Emma's Eating Disorder

February 12, 2018 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
By Yasser Al-Obudi (5th year Medical Student)
Emma Smith
12/01/2001 (17 years)
College Student
I was brought in by her mother. She is worried that I am using things to help look after myself

[If pushed] I am looking after myself to lose weight. I am very proud of going from a size 14 to a size 8 because of how healthy I am feeling and looking. I have done so well in the last 6 months! 
"I can't be ill, I'm doing so well in school". I am aiming for A* in my A-level exams and I am doing very well. 
My mother doesn't know what a healthy diet is. It is important not to eat often and so I always tell my mum that I feel full. I refuse to open up about my diet, only stating that I eat very healthily. 

[Very reluctantly] Becomes angry and agitated when asked. "Please don't ask stupid questions." 
I have been unhappy with my looks since the age of 10. I always thought I was ugly, my friends just lie that I'm pretty to make me feel better. 

[If asked about laxatives directly] I got some laxatives from the pharmacy because the food I was eating wasn't coming out. It is only for constipation. I sometimes take a couple of doses a day until I'm getting it all out.  

[Physical symptoms] My periods have stopped. "It is ok, I checked - I'm not pregnant". Volleyball tires me out very quickly these days. 
She denies vomiting up any food or using any illicit drugs. She denies any recent episode of self-harm or any suicidal thoughts. Her mood is good, and she enjoys going to school. 
Past Medical History
General anxiety as a teenager
Anaphylaxis (4 years ago) - unclear cause 
1 episode of self-harm (cutting her arm) 6 years ago – but she regretted doing this
Drug History
None. Allergic to penicillin
Family History
Social History
Occasional cigarettes when hungry, no alcohol as that would be unhealthy. 
Lives with mother, father and one younger brother in a five-bedroom house. Father runs a very successful business and mother is a primary school headteacher. 
She regularly goes out with friends and is the captain of the girls’ volleyball team.
Introduction & consent

Name, age, occupation

Establishes duration of symptoms

Establishes triggers/stressors/life events

Explores pattern of eating disorder

Explores eating habits

Screens for vomiting and laxative abuse

Screens for exercise and drug use

Explores body image perception (body shape ideas, fear of fatness, perception of normal weight)

Screens for episodes of bingeing

Evidence of physical signs (cold, dizziness, weakness, thin hair)

Endocrine dysfunction (amenorrhoea, libido)

Explores views on consequences of behaviours

Looks for risk to self including suicide

Screens for Anxiety (feeling anxious, physical symptoms)

Screens for depression (low mood, anergia, anhedonia)

Explores impact on occupation or social life

Explores available support

Identifies level of insight and willingness to accept treatment

Looks for substance misuse

Previous medical & psychiatric history

Family history of psychiatric or medical disorders

Drug history, smoking and allergies

Ideas "Was there anything you thought it might be?"

Concerns "What about it is worrying you in particular?"

Expectations "Is there anything in particular you were hoping we would to today?"

Communication skills (empathy and avoids jargon)

Summarises back to patient

Gives reasonable differentials & discusses risk (Anorexia Nervosa, Body dysmorphia)