guilty and shame).
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To find out her strength to fight against BN. The
strength included she want to get marriage and she
want herself well.
The PC in Action group validated her “symptoms” and
empower her.
She had to discuss, agree and accept those methods
suggested by the group before implementation.
To learn to enjoy eating, rather than suffering from
eating.
Behavioral strategies were designed
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To let her trusted persons to know her condition and
difficulties. To seek support from people.
On the urge to eat, she agreed to perform other
activities such as talking to people, walking away and
being occupied by other event instead of eating (i.e. to
interrupt the chain of behavior).
To brush and clean her mouth as a full-stop signal of
eating when she felt the urge. This method was
considered most useful by her.
Once she could not help her from eating, she was
advice to eat and chew the healthy food such as carrot
sticks slowly.
Follow up visit
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Two follow-up consultations afterward.
In the sessions, to find out her difficulties and work out
the solutions with her.
To find out her “dysfunctional thought”.
To maintain her gain. To show her people were taking
care of her. She needed not to conform to people.
Six weeks later, She could control her eating problem
and showed great clinical improvement.
Clinical result
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No more binge eating.
Better inter-personal relationship.
More self-fulfillment, more sense of mastery,
more self-efficacy, improved self-esteem.
Improved general health.
Group support and courage were important for
success.
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She believed that every BN patient should not
lose confidence.
She continued to aware not to engage in binge
eating again.
She would be enthusiastic to help other BN
clients.
Points to learn
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This case demonstrated the powerfulness of
conducting interview in this PC in Action group
setting.
Behavioral methods in controlling BN were
effective.
To handle the inner self of client was also
important in management of BN.
Suggestions
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To work out her past developmental history and attachment
pattern. To conform other may be relevant to the Chinese
Psychology in the relational self.
Difference in the prevalence rate of BN between Western and
Chinese societies?
Usually, BN patient show some problems in these aspects.
To invite her family members to the interview will be
appropriate.
To prevent her from relapse, we should find out the cause why
she adopt binge eating as defense.
That is CBT alone is not the only answer to her.
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Medication can be considered if patient is associated
with depressive features that are common and
psychotherapy alone failed.
To study the efficacy of CBT in this PC in Action
group setting, CBT in traditional group setting and
CBT in individual basis may be useful to find out the
effectiveness of PC in Action group setting in
Counseling and Psychotherapy.
Interpersonal psychotherapy (ITP) is another option of
psychological treatment. ITP does not focus on BN
symptoms.
Slimming industry is suspected
leading to more eating disorder cases.
Eating disorder management is going
to be a big business.
Bulimia Nervosa
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Individual with bulimia may be of normal or
low body weight.
90% are female.
Typically begins in adolescence or young adult.
Usually begins after dieting.
Persists for several years.
Can be chronic or intermittent with periods of
remission alternating with binging.
Common Comorbidities
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Major depressive disorder
Dysthymic disorder
Social phobia
Anxiety disorders
Substance use disorder
Medical complications
Thank you!
Questions welcome