John Cedric R. SimanII-BSPCase Study for Anorexia Nervosa

Anorexia: Katie's story

Katie, 21, had anorexia between the ages of 14 and 19. She shares her experiences of life with anorexia and explains how she recovered.'When I looked in the mirror, a mound of blubber stared back' Katie Metcalfe, 21, is starting a creative writing degree at Cumbria University, but seven years ago her life was very different. "My battle with anorexia started when I was 14. My situation at the time was unusual: I was at a Rudolf Steiner school in Botton Village, near Whitby, in a class with three other boys. The pressure of being the only girl with hormone-raging teenagers was enormous. I had no self-confidence, and my body became a focus of paranoia."Stress in my life multiplied when my parents told me there was trouble in their marriage. In addition, we were about to move house."Nothing in my life seemed to be right. I started to think that perhaps if I lost some weight and improved my fitness, things would change for the better. I assumed that thin people had fantastic lives and I could too."I made a New Year's resolution to go on a diet, so I began to restrict my eating. I cut out fats, carbs and dairy, and lived on rice cakes, apples and lettuce."As I began to lose weight I started to feel that life was worth living. At last I seemed to be achieving something. A voice began to whisper in my ear and as I lost more weight, it became louder. Eventually, it was all I could hear. Nothing mattered more than satisfying the voice's need for weight loss and, ultimately, perfection."My weight dropped from 8.5st to under 5st. My hair fell out, my skin cracked and bled, my bones ached and my periods stopped. I was also cycling between 13km (8 miles) and 24km (15 miles) a day to satisfy anorexia's need for exercise. But I still didn't believe I was thin enough. When I looked in the mirror, a mound of blubber stared back."My mum took me to the GP when my periods stopped, but they sent me home with a diet sheet, which said I must try to eat more."Eventually, I collapsed and ended up in hospital after having a minor heart attack while riding my bike. I was kept on a heart monitor for two days. I was sent home with another diet plan and the simple instruction: 'eat'."Eventually, my GP realised I needed help. I was admitted to a psychiatric ward in a hospital in Middlesbrough, where I stayed for the next nine months."I was put on bed rest for five months. My treatment involved cognitive therapy sessions once a week, and I gradually started to eat small amounts of food again. My recovery was slow. What really helped to pull me through was writing and the consistent support from my family."I started to write about my experiences and realised that I wanted to recover so I could help others who were battling with the same problem. I gradually got better and went back home the day before my 16th birthday."I have had a couple of relapses, but five years on I am fully recovered, with few long-lasting effects. Although I have been diagnosed with the early stages of osteoporosis, my periods have come back, so I can have children."I still feel depressed at times, but writing about it helps me get over it. I eat healthily and exercise for pleasure, not punishment. My book, A Stranger in the Family (Accent Press), has been published and I'm about to start a university degree. A few years ago I would never have imagined that."If you're going through what I went through, you must talk about how you are feeling to your parents, friends or doctor, no matter how insignificant you believe your issue might be. It's vital to express depressive feelings because things only get worse if you bottle them up, and this can lead to major health problems."Aim to live every day as though it is your last and not submit to anorexia. Try to defeat anorexia before it defeats you. Always remember that help is out there."

