Case Study 4 – EDNOS
A 24 year-old female fulfilled the DSM-IV criteria for eating disorders not otherwise specified (EDNOS) and was admitted to the Mandometer® Clinic in San Diego. She had been treated unsuccessfully in six treatments programs, hospitalized twice and admitted to the emergency room several times. Just prior to admission, she had been in treatment for a year for anorexia nervosa, obsessive-compulsive disorder, dehydration and adverse effects of medication. During that treatment, she had been tube fed, which resulted in a weight gain of 20 lbs.
At admission to the Mandometer® clinic, she was on 9 medications: Asacol 1,200mg 3x/day, Benthyl 20 mg 3/day, Resperdal 25 mg 3/day, Toprol 25mg/day, Cymbalta 30mg 2x/day, Dexedrine 10 mg 2x/day, Allegra 180mg/day, and Nexium 40 mg/day. She had highly abnormal psychiatric symptoms (obsessional acts and thoughts 19, anxiety 17, depression 16.5; normal is 6). The patient was afraid of many common aspects of life, including being outdoors, living alone, walking to and from the clinic, as well as dogs and cats. Her mother stayed with her in her apartment, though had to leave regularly for work and the patient was afraid to stay at her apartment alone. This situation was extremely disabling to both the patient and her family. She admitted to suicidal thoughts, but never attempted suicide.
Her BMI was 18.3 kg/m2 with normal physiological status and normal vital signs.
The patient had to stop her college studies due to her eating disorder. She also had worked in some seasonal jobs but has never been able to maintain a long-term position. She had not visited her parents in almost two years.
After 6 weeks of treatment she agreed to reach a normal BMI. She was eating everything that is asked of her: 300 grams in 10-15 minutes. She also agreed to eat meat, which she had previously rejected. She contacted friends and family that she had not spoken to for years. She spent several days on her own in an apartment. She was coming to the clinic on time, which had previously been a problem. She was watching movies all the way through and was able to comprehend the story. She was grocery shopping on her own, and walking to and from the clinic. She agreed to set a timeline for re-establishing her normal life, which would include volunteer work, swimming and returning to school. The patient reached the point where she was willing to accept a gradual withdrawal from her medications. However, when the total costs for treatment reached $16,000, the insurer decided not to pay despite pre-authorization. The treatment was therefore terminated.