Mental Health In Practice Case Study

Mental Health In Practice Case Study

Introduction: Mental Health In Practice Case Study

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Mental health disorders, also known as mental illness is a term that can cover a wide range in the study of psychology. On one side it includes disorders related to mood or behavior on the other hand it can focus on the thinking process. However, some mental illnesses are related to eating disorders such as anorexia nervosa (AN), bulimia nervosa, and binge eating disorder. In this study, we will focus on anorexia nervosa only. In support of the psychological analysis, one case study of a 14-year-old girl named Jessica is taken, who is suffering from AN. All the information that is gathered in the study can be analyzed by using the 5p's formulation which includes 5 factors presenting, participating, perpetuating, predisposing, and protective. They are a part of gathering the background information of the patient that can play a relevant part in the treatment procedure.

The behavior of self-restricting oral intake and hoarding food

Anorexia nervosa commonly referred to as anorexia is one kind of eating disorder that can be initially identified as abnormally low body weight. The main cause of this health condition is believed to be a fear of putting on weight (Krug et al. 2022). Those patients who are diagnosed with this health condition are found to be controlling their body weight and shape. To prevent gaining weight or the exact opposite means to lose weight they start restricting their food intake amount (mayoclinic.org, 2022). They can use vomiting as a way to balance the food or by excessive exercising.

However, it is believed that Anorexia is never about any kind of food rather it is a way to deal with other emotional problems. In this, the family system is considered the main factor that can affect one person, especially young people (Muratore et al. 2021). In most cases, the person who is suffering from this health condition is below 26 approximately because it is the time when humans become conscious about their appearance and other mental condition simply triggers those. It can occur in patients of all age groups, sexes, races, and origins, but mostly it is observed in girls and young adult women (Krogulska et al. 2019). There was a case of a 13-year-old who was diagnosed with AN and immediately referred to the hospital with the symptoms of disorders of consciousness and cardiorespiratory failure. It is mainly a health condition where the girl was having self-restricting oral intake and hoarding food.

Figure 1: 5P’s formulation in Anorexia Nervosa

5Ps Formulation of Anorexia Nervosa

Presenting Factors

Point: This says about the issues and problems that the person with Anorexia Nervosa is facing. Jessica is a teen of 14 years, going through the issue. It includes restricting foods, anxiety, poor mood, and so on (Paquin Hodge et al. 2019). She refuses to eat and skips her meals frequently. Due to this disease, she makes excuses to avoid eating and ingests low-calorie foods.

Evidence: It is all about Jessica but there are many such cases found all over the world where the person suffering from such a disorder. A person has Obsessive Compulsive Disorder (OCD), thus the person went through various issues.  

Analysis: It is important to acquire knowledge about how the patients present themselves while going through such disorders. They tend to avoid taking an adequate diet and ignore foods that have high calories and fats. The sufferer ingests a very small amount of food which is necessary to sustain only.      

Link: In the above case study it is found that the patient had a serious problem of gaining lots of weight and it was the same with the case of Jessica.

Previously she was suffering from obesity and after this health issue the little is gradually slimming down. This health issue can be a barrier to achieving my future goal which is to be an English teacher.  Their body size, as well as, weight was increasing very quickly and their mental condition got poor (Krug et al. 2021). Both cases are connected as they have the same problems and at the early age of this disorder, they checked their diet chart and daily routine. Both Jessica and that person neglected to take fats as well as calories.

The little girl was gradually decreasing her eating habits which harms the physical or mental health of Jessica. Here, in the growing stage, the girl is not consuming food that can cause severe health issues. During such problems, it is found that the patient’s mental condition gets changed (Meierer et al. 2019). During school days, that person attended a health-related class where the trainer taught the students about the risks of eating junk foods and this teaching made that person change their mentality. That person stopped taking food with fat and prepared a rule for ingestion of food (Ivancic et al. 2021). When the family of that person understood the issue, they took that person for treatment and admitted them to the Partial Hospital Programme (PHP) for a positive result.     

