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Binging Betty
Betty, 23, is a student at the local university studying to be a fashion designer. With her innovative styles and drive Betty was almost guaranteed to get the coveted design apprenticeship in New York City offered to the top student in her design program. During a recent break from school Betty’s mother Janet began noticing that Betty was thinner than usual and figured it was due to a “lack of home cooked meals.” Betty always would eat “lots of food” but never gain a pound. One evening Janet was folding laundry in the next room and she heard Betty making an odd “choking sound” in the bathroom after dinner. Janet opened the door and saw her daughter hunched over the toilet sticking her fingers down her throat purging. Alarmed, Janet immediately thought these problems had “went away” as Betty had been caught purging once on Thanksgiving Day after eating “a bunch of sweets” as an early teen. Back then Betty convinced Janet that it was a “one time thing.” It was not until Janet received a call from the hospital three weeks after Betty returned to school that the depths of Betty’s eating disorder were revealed.
Case description
Betty had received “counseling for her thoughts” in her teen years but revealed that the therapy “just made her better at hiding her problems.” She was diagnosed with Dysthymic Disorder and finished therapy after about 10 sessions. The binging, purging and restrictive behaviors were never fully addressed in therapy as Betty “hid things from her therapist.” A medication evaluation was recommended. Betty’s father Mitch was against the use of medications so that avenue of treatment was never explored. Betty hid her dietary restrictions, purging & sadness from her mother and father as well as everyone else. No one knew that Betty had been using excessive diuretics and has been continually binging carbs & purging ever since adolescence. Medical tests revealed a tear of her gastroesophageal junction, malnutrition, and significant dehydration. There was marked dental damage as well as significant erosion of area of the esophagus. In tears, Betty looked to her mother from the hospital bed and she finally began to admit her struggles with Bulimia Nervosa.
Bulimia
1. Decreased tracer activity in both inferior orbits improving with concentration.
2. Significant asymmetry in basal ganglia with both the left and right displaying intense hyperperfusion. The asymmetry becomes more pronounced with the right side increasing and the left side lowering during concentration scans.
3. Significant hypoperfusion and dehydration throughout the cortical surface. The most pronounced areas were parasagittal parietal areas.
4. Increased anterior cingulate gyrus activity more pronounced during concentration.
LifeBridge Treatment Plan
Betty was paired with a local psychologist that was very familiar with behavior therapy and a treatment regime was devised to break conditioned patterns of binging, purging and excessive use of diuretics. Betty was prescribed both individual and group therapy in addition to the behaviorist. A communication/education planning session was held with Betty’s family about medications. After Betty’s father was educated about some misconceptions he held about medications, he was on board. A serotonergic antidepressant regime was recommended. It was suggested that Betty regularly attends support groups for eating disorders. Betty’s parents were given referrals to attend educational workshops about Bulimia Nervosa.
Treatment Update
Betty was able to have almost 45-days free from binging and purging behaviors since her comprehensive evaluation. While the road has been arduous, Betty is making some headway in revamping her self-image. Betty did have a setback when she did not receive the apprenticeship in New York. She discontinued her medication against medical advice, only to see symptoms return within days. Betty has since applied for another less prestigious apprenticeship in Los Angeles and has received a second interview request. Betty is dedicated to continuing her treatment and managing her Bulimia in order to live her dream of being a fashion designer.
