NR606 Final Exam
Lillian is a 9-year-old who presents with her mother after a referral
from the pediatrician. Lillian is 54 inches tall and currently weighs
55 pounds (lbs). As a toddler, Lillian ate most of the foods offered
to her. When she was 6, she witnessed her grandmother choke
on a piece of meat and receive the Heimlich maneuver; her
grandmother survived, but since then, Lillian refused to eat meat.
Over the past three years, her eating has become more restricted;
she will no longer eat anything that requires chewing. Her mother
has been offering soups, purees, and nutritional supplements, but
Lillian has failed to gain weight as she grows taller. Lillian
endorses that she is frequently bullied at school for her refusal to
eat at lunch and during classroom parties.
Does Lillian meet the diagnostic criteria for ARFID?
yes
no
unable to determine – Correct Answer – Yes
Rationale: Lillian meets the diagnostic criteria for ARFID. She
presents with avoidance of eating food based on the sensory
characteristics of the food and failure to meet expected weight
gain appropriate for age and height. The behavior interferes with
her psychosocial functioning and is not better explained by
cultural practice, lack of available food, or anorexia nervosa.
David is a 14-year-old who presents with his mother who voices
concerns about his behavior. David is 65 inches tall and weighs
102 lbs. David has been active in competitive wrestling since age
9 and dreams of joining the U.S. Olympic team. Since starting
high school, David has become preoccupied with his body shape
and body fat percentage. He constantly worries about “making
weight” for wrestling meets. Rather than eating lunch at school,
he goes to the weight room to exercise. David’s mom endorses
that when he gets home from wrestling practice, he eats “huge
amounts” of food. Typically, David will eat an entire frozen pizza
before dinner and then have second helpings during the family
meal. He eats dessert and then “disappears” into the bathroom
immediately following dinner. David’s parents became concerned
after hearing retching sounds in the bathroom. Upon interview,
David admits that when he start
- Correct Answer – bulimia nervosa
Rationale: David meets the diagnostic criteria for bulimia nervosa.
He eats excessive amounts of food in a discrete period and has a
loss of sense of control over his eating. After bingeing, he purges
and uses laxatives to prevent weight gain. His self-image is
influenced by body shape and weight.
Angela is a 15-year-old who presents for an evaluation due to
recent weight loss. She is 63 inches tall and has lost 12 lbs. in the
past 3 months. Her current weight is 89 lbs. Angela was active in
several extracurricular activities, including soccer, choir, and
cheerleading, until three months ago. She has become more
withdrawn from social interactions with friends and, according to
her parents, spends most of her time in her room sleeping. She
refuses to join the family for dinner and instead takes a plate to
her bedroom; her mother endorses that most of the food returns
to the kitchen uneaten. Angela states that she skips breakfast and
does not eat in the lunchroom at school, but she will take a
sandwich into the girls’ locker room and eat it in a stall during her
lunch period. Angela states that she believes she is unattractive
and admits she is probably too thin, but she does not care
because she is too tired
- Correct Answer – major depressive disorder
Rationale: Angela meets the diagnostic criteria for major
depressive disorder. She has withdrawn from extracurricular and
social activities, lost a significant amount of weight, and displays
hypersomnia. She has feelings of worthlessness and fatigue.
Although Angela’s BMI is in the 2nd percentile, she is aware that
she is too thin and does not fear gaining weight; therefore, she
does not meet the diagnostic criteria for an eating disorder.
Ronnita is a 17-year-old who presents with her mother who voices
concerns about her recent weight loss. Ronnita began the school
year at 64 inches tall weighing 106 lbs. She joined the cross
country team; initially, she practiced with the team and came
home immediately after. Now, she runs an additional 6-10 miles
per day after team practice and has lost 14 lbs. in 5 months. Her
mother endorses that Ronnita makes daily comments about how
fat she still is and how much more weight she needs to lose to get
to her ideal body size. Although Ronnita is otherwise physically
healthy, her pediatrician recommended a consultation with a
mental health provider to assess for a possible eating disorder.
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