Manny is a 29 y/o male, who is slim, good -looking and a smart guy.He wants to eat
healthy and exercise. His symptoms are more related to bad food habits. He wants
to explore different foods and enjoy them again. He is not looking forward to
fast foods, but he wants to stay in between. He does not want to go crazy about
using saturated fats or sugar. He obsesses about his stomach, and he wants to be
accepted, wants to look like a model from Abercrombie. He said that he feels
confused since he feels that he is not in to that, but his self esteem depends
on it. He reports he is not satisfied with his body image, because of the little
pouch. He reports that he is spending a lot of time thinking about it, at the
gym, he stares at he mirror etc. He feels that the pouch makes him look ugly,
then he may feel that his arms are too small, if he was in control he would
avoid social situations, he pushes his abdomen inside, he avoids people in
hallways if he could.
Three things:
size of the arms
his calves feel little
his pouch
His step dad was controlling about what he wore, the kind of shirts, the food he
ate etc. There were restrictions on every step of the way. After his mother
divorced him, he was not in to the ED.
He got in to the fitness as a profession after he got out of peace corp.
His uncle was a body builder, he kept very active, but his diet was bad.
He got in to the physical fitness while in the army. He was also athletic in
school.
He fears gaining weight, and he is preoccupied with weight and food. He
understands that the weight is the result of the food. The food at the Dom is
not very healthy. The rules are not acceptable for him. He restricts himself
from eating certain foods at the Dom.
PLAUSIBLE INFERENCE:
Pt. was administered the Eating Disorder Symptom Severity Scale.
Pt. seems to meet the DSM -5 criteria for Body Dysmorphic Disorder. He is
preoccupied with he flaws in physical appearance that are not observable or
appear slight to others( for instance his abdominal pouch)
At some point he has performed and has continued to perform mirror checking to
an excessive degree, excessive grooming and comparing his appearance and trying
to pull his stomach in by holding his breath in meetings or group settings.
He has avoided social situations from sheer embarrassment in
response to his abdominal pouch(which is practically inconspicuous)
This preoccupation has caused him emotional distress and caused interference in
his social functioning.
He has comorbid anorexia nervosa traits.
This writer will use the specify at this time
WITH MUSCLE DYSMORPHIA- as he is preoccupied with the idea that his calves are
too small, and his hands are also small and insufficiently muscular in proportion
to his body.
WITH POOR INSIGHT- as he thinks that the beliefs are definitely or probably
true.
Following are the traits of Anorexia Nervosa:
Restriction of energy intake relative to his requirements
Intense fear of gaining weight or becoming fat
Disturbance in the way he perceives his body image
He does not demonstrate the classic presentation of binge eating or purging
type.
He falls under the restriction category where he will accomplish the weight loss
through dieting, fasting or excessive exercise.
Diagnosis: Body Dysmorphic Disorder with Muscle Dysmorphia and poor insight
with anorexia nervosa traits or comorbid diagnosis.
Treatment Recommendation:
CBT with specific focus on BDD to follow with Dr. H
at a treatment Program ( Patient has already verbalized the follow-up)
PAST, FAMILY, SOCIAL HISTORY: He said that he was in treatment for ED for few
months in the past
PERTINENT PAST HISTORY:
Inpatient Admissions-n
Suicide Attempts: n
Outpatient Treatment:
Past Medication Trials: Seroquel, Zoloft, Gabapentin, Wellbutrin, Vistaril,
and Buspar. Pt. reports that he did not feel any relief from any medications. He
had lot of side effects from the medications.
Domestic Violence: n
PAST MEDICAL HISTORY:
Poisoning by other opiates and related narcotics
Opioid Depend, NOS
Herpes Labialis
OCD
MDD , severe, in remission
Unspecified episodic mood Disorder (ICD-9-CM 296.90)
Lack of Housing
Adult attention deficit hyperactivity disorder
Anxiety
Problem situation relating to social and personal history
Eating disorder
mentalhealthmedications 