The subject of the study is Miriam Rosen, a 16-year-old female who is suffering from a variety of nutrition-related issues. She is underweight, her hair is thinning, and her teeth are in poor condition. During the interview, Miriam and her parents describe several disturbing tendencies that she exhibits, and in a private conversation Miriam reveals that she has been sexually assaulted. This essay identifies the interview questions, steps for evaluating Miriam’s condition, and the appropriate treatments.
As the patient has come in to receive consultation about her nutrition concerns, the determination of the variety of eating disorder comes first. Anorexia or bulimia are the most likely causes, and so the initial questions should attempt to determine Miriam’s attitude toward food. Once the type of disorder has been confirmed, I can begin investigating for the presence of accompanying issues. I would ask Miriam about the incidence of self-harm in private, as it is often associated with mental disorders. Lastly, the period of the change that was identified by the parents is a matter of interest, and I would encourage Miriam to explain the event that caused the issue.
Miriam’s condition is not severe enough to warrant inpatient treatment. Frank, Hagman, and Solomon (2015) state that outpatient approaches are often sufficient for people who can eat with family support. Garisch, Wilson, O’Connell, and Robinson (2017) state that self-harm in adolescents is usually treated via regular therapy sessions that do not involve the hospitalization of the patient. The same approach should be taken with the depression, in separate visits or via the combination of treatments in one session. The psychological therapy should be supported with appropriate medication use, but the number of different drugs should be minimized, as the threat to the patient’s health is not severe.
I would order a CBC test to evaluate Miriam’s overall health and nutrition and check for the presence of anemia. I would also request a CMP for the same purpose, as the two tests provide a comprehensive overview of a person’s metabolism. The condition of the patient’s teeth indicates a need for a vitamin D test. I would also like to perform a drug screening via urine toxicology to determine Miriam’s medication intake and potential substance abuse tendencies. Lastly, I would request that Miriam take a pregnancy test to check the consequences of the sexual assault.
I suspect that Miriam may be affected by thyroid issues and would like her to undergo testing for potential concerns. TSH is the primary check that determines the level of thyroid-stimulating hormone production in the patient’s body and defines the type of the issue: overactivity or underactivity. T3 and T4 tests will also be necessary to evaluate the functioning of the thyroid gland, estimating the production of its primary hormones. If the evaluation determines that the organ is malfunctioning, additional inspections and treatments will be required.
I believe that Miriam is affected by anorexia and depression, and therefore I have determined Fluoxetine 10 mg q am to be an appropriate starting medication. According to Fluoxetine HCL (n.d.), the drug addresses eating disorders and depression and does not significantly influence metabolism. Classified as an antidepressant/SSRI, the medicine is administered orally once or twice a day in a low dose that steadily increases as the drug is used. Side effects include nausea, drowsiness, trouble sleeping, loss of appetite, and anxiety. The medication can stay in the body for several weeks after last use before being excreted and interacts with numerous other medicines, including MAO inhibitors and aspirin.
I believe that the eating disorder is a side effect of Miriam’s condition. In my opinion, the sexual assault and the associated thoughts, particularly the refusal to open up to anyone about the event, led to Miriam’s depression and self-harm tendencies. After the act, she has begun perceiving herself as “dirty,” as she mentions in the interview. However, her betrayed expectations on prom night led to lowered self-esteem and depression, and she has developed anorexia in a misguided attempt to improve herself and remove the perceived negative factors. Lastly, the tension that arose from Miriam’s inability to tell anyone about the situation led to self-harm in an attempt to relieve the stress.
I consider cognitive behavior therapy to be the most appropriate to the situation. According to Garisch et al. (2017), the treatment is effective at addressing concerns related to adolescent self-harm. Frank et al. (2015) also describe the approach as valid and efficacious for patients with eating disorders. As Miriam’s issues are caused by misguided perceptions of herself and her family, the treatment should concentrate on addressing the underlying causes before shifting attention to the patient’s physical state. Miriam will also receive an antidepressant medication in the form of Fluoxetine. Other possible interventions include interpersonal psychotherapy and dialectical behavior therapy.
Legal and Ethical Reporting Implications
As the sexual assault was not a crime that involved weapon injuries or a domestic violence matter, I am not legally mandated to report it to the authorities. Therefore, I believe that not keeping the information confidential and letting the patient make the decision herself once her treatment is over is the optimal approach from the ethical standpoint. The assault happened a long time ago, and Miriam is not in danger of a repeat offense.
Furthermore, in Untitled (n.d.) she specifically requested that I do not disclose the information to her parents, who would learn about the situation from the police. Alerting the authorities would betray the trust the patient has placed in me and impede the quality of future care, as she will no longer feel comfortable describing her concerns to me. It also infringes on Miriam’s authority and ability to make decisions about her life.
During the interview, I would attempt to determine Miriam’s specific eating disorder and the accompanying effects. I believe that her condition does not warrant hospitalization, and regular therapy sessions with medication intake should be appropriate. I would order a variety of medical tests, primarily to check the patient’s metabolism and investigate for the presence of thyroid gland disorders.
The medication I would begin the treatment with is Fluoxetine, as it addresses both aspects of Miriam’s issues. I believe Miriam’s dangerous habits are caused by her warped self-perception and the resulting attempts to improve herself. Therefore, I consider cognitive behavioral therapy the best approach to treatment, although other options exist, and the patient should still take medication. Lastly, I am not legally obligated to report the sexual assault, and ethical concerns lead me to conclude that not doing so would be better for the patient.
. (n.d.). Web.
Frank, G. K. W., Hagman, J. O., & Solomon, M. (2015). Eating disorders in children and adolescents. Colorado Journal of Psychiatry & Psychology, 1(1), 50-68.
Garisch, J. A., Wilson, M. S., O’Connell, A., & Robinson, K. (2017). Overview of assessment and treatment of non-suicidal self-injury among adolescents. New Zealand Journal of Psychology, 46(3), 98-105.
Untitled [Video file]. (n.d.). Web.