Predisposing factors

Point: This factor examines how a person is susceptible to Anorexia Nervosa. This gives us a general idea of how an individual got such an issue.

Evidence: In a case study it is seen that a 25-year-old female belonging to a Hindu Marwari family had reported having gradual weight loss, and repetitive vomiting for a continuous period of two years.

Analysis: Having a close relative who already has a history of getting affected by Anorexia Nervosa like parents or siblings is most likely to affect the future generation as well with an eating disorder, and mental conditions like going through anxiety and depression (Adamson et al. 2019).  Addiction to anything can also affect the cause of the disease.

Link: Jessica a 14-year-old girl who is from Leeds is seen to be suffering from Anorexia Nervosa.  

Physiological factors state that a person is either not satisfied with their body image, or has a history of carrying anxiety in the past this also shows an effect on the cause of the disorder (jeatdisord.biomedcentral.com, 2022). Social factors like teasing or bullying about the shape of the body can also affect an individual to eat less. Menstrual irregularities for 1 year, She was seen to have a history of obesity in the past, subjected to body shaming, and a family history that led to depression. All these symptoms led to the same disease (Ncbi.nlm.nih.gov, 2022). It is seen that, after the separation of her parents this issue was diagnosed as her mother was regularly out of home for her duty and she was completely taken care of by her sister. It is seen that her elder Sister Fiona also suffering from the same health issue but she recovered from the issue.  

Various factors are the cause of this disorder. She is seen to have all the factors that can cause the disease like she has a genetic connection with the disease like her Elder sister Fiona also had a history of getting affected by the same disease. She also has social factors like she was bullied and fat shammed at school is another similarity. She has also seen her parents get separated at the age of 10 which could have led to depression of some sort. Social factors include weight stigma, bullying, appearance, and limited social networks (Milios, 2019). There are Biological factors that include having a close relative, mental health condition, body image dissatisfaction, a history of anxiety in the past, and behavioral inflexibility.                        

Precipitating 

Point: Jessica had family issues as her parents got separated when she was 10 years old and she lived with her mother. She was a working mother thus Jessica did not get the required concern as her mother was busy with her work.     

Evidence: The issue of Anorexia Nervosa was also found in a teenage girl. She started gaining weight at the age of 12.  

Analysis: The problem of this girl and Jessica are quite similar as they went through poor mental conditions. That girl got depressed by the criticism of her friends and family.

Link: In the case of Jessica, the Precipitating factors are the hurdles that she faced in school, bullying, and fat shaming because of her body shape.

Jessica, the affected girl is socially interactive as she tends to a lovely dog and is interactive in her friend’s group. This refers to the events and factors which are responsible for developing such problems. This may include issues in the family, high stress, loneliness, low self-confidence, feelings of isolation, and so on (Marx, 2019). She was not too fat at that period, but still, she had to undergo various criticisms from both family as well as friends and this affected her mental condition. Thus to lose weight, she changed her diet routine and avoided taking meals. Her parents’ efforts to make her eat brought zero results and she continued negligence in taking proper food.

All the problems started after the separation of her parents. According to doctors, the mental health is fully connected to physical health in this case. Loneliness and depression can be a great reason for these health issues.  At that time she was not so fat to be criticized, still, she was criticized and her mental condition went downward which resulted in her neglecting proper diet and she avoided taking heavy food. They are the factors that worked as a trigger in this case and she started excessive dieting to get out of the situation.

Perpetuating

Point: This factor is about explaining how the current issue is maintained.      

Evidence: In a case study it is seen that a 16-year-old girl was on a diet for some reason.    

Analysis: Mental conditions need to be improved which will lead to less stress and anxiety, improving eating habits will also decrease vomiting and other side effects due to the disorder (Gibson et al. 2021). Self-esteem will positively improve the quality of lifestyle.

