PS440 Unit 8 Eating Disorder Paper Example

Making Weight Until His Heart Slowed: A PS440 Unit 8 Eating Disorder Paper

[Student Name]

Purdue University Global

PS440: Psychopathology

Unit 8 Eating Disorder Paper

[Instructor Name]

[Date]

The teen, his family, his team and the crisis team are composite; the manual, review and trials cited are real.

How He Came to Us

Besides its beds, the center fields a mobile crisis team that meets families in homes, schools and emergency rooms. In February the team was called to a hospital emergency room by the mother of Mason, a 16-year-old high school wrestler from a town in the northern Black Hills. Mason had fainted in the shower. In the emergency room his resting heart rate was 38 beats a minute, his blood pressure was low, and his potassium was slightly below normal. He was admitted to the pediatric unit for medical stabilization. When a nurse told him he would need to eat a full meal plan, he became so distressed that he said he would rather die, and the hospital called our team for a safety assessment.

The history came from Mason and his parents over several conversations. He wrestles at the 132-pound weight class. Last season he cut weight before matches, as many teammates do, by restricting food and water for a day or two. This season the restriction never stopped. He was eating one small meal a day and running five miles before school, and he had dropped from 141 pounds in August to 114, well below the lowest weight class he could compete in. He weighs himself several times a day, says he still looks soft around the middle and panics at the idea of gaining weight. His coach praised his discipline. His mother noticed he had stopped eating dinner but assumed it was about wrestling. His younger sister was the first to say something was wrong. She told her mother in January that Mason's hands were always cold and that he wore two sweatshirts in the house, which she had read about in a health class. Her mother mentioned it to the coach, who said Mason was in the best shape of his life.

Diagnosis

The DSM-5-TR builds anorexia nervosa from three features (American Psychiatric Association, 2022). First, the person eats so little that weight falls significantly below what is expected for their age, sex and growth. Second, they are intensely afraid of gaining weight or keep acting in ways that block gain even when underweight. Third, their sense of their own body is distorted, their self-worth rides on weight or shape, or they do not grasp how dangerous the low weight is. A restricting type and a binge-eating or purging type are distinguished.

Mason meets each criterion. His intake is severely restricted, and his weight is far below what is healthy for a growing 16-year-old. He fears weight gain and exercises to prevent it. He sees fat that is not there and judges himself by his weight. He is of the restricting type, with excessive exercise. His heart rate and fainting show that his illness has become medically dangerous.

What his coach called discipline was the disorder: a fear of weight gain that no longer had anything to do with making weight for a match.

Why It Was Missed

Murray et al. (2017) reviewed research on eating disorders in males and argued that they have been poorly understood, partly because diagnostic criteria and screening tools were developed mainly with girls and women in mind. Boys and men are less likely to be identified and to seek treatment, and their concerns may center on leanness and muscularity rather than thinness alone. The authors also noted that certain sports, especially those with weight classes, may increase risk by normalizing restriction.

Each of these points applies to Mason. His goal was described, by him and his coach, as being lean and strong rather than thin. Weight cutting is a normal part of his sport, so the early stages looked like ordinary preparation. And because he is a boy, neither his parents nor his physician at a sports physical in August considered an eating disorder. By the time he fainted, he had lost nearly a fifth of his body weight.

Why It Is Dangerous

Anorexia nervosa is among the most lethal psychiatric disorders. Arcelus et al. (2011) conducted a meta-analysis of studies reporting deaths among people with eating disorders and found that people with anorexia nervosa died at a rate several times higher than people of the same age in the general population. About one in five of those deaths was by suicide; many others resulted from medical complications of starvation, including heart problems.

Mason's low heart rate and potassium level are the kind of complications the review describes, and his statement that he would rather die than eat raised the second risk. Our team's assessment found no plan or intent, but his distress at the meal plan was intense, and the hospital placed him on close observation.

Treatment

For adolescents with anorexia nervosa, family-based treatment has the strongest research support. In this approach, parents take temporary charge of restoring their child's eating and weight, supported by a therapist, and then gradually return control to the adolescent as health improves. The therapist treats the illness as separate from the teen, avoiding blame of either the adolescent or the parents.

Lock et al. (2010) randomly assigned adolescents to family-based treatment or to an individual therapy centered on the teen with adolescents with anorexia nervosa. Both treatments produced improvement by the end of treatment, but at follow-up more adolescents in the family-based treatment group had reached full remission. The authors concluded that family-based treatment was the more effective option for most adolescents.

Mason's family is a good candidate. His parents are engaged and willing, and his mother has already rearranged her work schedule. The challenges are distance, since the nearest therapist trained in the approach is more than an hour away, and his identity as a wrestler. The plan includes family-based treatment with a therapist by video after discharge, with in-person visits monthly; regular medical monitoring by his pediatrician; and a conversation, led by the therapist and his parents, with his coach about withdrawing from competition this season and the team's weight-cutting culture.

Conclusion

Mason's anorexia nervosa grew out of a sport that rewards restriction, in a boy no one expected to have an eating disorder. The diagnostic criteria fit him fully, research on males explains why it was missed, and mortality data show how close he came to serious harm. Family-based treatment offers him the best chance of recovery, and its success may depend as much on changing what his team calls discipline as on what he eats.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731. https://doi.org/10.1001/archgenpsychiatry.2011.74

Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025-1032. https://doi.org/10.1001/archgenpsychiatry.2010.128

Murray, S. B., Nagata, J. M., Griffiths, S., Calzo, J. P., Brown, T. A., Mitchison, D., Blashill, A. J., & Mond, J. M. (2017). The enigma of male eating disorders: A critical review and synthesis. Clinical Psychology Review, 57, 1-11. https://doi.org/10.1016/j.cpr.2017.08.001