Case Formulation or Case Management
Confidential Psychological Assessment
Biodata
Name: Azeen Hassan
Age: 19 years old
Sex: Female
Ethnicity: Muslim
Date of Report: 3 December 2019
Name of Examiner: Asayesha Kasana
Symptoms
Headaches, Obesity, High Blood Pressure, Excessive Eating in Less Time, Stomach Burn,
Ulcers, Disturbed Sleep, Distorted Self Image, Harming Herself, Vomiting
1. Excessive Eating
2. Stomach Burn
3. Ulcers
4. Vomiting
5. Headaches
6. High Blood Pressure
7. Disturbed Sleep
8. Obesity
9. Distorted Self Image
10. Harming Herself
Diagnosis
Bulimia Nervosa (BN, 307.51{F50.2}), Recurrent episodes of binge eating, Self induced
vomiting (inappropriate compensatory behavior) with an average of 4-7 episodes per week for 4
months, Moderate
Psychoeducation
She was resistant at first to come to me again because for first time she came with her
mother but after that she said she won’t come to me because she was taking medicine from
doctors but wasn’t getting well. Then I asked that why she don’t want to come? I asked that
don’t you want to resolve this problem? And want to get rid of these issues which you are
facing? You are going through a disturbed phase, you are taking medicines for stomach issues,
for headaches but still you are not getting well because you can’t stop eating which is the main
cause. I told her that your excessive eating and then self induced vomiting is the crux of all these
problems. I said that I am not going to recommend you any medicine; I will just perform some
distraction exercises with you for your good health. I need your corporation because I literally
want to see you as a healthy and active person. Then she agreed and we started our work.
Treatment Plan
Bulimia nervosa can easily be treated but there are chances for relapse too, so careful
treatment is required. For this treatment planning, I checked first her exercises which she was
doing already, and then I made a schedule with her agreeableness because she was also a student
so definitely I had to be careful.
Treatment Options:
1. Cognitive Behavioral Therapy for Bulimia Nervosa (CBT-BN)
2. Healthy Weight Program for Bulimia Nervosa (HWP-BN)
3. Interpersonal Psychotherapy for Bulimia nervosa (IP-BN)
4. Dialectical Behavioral Therapy (DBT)
Therapy
At first I explained every treatment option to her so that she easily understands that what
we are going to do next.
So the details of all above four treatment options were as followed:
1. Cognitive Behavioral Therapy for Bulimia Nervosa
Cognitive Behavioral Therapy (CBT) for bulimia nervosa directly targets the core
features of this disorder, namely binge eating, inappropriate compensatory behaviors, and
excessive concern with body shape and weight. This treatment focuses on how these
symptoms cycle to perpetuate themselves in the present, as opposed to why they
originally developed in the past. CBT for bulimia nervosa is conducted in approximately
twenty weekly sessions, which encompass three phases. The first phase includes
psychoeducation regarding weight and the adverse physiological effects of binge eating,
purging, and extreme dieting, and helps the patient establish a regular pattern of eating
and an appropriate weight monitoring schedule. In the second phase, the focus shifts to
reducing shape and weight concerns and dieting behavior, and identifying precipitants to
any remaining binge-purge episodes. The third phase is devoted to maintenance planning
and the prevention of relapse in the future.
2. Healthy Weight Program for Bulimia Nervosa
The Healthy Weight Program for bulimia nervosa consists of six sessions designed to
help the patient engage in weight control strategies that do not pose the same
physiological and psychological liabilities as the inappropriate compensatory behaviors
inherent to the disorder (e.g., purging, fasting, excessive exercise). These healthier
strategies include altering food consumption (e.g., cutting out high-fat foods) and
increasing exercise to achieve a negative energy balance and a slim, healthy figure.
Unlike CBT for bulimia nervosa, the pursuit of a thin ideal body is not challenged, binge
eating and purging are not directly targeted, and dieting is encouraged (albeit in a
healthier manner than individuals with bulimia nervosa typically employ) rather than
discouraged. Nutritional education is provided as part of the treatment to inform the
patient’s food choices. Treatment is conducted in a small group format.
3. Interpersonal Psychotherapy for Bulimia Nervosa
Interpersonal psychotherapy focuses on helping clients understand how interpersonal
factors contribute to, and are associated with, bulimia nervosa symptoms. Therapists
work with the client to explore, identify, and change maladaptive interpersonal patterns;
as more adaptive interpersonal patterns are developed, bulimia nervosa symptoms will
decrease. Treatment is divided into three phases. The first phase focuses on raising
awareness of how interpersonal factors are associated with bulimia nervosa symptoms.
The second phase focuses on addressing and resolving the client’s interpersonal conflict
and problems. The third phase focuses on discussing impending termination, reviewing
progress made in therapy, and exploring ways the client can address interpersonal
difficulties in the future. Almost 12-16 weeks requires for this therapy.
4. Dialectical Behavioral Therapy
Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main
goals are to teach people how to live in the moment, cope healthily with stress, regulate
emotions, and improve relationships with others. It was originally intended for people
with borderline personality disorder (BPD) but has since been adapted for other
conditions where the patient exhibits self-destructive behavior, such as eating
disorders and substance abuse. It is also sometimes used to treat post-traumatic stress
disorder.
Target Symptoms
Her target symptoms were actually those outcomes which seen after excessive eating like
stomach burn, ulcers, high blood pressure, headaches, disturbed sleep etc. so I worked first on
those target symptoms I recommend her some light exercises and here I also had to give her
some medicines but after taking a suggestion from my friend who was a psychiatrist. I told her
first that I won’t give her any medicine but at this time she knows that she needs medicine and as
we had built a good client-therapist relationship so she doesn’t resist and took medicine.
Short Term Goals
Short term goals are those goals which we want to complete or meet in less time. So in
bulimia nervosa short term goals are to control the target symptoms or outcomes immediately.
For this reason, I recommend her medicine and controlled her physical health issues.
Long Term Goals
Long term goals are those goals which remain consistent or lifelong like complete
recovery of bulimia nervosa. For this purpose I performed therapies with my client after all she
came to me for a complete recovery not just timely relaxation.
Initial Phase of Treatment
In every disease or disorder initial phase of treatment based on short term goals which are
related to mostly physic of the patient. So we also started with meeting short term goals for a
successful treatment of bulimia nervosa. When I saw that now she is getting well physically after
taking those prescribed medicines than we moved to next, to therapies.
Middle Phase
I done almost 15 sessions with my client, 1 session in every week, so in middle phase of
treatment we were on 7th session at that time we had started therapies and she was on her way to
betterment and I was providing services to her because we had too much work to do to complete
the treatment. She remained cooperative during the treatment because she had understood that
we are struggling for her better physical and mental health.
Follow Ups
After completing the treatment I said my client to come again after one month for follow
up session. I already had explained her in structuring session that we will also do some follow up
sessions to check either she has chances for relapse after some break or not. I called her for first
time after one month, for second time after three months and for last time after six months for
follow ups. Her reports showed that there is no more need to call her again because she was
finally recovered completely from bulimia nervosa.