Link: The Perpetuating factor that is currently affecting her health condition Jessica is her low self-esteem which is an after-effect of the bullying.

Lower confidence levels and bullying at school can be a great reason for this health issue and the mental disorder. Apart from that, the wrong process of dieting and an unhealthy lifestyle can be a great reason for the gradual health decrement of Jessica. Here the disease of Anorexia Nervosa is treated by examining the mental conditions of the patients, improving their eating habits, improving their parental bonding, and working on their self-esteem and Perfectionism (Moreno-Encinas et al. 2020). Her parents were unable to understand the reason behind it. She had stopped eating, and one day she fainted in school and was taken to the hospital.

After various tests, she was discharged from the hospital with a recommendation to improve her diet (Mairhofer et al. 2021). After thorough advice from her parents and physician, she started eating and her health improved thereby recovering from the disorder. As a result of it, she started having control over her food restricted her diet, and also became unavailable for any kind of positive feedback (medicalnewstoday.com 2022). These factors are the most important to deal with because based on that her health condition can be improved.

Protective

Point: Protective factors are those that provide the required strength to one person who is suffering from any kind of mental health disease.  

Evidence: In the case of Anorexia Nervosa, the main protective factors that work in most cases are the individual attributes, families, and communities. These factors contribute as separate positive effects in the diagnosis, treatment, and recovery.

Analysis: In most cases, the main potential factor identified is either family support or self-realization to fight back against the situation.

Link: In the case of Jessica, her family appreciated her friend’s support, her love for her dog, her aspiration towards her career, and most importantly seeking help.

Protectiveness helps them maintain healthy mental health, which is necessary to fight against any odds (Peterson and Fuller, 2019). It is an essential part of the treatment process, to reduce mental stress and trauma. In different cases, the factors can be different; sometimes it can be family or any other activity. She can recover quickly if she gets proper attention from her parents, who can provide her with an environment to fight back, especially because her sister can help her the most. Especially in Anorexia Nervosa, the family can play a factor if they can modify the environment around food, eating, and weight. However, in some cases, self-realization can be helpful in improvement, which was shown in the prior two cases (Lockertsen et al. 2020). However, there are negative sides to this kind of factor. Sometimes it is tough for the therapist to identify the factor.

Even the patient can lie about their strength or hide information regarding personal likings. A 19-year-old female patient was admitted to the hospital with Anorexia nervosa (Faragalla et al. 2022). Her health condition improved when she started gaining weight. In this case, her inner fighting spirit worked as strength. She is a full-time school girl and in that case, she has to do several activities to continue her study. The malnutrition and gradual weight loss cannot be helpful for her daily activities. In another case, a 25-year-old woman with AN admitted to the clinic whose disorder started 2 years before her current admission (Di Lernia et al. 2019). She started getting better the moment when she improved her eating behaviors.

Conclusion

AN is the loss of appetite or the incapability to eat it can be observed as a symptom of many other diseases. However, those cases mostly relate to mental trauma, which can be caused by family or any other reasons. In the case of Jessica, a 14-year-old female teenager who is fighting with the AN tends to restrict her food intake amount. In her case, the resin can be the bullying that she faced in the school because of her obese nature or it can be her parents splitting up. However, AN can occur by genetics because her elder sister Fiona was also diagnosed with the same health condition and later recovered. The 5ps formulation is the way, that helps the study to be more specific, therefore all the information related to the case can be identified. It helps to analyze the true path of treating the 14-year-old girl.

Reference

Journals

Adamson, J., Ozenc, C., Baillie, C. and Tchanturia, K., 2019. Self-esteem group: Useful intervention for inpatients with anorexia nervosa?. Brain sciences, 9(1), p.12.

Di Lernia, D., Serino, S., Polli, N., Cacciatore, C., Persani, L. and Riva, G., 2019. Interoceptive axes dissociation in anorexia nervosa: a single case study with follow up post-recovery assessment. Frontiers in Psychology, 9, p.2488.

