Mary is a 32-year-old secretary working at a solicitor’s office. Mary has been overweight since she was an adolescent but in recent years this has increased to the point where she is severely obese, her current BMI being well in excess of 40 kg/m2. Over the years Mary has tried a number of diet and healthy eating plans, but she has never been able to adhere to the recommendations for any length of time. Mary lives by herself, has a strained relationship with her family – her mother in particular – and has few friends that she feels she can rely on.
Generally Mary’s diet is regular in that she eats three meals a day and her meals contain a wide variety of foods. However, to help cope with her feelings of isolation, Mary “treats” herself with “luxury” foods, such as chocolate, cheesecake and ice-cream. Because this sort of eating is linked to Mary’s emotions, rather than her level of hunger, it can occur at any time. When Mary gets home from work she often goes to the fridge for a small snack; however, Mary finds that after eating the snack she is unable to stop eating and she continues to eat a large amount of food. She may eat, for example, an apple, a slice of cheesecake, several biscuits, a peanut butter and jam sandwich and two or three glasses of chocolate milk. Later in the evening Mary will eat dinner and sometimes she loses control with this as well and eats the extra helping that she was planning to save for the next day, along with a bowl of cereal for dessert. Mary feels guilt and sadness after eating like this and she despises the shape of her body, although she has never told anyone about the way she feels or the about her eating behaviour, even though these episodes of overeating have been occurring, several times a week, for the past 18 months.
Although Mary has often thought about different possible ways to counteract the effects of her overeating, such as going without food for one or more whole days, exercising really hard or taking laxatives, she has never tried any of these things. Ideally she would like to join a gym, but she hates the way she looks and is terrified at the prospect of being exposed to ridicule or derision in the gym or any other public place. In addition, due to her chronic obesity, Mary is frequently short of breath and has chronic joint and back pain, so that even gentle exercise is difficult. At the same time, Mary has been told by her GP that her high body weight, when combined with high blood pressure and high cholesterol levels, is greatly increasing her risk of cardiovascular disease and diabetes. Hence, for the past 3 months, Mary has been taking blood-pressure- and cholesterol-lowering medication. Although Mary has considered, and would like to undertake, bariatric surgery, her current BMI is too high for her to be able to claim insurance coverage and, being on a relatively low income and having no friends or relatives to help her, she cannot afford to pay for the procedure.
For much of the past 12 months, Mary has been feeling down, to the point that she is having difficulty concentrating at work and difficulty carrying out other, everyday tasks. Most days she dreads the thought of getting out of bed. This pattern has been going on since Mary’s 30th birthday and although Mary has never experienced any periods of intense sadness or despair, there is pervasive sense of hopelessness that has been present most days, every month, for the past 2 years. In addition to her other medications, Mary has recently started taking anti-depressant medication. Thus far, however, this medication appears to be doing little other than giving Mary indigestion and exacerbating her already poor quality of sleep.
Although Mary knows that she needs more intensive treatment to get her eating and emotional problems under control, she doesn’t have the strength to rake over her personal life with a therapist and in any case she sees being overweight as her primary problem. To compound things, Mary’s boss has noticed that Mary is not being productive at work and, while sympathetic, has made comments suggesting that unless Mary can improve things he will have no choice but to let her go.
Case study instructions:
Write a report on the above case of Mary containing the following information.
1: Assessment:
(a) Based on the available information, what is Mary’s primary DSM-5 diagnosis and what comorbid psychological and/or physical health problems is she presenting with? Summarize these and other relevant pieces of information in the form of a table that indicates the DSM-5 relevant diagnostic codes, including any relevant V/Z codes.
(b) Outline the symptoms – i.e. key features – that have led you to make this primary diagnosis, including considerations of differential diagnosis.
2. Epidemiology and Classification.
(a) What is the prevalence of Mary’s primary diagnosis in the general population according to the best evidence available?
(b) What evidence is there for differences in the prevalence of Mary’s primary diagnosis as a function of key socio-demographic variables, such as age and gender?
(c) What does the available evidence tell us about the aetiology of Mary’s primary diagnosis?
3. Treatment:
(a) Describe the main treatment options for Mary’s primary diagnosis and the strength of the evidence supporting each of these approaches
(b) What evidence is there concerning the long-term outcome of individuals treated with different possible approaches ?
(c) What are some of the main considerations in deciding which treatment approach, or combination of approaches, is best for Mary marks)?
4. Other
(d) Quality of written expression (appropriate paragraph and sentence construction, appropriate – i.e. scientific – writing style, text clear and concise, correct spelling and grammar)
(e) Inclusion/quality of reference material
(f) Adherence to word limit
(g) Adherence to APA format (in citations and references)