Kevin O. MendiolaII-BSPCase Study for Bulimia Nervosa

A Classical Case of Bulimia Nervosa from IndiaAbstractA classic case of the bulimia nervosa in a young Indian female is reported. This is in the context of the impression that due to increasing western influence, and change in cultural concepts of beauty and thinness among women, illnesses previously considered rare in Indian subcontinent might be becoming more prevalent. Many of the established pre-disposing factors such as female gender, metropolitan domicile, family history of depressive disorder have conglomerated in this case. Rapid and sustained improvement with the low-dose Fluoxetine and the Cognitive Behavioral Therapy is also worth paid attention.INTRODUCTIONThe influence of culture on the development of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) has been long appreciated. These syndromes are more prevalent in industrialized, and often Western cultures and are far more common among females than males, mirroring cross-cultural differences in the importance of thinness for women.[1] These patterns indict current cultural beauty ideals in the etiology and maintenance of eating disorders. A secular trend of increased prevalence of BN is observed in the west during the current century, and the recent point prevalence of BN is around 1% of young western women.[2,3] with another 3-5% suffering from similar eating disorders, known as Eating disorder not otherwise specified (EDNOS) in the Diagnostic and Statistical Manual-IV (DSM-IV).[4] Only few classical cases has been reported so far from the Asian countries, particularly having more western influence, such as Japan, Hongkong.[1] Atypical case of BN has recently been reported from India.[5,6] To our best knowledge, a classic case of BN had never been repo rted from India.CASE REPORTA 22-year-old, unmarried female medical undergraduate, belonging to an urban Hindu extended nuclear family of the upper socio-economic status from a metropolitan city, with predominantly narcissistic and a histrionic traits and family history of recurrent depressive disorder in paternal grandmother, presented with the poor eating habits of insidious onset for 9 years. During her 8th class, she developed liking for a boy in her class who rejected her calling fat. Though, she managed to move on; however, developed dissatisfaction for her body image, and would consider herself fat on the mirror and started looking for means to reduce weight. With gradually increasing concern over growing fat, she started skipping two meals and would take only one meal and salads in class 10th. Over next 6-7 month period, she lost up to 12 kg and looked thin, although she would consider it inadequate and would find herself flabby, in front of the mirror, although at other times, she could appreciate that her clothes had become loose. However, she never had symptoms of micronutrient deficiency or menstrual irregularity. At the same time, she also developed intense liking for the high calorie foods. She would binge on them 5-6 times a month and would regret afterwards. She tried to induce vomiting also once or twice. She started exercising for 1-1 h in order to compensate weight gain out of binging. This pattern continued for next 1-1 when she gave up working out unwillingly, to focus more on studies, and she gained about 4-5 kg. She would be distressed with it. She passed class 12th with expected marks and qualified for MBBS course. She restarted dieting; however, within few months she again started having increased craving for the high calorie foods and binging, which would be more when she would deny food in parties. Though she knew that her Body Mass Index (BMI) was well within normal range, she started taking one tablet of Orlistat daily secretly along with skipping meals and rejoining gymnasium in order to reduce her weight to below 50 kg, which was below normal for her height. She would often consume isaphgul husk for purging after binging. She sold her gold necklace without informing the family members to undergo liposuction. She could undergo a single session after which it came to the knowledge of a family member, who refrained her. During last 5 year, she would compare herself with every female she met or read about in novels, would feel better on seeing obese females, and feel let down if they were slim. She could not spend an hour without fear of becoming obese. In recent times, she would avoid parties, going out with friends, standing for photos, and would spend hours in the gymnasium.At the time of consultation in the Psychiatry out-patient department, her BMI was 23, which is within normal range. Her laboratory investigations including, complete hemogram, liver, and renal function tests, serum electrolytes, plasma blood glucose levels were normal. She was put on Fluoxetine 40 mg, and Cognitive Behavior Therapy was started. She is under regular OPD follow-up with sustained improvement since last 18 weeks. DISCUSSIONThis case is a typical case of BN with obvious presence of a morbid dread of fatness, body image dissatisfaction and setting a sharply defined weight threshold and binging associated with compensatory behavior. Rapid and sustained improvement with the low-dose Fluoxetine and Cognitive Behavioral Therapy as observed in this case is usually not seen. Despite ongoing adoption of western values world-wide, body dissatisfaction is remarkably lower in non-western countries.[7] Cases reported earlier from India was lacking fear of fatness.[5,6] Study on Indian medical students by the Srinivasan et al. found 15% of the 210 students had a form of distress and disorder in attitude towards eating habits and body weight, which are milder or subtle than AN or BN.[8] The author termed this as Eating Distress Syndrome.[9] Pary-Jones, referring to the historical evolution of eating disorder have mentioned about its archaic form, a less sever and benign form of AN or BN.[10] The authors stated that the current severe form of eating disorder such as AN, BN might have emerged form of this archaic form. This historical evolution of major eating disorder from older form had been observed in studies carried out across different culture and region over different periods of time. Hence, it is possible that major eating disorder might be in evolution phase in countries like India, and largely present here in its archaic form. However, this case may be taken as an indicator of emergence of BN in the context of rapidly increasing western influence in India. Well-designed systematic studies might be able to find out more cases.

Cedric D. BoraboII-BSPCase Study for Bulimia Nervosa

Bulimia an Eating Disorder

A case studySarah, a 26 year old female patient, suffered with bulimia since high school. Her body mass index was 20 kg/m2. She went through periods of excessive bingeing after which she would hide all of her food wrappers under her bed. This behavior would be followed by excessive vomiting and laxative abuse. It was only at her most recent dentist appointment that the dentist picked up the abnormal eating behaviors.IntroductionIn many ways, bulimia nervosa represents the inability of the person to sustain prolonged starvation or semi starvation such as the classic anorexia nervosa. Unlike anorexia nervosa, these patients normally stay within the normal weight range or may sometimes be overweight.The eating binges provoke terrible feelings of guilt and are then followed by attempts to compensate by purging or excessive exercise.Social interruption or feelings of immense discomfort will often terminate the binge and this will be followed by feelings of self-disgust, guilt and depression.Definition of Bulimia NervosaPresents when one episode of binge eating occurs relatively frequently (twice a week or more) for at least 3 months; compensatory behaviors are practiced after binge eating to prevent weight gain primarily self-induced vomiting, laxative abuse, diuretics, or abuse of emetics and in less than 20% severe dieting and strenuous exercise. The weight does not drop as much as in anorexia nervosa. The patients had a morbid fear of fatness, a relentless drive for thinness, or both. A disproportionate amount of self-evaluation depends on body weight and shape.EpidemiologyBulimia nervosa is more prevalent than anorexia nervosa and is more common in woman than men. A total of 2 4 % of young woman sufferfrom bulimia nervosa. However, onset is often earlier than in anorexia nervosa.Clinical Presentation of Bulimia Nervosa Falls within a normal body weight range or may be overweight; Enlargement of the parotid gland resulting in typical chipmunk face; Serum amylase levels raised; Erosion of dental enamel; Dehydration and electrolyte changes; Tears in the gastric mucosa, and bleeding; Laxatives can lead to large bowel problems; Often scratches on the back of palate and hands from inducing vomiting.Treatment of Bulimia NervosaMost patients with uncomplicated bulimia nervosa do not require hospitalization. If behavior is accompanied by suicidal tendencies or self-harming behavior or there is a physiological cause then hospitalization may be required.Psychotherapy is frequently stormy and may be prolonged.SummaryBulimia Nervosa is characterized by higher rates of partial and full recovery as with anorexia nervosa.Two-thirds of the patients will benefit from treatment. Poor prognostic factors include the presence of a personality disorder and substance abuse. Patients are vulnerable to relapse after discharge.

Good Evening,A warm word of welcome to everyone tonight as we celebrate[insert event or occasion].Tonight is a exceptional evening - I am so glad that so many special people have been able to join us this evening.As, always, to absent friends - we still miss you.But, tonight is all about celebrating!It brings to mind the all too true words, that at times, we should "dance like no-one is watching"!And tonightisone of those nights!Let's capture some magical moments, let's create happy memories and let's surround ourselves with laughter and friendship as we celebrate this special occasion.Have fun, thank you for joining us and go ondance a little...like no one is watching!-jc siman