Faragalla, K., So, J., Chan, P.C., Wang, H.L. and Liu, J., 2022. Value of liver biopsy in anorexia nervosa?related transaminitis: A case study and literature review. Hepatology Research, 52(7), pp.652-658.

Gibson, M., Dittmer, K., Hickson, R., Back, P., Wehrle-Martinez, A. and Rogers, C., 2021. The Mid-Diaphysis Is a Poor Predictor of Humeral Fracture Risk Indicating That Predisposing Factors Are Recent. Ruminants, 1(1), pp.23-30.

Ivancic, L., Maguire, S., Miskovic-Wheatley, J., Harrison, C. and Nassar, N., 2021. Prevalence and management of people with eating disorders presenting to primary care: a national study. Australian & New Zealand Journal of Psychiatry, 55(11), pp.1089-1100.

Krogulska, A., Nowicka, D., Nowicki, Z., Parz?cka, M., Sakson-S?omi?ska, A. and Kuczy?ska, R., 2019. A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview. Eating and Weight Disorders-Studies on Anorexia, Bulimia, and Obesity, 24(5), pp.969-974.

Krug, I., Binh Dang, A., Granero, R., Agüera, Z., Sánchez, I., Riesco, N., Jimenez?Murcia, S., Menchón, J.M. and Fernandez?Aranda, F., 2021. Drive for thinness provides an alternative, more meaningful, severity indicator than the DSM?5 severity indices for eating disorders. European Eating Disorders Review, 29(3), pp.482-498.

Krug, I., Giles, S.E., Granero, R., Agüera, Z., Sánchez, I., Sánchez?Gonzalez, J., Jimenez?Murcia, S. and Fernandez?Aranda, F., 2022. Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM. European Eating Disorders Review, 30(1), pp.36-49.

Lockertsen, V., Nilsen, L., Holm, L.A.W., Rø, Ø., Burger, L.M. and Røssberg, J.I., 2020. Experiences of patients with anorexia nervosa during the transition from child and adolescent mental health services to adult mental health services. Journal of eating disorders, 8(1), pp.1-11.

Mairhofer, D., Zeiler, M., Philipp, J., Truttmann, S., Wittek, T., Skala, K., Mitterer, M., Schöfbeck, G., Laczkovics, C., Schwarzenberg, J. and Wagner, G., 2021. Short-term outcome of inpatient treatment for adolescents with anorexia nervosa using DSM-5 remission criteria. Journal of Clinical Medicine, 10(14), p.3190.

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Meierer, K., Hudon, A., Sznajder, M., Leduc, M.F., Taddeo, D., Jamoulle, O., Frappier, J.Y. and Stheneur, C., 2019. Anorexia nervosa in adolescents: Evolution of weight history and impact of excess premorbid weight. European Journal of Pediatrics, 178(2), pp.213-219.

Milios, A., 2019. Holistically addressing motivation and maladaptive traits in anorexia nervosa: Impact on prognosis and treatment outcomes. Dalhousie Medical Journal.

Moreno-Encinas, A., Sepúlveda, A.R., Kurland, V., Lacruz, T., Nova, E. and Graell, M., 2020. Identifying psychosocial and familial correlates and the impact of the stressful life events in the onset of anorexia nervosa: Control-case study (ANOBAS): Psychosocial and familial correlates and stressful life events in AN. Psychiatry Research, 284, p.112768.

Muratore, A.F. and Attia, E., 2021. Current therapeutic approaches to anorexia nervosa: state of the art. Clinical therapeutics, 43(1), pp.85-94.

Paquin Hodge, C., Meilleur, D., Taddeo, D. and Frappier, J.Y., 2019. The behavioral and affective profile of inpatient adolescent girls with restrictive anorexia nervosa. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 24(4), pp.645-649.

Peterson, K. and Fuller, R., 2019. Anorexia nervosa in adolescents: An overview. Nursing2021, 49(10), pp.24-30.