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Vignette 2: Brandy

This case involves a 19 year old Caucasian female named Brandy. She is 5’5” tall and weighs 116 lbs. She states that on a “good day” she would eat a breakfast of dry toast and juice, a lunch of turkey or dry tuna on diet bread, and a low fat frozen meal at dinnertime. When she was being ‘bad’ she would include a couple of candy bars and two large ‘gourmet’ chocolate chip cookies.

Brandy says that she feels fat and is sure that others are disgusted by the way she looks. She doesn’t think that others want to be around her because of her weight “problem” and how she looks.

She has tried a number of diets to control her weight. A couple of years ago, she saw a television show that discussed throwing up after eating as a way to control their weight. She has hidden her habit of purging after eating. She doesn’t want anyone to know.

Brandy has begun to isolate herself and states she feels sad most of the time. She has begun to have trouble with friends at work because she makes excuses not to go out with them. When friends express concern, she becomes more distant and becomes agitated with them.

She admits that she doesn’t have much hope that anything will change about her weight or her feelings.. She mentions that she has stopped having regular periods and developed some dental problems which causes more concern over the way she looks.

The information regarding Brandy’s family of origin is sketchy, however, Brandy describes her mother as someone who was severely overweight and was always on a diet. She recalls her father being particularly cruel to her mother with his snide comments about her weight. Brandy also remembers times that her father looked at her in ways that made her uncomfortable and his conversations often included sexual overtones. However, she states that he never touched her inappropriately.

Writing a case study:

The following provides a brief outline for writing a case study:

Start your case study by providing a brief introduction to the case including relevant background and basic demographic information. Do not restate everything in the vignette at this point. Consider what is most important to include in an introduction to the case.

Symptoms and Diagnosis

Identify important symptoms and compare the symptoms (including severity and how long the symptoms have been present) to the DSM-5 diagnostic criteria to identify a diagnosis. Clearly explain how the individual’s symptoms meet the criteria and support your diagnosis. Also note any criteria the individual and their symptoms do not meet.

Differential Diagnosis

Consider other possible diagnoses or additional diagnoses. Once again, provide the DSM criteria that supports or rules out the diagnosis. Fully explain and support your position.

Treatment

Present a rational treatment plan. Some attempts at treatment may be mentioned in the case study, but are do these represent the best treatment approaches? Are there also other treatments that could be used in lieu of the current treatment or in addition to it? Consider the social/environmental issues that may make treatment more challenging or complicate it.

Prognosis

What is the prognosis for the individual in the vignette considering his diagnosis, treatments available, and other factors including social/environmental issues.

 

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