Case Study Analysis: Victoria

Victoria is a 24-year-old Dallas Cowboys Cheerleader from Arlington, Texas, who has struggled with emotional distress, particularly following her parents’ divorce. Even though she no longer takes medications that contributed to her gaining weight, Victoria has had a history of binge/purging behavior, during which she engages in more preoccupations that lead to depression: Case Study Analysis: Victoria.

This makes her feel guilty and ashamed that she feels a great deal of suffering after the event. In this case study, the diagnoses, possible treatment, and administration of pharmacologic treatment for her eating disorder, depression, antibiotics, and anxiety disorder will be presented. It means he needs a multiple-method, holistic care process – to make her situation better.

Diagnoses and Differential Diagnoses

Primary Diagnosis: Bulimia Nervosa (ICD-10 Code: F50.2)

Specifiers

Purging Type: The purging subtype of bulimia nervosa refers to undesirable compensatory behaviors like vomiting, exercising, or utilizing laxatives whenever one has a binging episode (Jain & Yilanli, 2023). Self-induced vomiting after the intake of large portions of food is present in Victoria, which confirms this subtype of bulimia nervosa.

Victoria presents with clear symptoms of bulimia nervosa. She describes regular episodes of compulsive eating and then purging behaviors such as vomiting. These behaviors are consistent with the Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis for bulimia nervosa, including her feelings of guilt and shame after binge/refusal to eat and subsequent vomiting.

Bulimia nervosa can be seen in any normal weighted person even though it is a common notion that it targets only underweight individuals. This diagnosis is supported by her reported disordered eating behaviors and emotional issues that signify bulimia nervosa. The psychological characteristics of bulimia nervosa, like obsession with body image and eating patterns, also back this diagnosis.

Differential Diagnosis

Major Depressive Disorder (MDD) – Recurrent, Moderate (ICD-10 Code: F33.1)

Victoria’s depressive symptoms began after her parents divorced and remained throughout her entire lifetime. She is sad, feels worthless, and is unmotivated, all of which are symptoms of a major depressive disorder (Bains & Abdijadid, 2023). The chronicity of her bouts of depression would be consistent with a diagnosis of recurrent moderate Major Depressive Disorder. Her depressive symptoms become more intense when stress is evident, and she turns to disordered eating.

Her perception that everyone would be better without her, though not suicidal intent, is a reflection of a serious depression that must be treated. Her bouts of depression seem to be exacerbated by the demands of her work as a cheerleader and the emotional issues that occur in her family background. Her depression must be treated in conjunction with her disordered eating.

Anxiety Disorder, Unspecified (ICD-10 Code: F41.9)

Victoria experiences high levels of emotional distress and anxiety, particularly in stress response. Although her anxiety does not amount to the severity that would justify a predefined anxiety disorder, her generalized anxiety is sufficient for a diagnosis of other specified anxiety disorder (F41.9). Bulimia nervosa also tends to co-occur with anxiety and depression, which also seems to apply to Victoria because it illustrates her mood disorders that also affect how she shows signs of the disorder’s eating patterns. Her lack of ability to cope with stress and other stressful states, problems with medications as well as antisocial behavior also point to anxiety as one of the significant factors contributing to her emotional problems.

Pharmacological Treatment Recommendation

Fluoxetine (Prozac) 60 mg/day

The recommended starting dose for fluoxetine is 20 mg daily, typically taken in the morning. The dose can be gradually increased by 20 mg every 1 to 2 weeks based on clinical response and tolerability. The maximum dose is 60 mg daily. Refill authorization is typically provided for up to three months (Sohel et al., 2024).

Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression, anxiety, and eating disorders, including bulimia nervosa. Fluoxetine acts on neurotransmitters and assists in stabilizing moods, reducing anxiety, and decreasing compulsive behaviors that are part of bulimia. Several studies prove that fluoxetine can effectively lessen the frequency of binge-purge episodes, and therefore, it can be recommended for Victoria (Sohel et al., 2024).

The reason fluoxetine is crucial is that it can treat both her depression and anxiety, which will make her avoid eating less emotionally. This approach can help achieve therapeutic doses that achieve the goal of the intervention without possible side effects, which is important in Victoria’s treatment. This is because 60 mg is the maximum daily dose they allow for the treatment of bulimia nervosa and is equally effective for depression.

Conclusion

The integration of Victoria’s case shows how eating disorders are interrelated with depression and anxiety. Self-induced vomiting intensifies in response to her depressed and anxious moods. With the use of fluoxetine (Prozac), which should be taken at 60 mg per day, all these aspects of her illness are treated effectively: depression, anxiety, and bulimia nervosa.

This medication can be taken together with psychotherapy, such as Cognitive behavioral therapy (CBT), to effectively manage the emotional and behavioral aspects related to her eating disorder. It is thus possible to help Victoria start her process of healing so that the episodes of binge-purging are fewer and her mental health is better.

References

Bains, N., & Abdijadid, S. (2023). Major depressive disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Jain, A., & Yilanli, M. (2023). Bulimia nervosa. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562178/

Sohel, A. J., Shutter, M. C., & Molla, M. (2024, February 28). Fluoxetine. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459223/

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Case Study:
Victoria is a Dallas Cowboy’s Cheerleader. She is 24 years old and lives in Arlington, Texas.

C.C.: My eating is out of control

HPI: Victoria has a history of depression but is not currently taking any medication due to the concern for weight gain. In the last couple of years, when her depression gets bad, she will binge eat and then purge.

In one episode, she will eat an entire large pizza followed by a quart of ice cream with hot fudge and whipped cream. She feels so bad after the binging that she makes herself vomit everything up. She feels shame and guilt. She doesn’t know how to make it stop.

Current medication: Occasional Motrin for pain, MVT

NKDA

Past Medical Hx: negative

Past Surgical Hx: negative

Ht 70 inches. Wt. 120 lbs. BP 110/72 P83 R12

Past psych Hx: Hx of anxiety and depression since her parent’s divorce. Started on sertraline 50 mg when she was 16. Did not take it longer than 3 months due to concern for side effect of weight gain.

Since that time she tries to work out when she feels stressed or low. No hx of SI or HI but has had thoughts people would be better off if she was no longer here. No hx of hospitalizations.

Social Hx: She lives with her mother, who was a Dallas Cowboy Cheerleader when she was a young woman. Victoria’s parents divorced when she was five years old. She does not have much contact with her father.

When not practicing with the team, she teaches dance and yoga. She does not date and does not have many friends with whom she socializes.

Denies hx of smoking, ETOH, or any illegal drug use.