Case studies
Case Study 7 – Eating Disorders Not Otherwise Specified (EDNOS)
An 18 year-old female who had been suffering from an eating disorder from the age of 12 was admitted to the Mandometer® Clinic in Stockholm. She had been through eight unsuccessful treatment programs that included multiple hospitalizations and anti-depressant drug therapy. She attempted suicide once by taking an overdose of multiple drugs, but there had been no further suicidal attempts.
At assessment
The patient fulfilled the DSM-IV criteria for an Eating Disorder Not Otherwise Specified (EDNOS). She was of normal weight (BMI = 20.9 kg/m2), induced vomiting after each meal and restricted her eating between meals. She had elevated scores on Comprehensive Psychopathological Rating Scale: anxiety 18, depression 22.5, and obsessional acts and thoughts 19,5, with normal values at 6. She was very shy, spoke very softly, and had problems facing the doctor. She was taking Avanza and ingested 50 laxatives a day. She had normal values for haemoglobin, red and white blood cell counts, platelets, albumin, creatinine, urea, liver transaminases, ferritin, plasma iron, thyroid gland hormones, electrolyte balance and acid/base balance. An electrocardiogram showed normal cardiac rhythm. She had irregular menses.
Treatment
She initiated treatment as an inpatient at the Mandometer® Clinic in Stockholm. Initially she ate small amounts of food, only when alone at night. After 1.5 months as an inpatient, she ate regularly, six times per day, including two meals of cooked food and she stopped purging. The antidepressants and laxatives were withdrawn and she was discharged from the inpatient clinic.
She then continued treatment as an outpatient and stayed in our patient hotel, a living situation that demands increased responsibility from the patient, which she handled very well. She started talking about how much she wanted to recover and said that her previous suicidal thoughts were “no longer an option”. She gradually was taught to take on further responsibility for her meals, eat with others, and she started to eat “forbidden foods” in different environments. Her self-esteem increased, and after seven months of treatment, her psychiatric symptoms were normal or close to normal (anxiety 6, depression 5.5 and obsessional acts and thoughts 7.0) and she reinitiated her menses. Her weight is 126 lbs and her BMI is normal at 22.1 kg/m2.
Remission.
She had a normal BMI, normal eating behavior, she no longer had any issues with food, she had a normal physiological status, and a normal psychiatric profile. She continued to eat six times per day, including two meals of cooked food and her eating behavior was completely normal. She will return to her school upon her return to Australia, where she will continue aftercare treatment at the Mandometer® Clinic in Melbourne until she is in a stable situation back in school. She will then be followed for five years with 11 checkups.