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:    atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together

Question: All of the following are considered differential diagnoses for anorexia nervosa, EXCEPT:
(A): Dependent personality disorder
(B): Social anxiety disorder
(C): Bulimia nervosa
(D): Hyperthyroidism

Correct Answer: Dependent personality disorder
Explanation: Dependent personality disorder is characterized by feeling incapable of caring for or making decisions for oneself and is not a differential diagnosis for anorexia nervosa. Bulimia nervosa is similar to anorexia nervosa because it involves compensatory eating or exercise behavior; however, it is often accompanied by a more normal weight due to binges. Social anxiety disorder may also be a differential diagnosis if the client’s extreme eating habits result from fear with regard to the judgment of being watched while eating. Hyperthyroidism can be an undiagnosed cause of excessive weight loss. Pathophysiologic causes must always be ruled out if they are a suspected cause of a symptom. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis