Transcript About a Boy – Case Study

Lynne Bell
Willowgrove House
Holistic Model of Care
Member of Community of Communities
Recognised by:
The Royal College of Psychiatrists,
Centre for Quality Improvement
www.therapeuticcommunities.org
Referrals from Department of Child & Family
Psychiatry, St Johns Hospital Livingston
Referral Criteria:
Young Person 11 – 18 Years
Unlikely to respond to outpatient intervention
Commitment to participate in programme
Social phobia
Self-harming
Anorexia nervosa (F)
Psychotic symptoms
Low self-esteem
Anorexia nervosa (M)
Depressive disorder
CSA
Conduct Disorder
Anxiety
Communication difficulties
Autistic
Behaviour difficulties
ASD
Asperger's syndrome
“Any formulation of anorexia nervosa and
related eating disorders should aim to reflect
the complex interplay over time of the major
causative and maintaining factors”
Childhood Onset Anorexia Nervosa and Related
Eating Disorders Lask et al (1993)
The individuals unique story of how the
difficulties came about and why they have
continued to experience them.
NICE CG009 Eating Disorders
Core interventions in the treatment and
management of anorexia nervosa, bulimia
nervosa, and related eating disorders (National
Clinical Practice Guideline Number CG9)
developed by the National Collaborating Centre
for Mental Health
commissioned by the National Institute for
Clinical Excellence
Eating Disorders in Scotland
•Summary of Recommendations for
Management and Treatment
•NHS Quality Improvement Scotland 2006
•NHS QIS
April 07
•Jon 15 Years
•Increasing weight loss from time of reaching
healthy weight, 4 months ago.
•Lost further 2 stones since then
•Eating approx once every 3-days
•Then inducing vomiting
•Marked anorexic cognitions
•Fear of fatness
April 07
•Body image distortion
•Height 170cm, Weight 54Kg, BMI 18.7
•Absent from school previous 4 weeks
•Attending alternative curriculum
•Not eligible for exams – due to non
completion of course work
•Broke up girlfriend 3 weeks ago
•Mum also very concerned
School refusal, due to bullying, 3 years ago
•Description of Difficulties
•Overview of Experiences
•Parental Influences
•Environmental Influences
•How Difficulties Developed
•Summary of Maintaining Factors
•Positive Factors Influencing Recovery
Mum, brother & sister live at home
No contact with father
Shares room with brother
Mum
Jon
28
26
19
18
Living at Home
15
•Withdrawn from social contact with peers
•Isolating himself in room
•Previously large peer group – Skateboarding
•Smokes 10-12 Cigs per day
•No alcohol or drugs
•Previously overweight
•Bullied at school
•Losing weight sensibly diet & exercise.
•Emergent anorexia from time of reaching
ideal weight
•Not on medication cognitively impaired
•Muscle & bone pain
•At risk of developing bed sores
Anorexia nervosa & secondary depressed
mood in 15yr old boy attending school.
“To eat without having paranoid thoughts about
others staring at me and, maintain my weight and
feel better about my shape”. Jon
•Planned Action
•Individual Sessions
•Group timetable
•Weekly meetings with dietician
•Daily meal plan & meal time supervision
•Body image work
•Family Work
His mood was really bright and he shared that
he “loves life and all is going well”
He was attending open learning course at
college.
Celebrating 5mth relationship with his
girlfriend.
Jan 07
•Bryan 15 Years
•Restricting type anorexia nervosa
•Onset Nov 05
•More recent binging & bulimic episodes
•Body image distortion – fear of becoming fat,
4-5 weeks ago feeling faint, cold extremities,
peripheral cyanosis
None
Medical History
•1997 asthma
•2003 shingles
•2004 hay fever
•2005 chest infection
Lives at home with sister and parents.
Dad
Mum
Bryan
11
15
Social situation – several close friends tend to
be older.
•Vegetarian 2yrs ago
•Conflict with his parents about wanting to stay
out with older friends
•Not eating with family since June 06
•Episodes of bulimia followed by vomiting
Some developmental difficulties affecting him
academically, eccentric presentation and very
protective parents.
Eating disorder could be seen as reaction to
these difficulties, attempt to separate and
individuate.
“To eat normal healthy food intake without feeling
guilty and worried thinking about it afterwards.”
Bryan
Short term aims – “To feel OK about weight and
that being the thinnest person in the room is not
always the happiest.” Bryan
Planned Action – weekly individual meetings,
fortnightly meeting with dietician, attend group
programme, regular review with parents.
Positive about life and future
Eating regular and responding to feelings of
hunger
Confident, Determined to get better
Achieved exam results and going to art college
Enjoying life
1. Listen to Your Body
2. Realistic About Your Size
3. Exercise Enjoyable Way
4. Expect Normal Changes in Weight/ Shape
5. Work Towards Acceptance
6. Work on Accepting others
7. Discover Feelings What is Really Bothering
You
8. Ask for Support
9. Keep doing things you enjoy
10. Replace Time Criticising with Positive
11.
12.
13.
14.
Pursuits
Hold Head High
Accept Body is Changing
Question Messages in Media
Decide - Time Spent Pursuing the Perfect
Body Image or Enjoying Family, Friends &
Life