Case Study #3: Bernadine Hawley Part I: Diagnosis Bernadine Hawley is a 32 year old single woman who is suffering from Bulimia Nervosa Purging Type.According to the DSM-IV, the diagnostic criteria for 307.51 Bulimia Nervosa is:
A. Recurrent episodes of binge eating. Bernadine reports that she is having episodes of binging. She says it is because of her depression.
1. Eating in a discrete period of time’ an amount of food that is definitely larger than most people would. Bernadine reports that she often goes to eat fast food and eats four Big Macs within an hour. She also reports that she has eaten large amounts of food at one sitting.
2. Sense of lack of control over eating during the episode. Bernadine shows that she has eaten whatever is in her refrigerator or in someone else’s refrigerator.
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain’like misuse of laxatives’Bernadine reports that she has "frequently purged herself with laxatives". She also "shoplifts one package at a time" so she won’t be detected.
C. The binge eating and inappropriate compensatory behavior both occur’at least twice a week. Bernadine reports that she is having bingeing twice a week. Bernadine also is worried about her body weight and she has binges sometimes without anorexic periods.
(DSM-IV, 1994, p. 549-550).
According to the U.S. Department of Health and Human Services (2008), binge eating disorder is the most common of the various eating disorders. Usually it is seen more often in older adults but it seems that Bernadine started out with Anorexia and then it moved into binge eating disorder. Help Guide (2009) also states that people with binge disorder have a psychological addiction to food. These individuals cannot stop themselves when they are eating and many are overweight but many have eating disorders.
Part 2: Treatment
When dealing with eating disorders most psychiatrists will look at the behavior that makes someone binge. A common way of treatment is to use Cognitive Behavior Therapy (CBT) because it helps the individual keep track of what they are eating and when. CBT can also help the binge eater find different ways to deal with stressful situations which can eliminate some or all of the food bingeing.
Interpersonal psychotherapy can also help because it helps the individual look at their support system and helps them make changes if necessary. As an example, if the individual has challenges with their mother, they will learn different ways to deal with their mother in certain situations. Sometimes drug therapy is also used (U.S. Department of Health and human Services, p. 3).
In working with Bernadine, I would use a combination of drug therapy and Cognitive Behavior Therapy. She has stated that she eats when she feels depressed which may indicate depression. I would look at her symptoms around this and if she needed medication for depression it would become part of her treatment.
American Psychological Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV). Fourth edition. Washington, DC: American Psychological Association.
Helpguide.org. (2009). Binge eating disorder. Retrieved December 3, 2009 from http://helpguide.org/mental/binge_eating_disorder.htm.
U.S. Department of Health and Human Services. Binge Eating Disorder. Retrieved November 3, 2009 from http://win.niddk.nih.gov/publicationsPDFs/ bingedis10..04.pdf.