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PSYCHOLOGICAL REPORT

I. Identifying Information
Name: "Lara"
Age/Sex: 19 1/2 years old Female
Address: Vista Verde Imus, Cavite
Birth date: April 9, 1990
Civil Status: Single
Educational Attainment: 4th year Nursing student

II. Presenting Complaint


"Lara" has been presenting maladaptive eating behavior for almost a year. She
keeps her weight in control by restricting on foods, counting calories and running 5 times
a week for 1 hour. She secretly engages herself with bingeing, vomiting and excessive
exercise.

III. Case Background


"Lara" is a 19 1/2 year old female presenting with maladaptive eating behavior. She
is 5 feet 5 inches tall and weighs 115 lbs. with a small to medium frame size.
"Lara" was born in Imus, Cavite City. She is the only daughter of three children and
has two brothers, ages 21 and 15.
According to the client, she rarely eats a normal meal and mostly will consume a
small amount of food during social gatherings. However, whenever she feels stressed or
frustrated from her duty at the hospital, she would consume large amount of foods
secretly, which she says is not normal for her daily intake to release stress. But following
her overeating, she would feel anxious and guilty over her behavior and lack of control .
She would then stick her finger down her throat to be able to vomit.
Her preoccupation with weight and body image started way back in high school in
large part of her mother's consistent concern. It then elevated when she was 18 years old
and a 3rd year college student in EAC when she gained almost 125 lbs.
According to her, weight, appearance and overall self-worth was an issue that
troubled her mother most of her life and was determined to prevent that from happening
to her. Whenever they go shopping for clothes or during family dinner, her mother would
say harsh criticisms about her body and weight and at other times, making her weigh
herself in front of her mother when she says that she doesn't think that she had gained any
weight. In addition, her relatives would also say jokes about the amount of food that her
mother serves to her during occasions.
The client recalled an instance of August 2009 wherein she lost some weight and
was down to about 110 lbs because of her restriction with eating. But she admits that she
finds herself craving cakes and cookies, and other "forbidden" foods. But the moment that
this forbidden foods passed through her mouth, she would start to feel guilty and would
criticize herself. Following this, she would secretly engage herself in vomiting.
At present, "Lara" has been doing some modeling job and photo shoots for
freelance photographers since her boyfriend is a part-time model himself. Her present
Body Mass Index is 19.1, which is considered to be normal for her age. And she has never
been diagnosed nor hospitalized for her maladaptive eating behavior.
IV. Progress of the Case

Session 1: January 23, 2010


Before the first session was conducted at the client’s house in Cavite, the
interviewer first gathered relevant information about the client’s condition through her
boyfriend Eric and her close friend Nisan. The interviewer was already familiar with these
people even before the session began. Rapport was already established and data
regarding the client’s case were easily given and noted.
It was revealed in the interview that “Lara” (the client) was open about her behavior
and would confide this issues with her boyfriend and her friends as well. She is aware that
she has a problem and in fact wants to ask for help but humiliation stops her to do so.
According to Nisan (her friend), even though Lara seems as a happy-go-lucky person she
lacks self-esteem when it comes to presenting herself to people. She dreams of becoming
a model and she is very thankful that Eric (her boyfriend) helped her to be a part-time
model.

Session 2: January 24, 2010


Initial interview was conducted at the client’s house in Vista Verde Imus, Cavite.
Since the interviewer and the client know each other even before the session, it wasn’t
difficult to establish rapport.
The interviewer first assured that all information given by the client will be
confidential and that data gathered will be used for research purposes only.
When the interview started, the client was properly groomed and was able to
maintain her personal hygiene. She was completely at ease and was able to make good
social contact with the interviewer. She showed interest and cooperation during the
interview. She speaks both Tagalog and English with a medium volume of voice which the
interviewer can understand her clearly. When asked about her condition, she readily
admits that she knows that her eating behavior is not normal because she had taken up
Psychiatric Nursing, so she knows what is Bulimia Nervosa.
After the observation and interview, the interviewer decided to end the session
since all relevant information were already gathered.
The interviewer scheduled a battery of psychological tests for Lara. She agreed
right away and decided to meet the interviewer on February 2, 2010.

