Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem
Presenting Problem: You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.
Other Contexts: You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past

Question: Which one of the following drugs has been proven beneficial in treating anorexia nervosa?
(A): Amitriptyline (a tricyclic antidepressant)
(B): Olanzapine (an antipsychotic)
(C): Fluoxetine (a selective serotonin reuptake inhibitor [SSRI])
(D): Diazepam (a benzodiazepine)

Correct Answer: Olanzapine (an antipsychotic)
Explanation: The only medication with evidence-based proof of effectiveness in treating anorexia nervosa is olanzapine, a second-generation antipsychotic that has proven to be effective in the case of severe illness associated with drastic weight loss in anorexia. Olanzapine has shown the ability to aid in weight gain in this scenario. Antidepressants such as SSRIs and tricyclic antidepressants have not shown evidence of improving the negative behaviors associated with anorexia or in improving negative thoughts and distorted self-image, although antidepressants, specifically fluoxetine, have been recommended and are proven effective in the treatment of bulimia nervosa. Benzodiazepines slow down the information traveling between the brain and body and are not an effective treatment of anorexia nervosa. Therefore, the correct answer is (D)
Competency: treatment planning