History Taking Strategy: Anorexia Nervosa

History Taking Strategy: Anorexia Nervosa

Eating disorders have been popularized by society's fascination with weight and a thin body. These disorders can be grouped in to three categories: refusing to maintain a minimally normal body weight (anorexia nervosa), eating in binges and then purging (bulimia nervosa), and bingeing without purging. The Merek Manual defines anorexia nervosa as a disorder characterized by a distorted body image, and extreme fear of obesity, refusal to maintain a minimally normal body weight and in women, the absence of menstrual periods. The University of California Los Angeles states that "certain personality traits such as perfectionism may contribute to anorexia." (UCLA, 2006); it is also thought that cultural and psychological factors may contribute as well. This body image and eating disorder usually begins in adolescence, and primarily affects people in middle and upper socioeconomic classes. In the United States it is approximated that up to 1% of young American women have such an eating disorder. The following is a scenario demonstrating history taking techniques of a 16 year old female patient recently diagnosed with anorexia nervosa, taking into account the patients age and education level, such an assessment would be more effective in a comfortable environment that complimented the patients age and knowledge.

Leslie is a 16 year old female student currently just starting her sophomore year in high school; she is well groomed and meticulous in her studies as well as in her extra curricular activities. She enjoys school, holding a GPA of 4.0 and has made the deans list multiple times; currently she is taking advanced placement English and history and plans to continue with her AP studies with the hopes of graduating early and studying medicine in college. She's active with various clubs, including the president of the Christian club as well as the Asian American club. Aside from her academic studies she excels in sports; she's on the track team and runs the long distance events and was recently show cased in the local paper, when its not track season she's on the volleyball team and the basketball team where she is a key player in both. Leslie states she follows a strict exercise regiment in order to remain in shape. She doesn't consider herself popular or pretty, but say that she tries to be friends with everyone and considers herself to be average looking. Her parents do not let her date (alone), but states that she and her boyfriend hang out with their friends over the weekend. She says that they share similar religious beliefs and are not sexually active. She denies tobacco or alcohol use and states that she has never been seriously ill. Like most adolescents she'd rather hang out with friends than at home with her family, placing her within Erikson's Developmental Stage of ego identity versus identity confusion (Jarvis, 2004), which is appropriate for her age group. She appears advanced in her studies, and has a dedicated career plan, which shows she has been successful in her developmental stage.

Out side of school, Leslie enjoys to bake and cook for her family and friends. She owns a large selection of cook books and regularly watches the food channel and surfs the internet for new recipes. She states that she'd rather watch others enjoy her cooking, rather than actually eating it herself. She considers herself a healthy teen, and tries to "eat right". She admits that she's concerned about her weight, and doesn't want to become "any fatter" than she already is; and that she diets by strict portion control, filling up on bread so that she doesn't over eat "other" foods. She denies that she purges or uses laxatives to control her weight, but still thinks