Session 3: February 2, 2010


The background of the client’s case was completed based on the gathered
information from the client and people close to her. A battery of psychological test was
utilized for further assessment of the client’s case.
Draw-A-Person Test February 2, 2010
Sachs Sentence Completion Test February 2, 2010
In summary, test results showed that the client clearly rejects and depreciates her
mother while also feeling rejected by her family. Based on the interview, the client's family
especially her mother is very critical with her weight and appearance. They would make
criticisms and jokes about her weight during dinner or family gatherings. It also showed
that she is able to establish meaningful relationship with friends and the opposite sex.
Based on the interview from the client and her friends, she is honest about her eating
behavior and wants to ask for help especially from her friends. In addition, she is thankful
of having Eric (her boyfriend) in her life and made her fulfill her dreams of becoming a
part-time model. In terms of personality, she has no control over her impulsive behavior
with regards of her binge-eating and vomiting. According to her, whenever she feels
stressed or frustrated from her duty at the hospital, she would consume large amount of
foods high in fat and carbohydrates to release stress. Following her overeating, she would
feel anxious and guilty over her behavior and lack of control. She would then secretly
engage herself to vomit because she feels afraid that all those calories would make her
gain weight. In addition, it also showed that she is overly concerned with her appearance
especially with her body shape. According to her, she is concerned with her shape and
weight as aspects of looking good and always worries about how others see her.

Session 4: February 5, 2010


The interviewer arrived at Emilio Aguinaldo College to meet up with the client. The
interviewer discussed the results of the psychological test taken by the client and asked
further questions or confirmations about it. The client wasn't surprised with the results of
her test. She admitted that she has problems with her eating patterns but she is willing to
ask for help especially from her friends. She showed a tendency of blaming her mother for
being so critical with her weight. Before the session ended, the interviewer asked the client
to answer a quiz as part of their activity entitled The Eating Attitudes Test (EAT-26).
The client scored a total of 56 on the EAT-26. Based upon her responses to this
eating attitude test, her scores are similar to others who have an eating disorder or at risk
for developing an eating disorder. Based from the client's responses on the interview and
the test, it shows that she is actively dieting and have an active preoccupation with food
that is often associated with bulimia nervosa. She also has difficulty with self-control over
eating and vomiting.

V. Analysis
The client (Lara), was assessed using two (2) Projective Test such as Draw-A-Person
Test and Sachs Sentence Completion Test and an activity entitled the Eating Attitude Test.
After the interpretation of the tests and analysis of the case through interviews and
observations with the client and her friends, it was confirmed that the diagnostic criteria in
the DSM IV-TR for Bulimia Nervosa was met.
Evidences from the client's personal background influenced the cause and onset of
Bulimia Nervosa. Her mother and relatives persistent criticisms and jokes about her weight
and shape greatly affected and influenced the client's view of herself at present. Her
preoccupation with shape and weight as aspects of looking good is in fact her defense
because she has low self-esteem that rooted from the criticisms of significant others. She is
afraid of gaining weight and judges herself largely in terms of her shape and weight and
her ability to control them.

VI. Diagnostic Impression


Axis I 307.51 Bulimia Nervosa
Axis II None
Axis III None
Axis IV Psychosocial problem: problems with primary support group
(family); criticisms from her mother about her body shape and
weight; jokes from her relatives
Axis V Current Global Assessment of Functioning: 70 (Has occasional
impulsive behavior with binge-eating, vomiting and excessive
exercise but is generally functioning well in other areas e.g
school; is able to establish meaningful relationship with her
friends and the opposite sex)
VII. Prognosis
Good Prognosis
The client is aware of her maladaptive eating behavior (ego dystonic) and is willing
to ask for help. There is a good chance of partial recovery of Lara's condition. If the client
can learn how to deal with her problems of self-image and body weight she can go on to
lead a normal and productive life. But they should give attention to the mother-daughter
relationship of the client and her mother which can influence the recovery of Lara.

VIII. Recommendation
The purpose of this psychological testing was to provide assistance for "Lara" as
well as to her parents on what they can do to help her. Recommendation for "Lara's" future
plans are as follows:
• "Lara" should get professional help coming from a clinical psychologist, dietician or
nutritionist to facilitate and address her current condition and give proper
attention for her treatment.
• "Lara" should seek therapy especially family therapy to address her feeling towards
her mother and relatives.
• "Lara's" family should avoid making harsh criticisms and jokes regarding her weight
and body shape. They should instead make her feel loved and cared for by her
family.

Caban, Jareen T.
Psychology major