Case study in AN Flashcards
AN Case study Luk and Agoha (2014)
Aim
• to describe the experience of a Chinese American Adolescent girl w/ AN
using a case study design
from multiple perspectives
particularly considering culture
AN Case study Luk and Agoha (2014)
Method
1 case study of a Retrospective review of a Chinnese american Addolencent girl with AN and her experiences
Got Parential concent
and youth assent from the child
inpatient (when in hospital) and outpatient (when not in hospital) charts were reviewed
AN Case study Luk and Agoha (2014)
Sample
SAMPLE:
Amy, 15yr petite Chinnese american adolecent female
diagnosed at 13
Showed severe calorie restriction and excessive exersise
BMI = 11.8
she had developed Amenorrhea and cold intolerance and had body image distortions
AN Case study Luk and Agoha (2014)
Care received
Amy’s condition had to be stabilized by refeeding
then she was transferred to the inpatient child/adolescent psychiatric unit for further care
– where she underwent regular individual therapy, group therapy, daily weighings and monitoring of meals
she was discharged after 3 mnth hospitalization when the weight goal was reached and she was at a BMI of 17.25 kg/m²
she was reamited twice within six months for being unable to maintain her weight
after the third hospitalization
– she was assigned a home therapist
– regular visits with nutritionists
– and weekly psychiatric visits
AN Case study Luk and Agoha (2014)
ppt background
FAMILY LIFE
Family Life
• family Dynamics at mealtimes was significant for Amy behaving
– in a child-like manor towards a father
– argumentative with her mother
– who she described as too “traditional” and “annoying”
• mother accompanied her to outpatient appointments their communication was oft tense
• Amy seemed annoyed with her mother’s queries and promptings to maintain calorie intake
• she had emotional outbursts towards her mother complaining she didn’t want to eat at home
– because her mom would do things like:
– keep bread in the freezer
– and insist on whole milk rather than soy milk that Amy liked
• Amy refused to eat meals of her family
– saying she didn’t like the food
– and preferred to make her own
AN Case study Luk and Agoha (2014)
Recovery
Recovery
• as in home services decreased Amy showed herself as competent in consistently making it to appointment alone
• she continued to refuse meals with her family and prepared them on her own
• Amy was determined to find a job and she got a part-time job in a local cookie store
• as treatment progressed she was able to maintain a BMI above 18.5 kg/m²
• she reported an episode of menstrual bleeding 15 months after discharge
– showing a Reversal of anorexia symptoms
AN Case study Luk and Agoha (2014)
Analysis of Data and comclusions
• Amy struggle with mother, food refusal and developmental stage are consistent with developmental theories of anorexia
– as a product of the need for independence and control
• in their interactions maternal nurturance and warmth was often lacking
– Amy’s perception of her mother was one of being overbearing and controlling
• Amy did not Express a Desire for fitness verbally or non-verbly of any therapy Sessions
– her reason for not eating was often her disgusted with the food options that had been offered
• Amy well accepted by her peers
– mumford et al 1991’s concept of ‘culture clash’ explains that perhaps Amy was experiencing conflicting cultural norms
– those of her peers and the local community
– against those of her parents
– she decided to reject her ancestral culture through her rejection of the families food and food rituals
– which may have worsened her already tense conflict of gaining automony and independence from her parents
– as Amy symbolically rejected her parents love and care
• Amy’s treatment was tailored to address each of the above issues
– under her nutritionist she was held accountable for more balanced food choices and meals
– this works in conjunction with the in-home therapist
– who was able to transverse the cultural divide
– and made treatment recommendations practical from the home setting
• after 10 months without patient treatment Amy visited China with her family
– there she no longer needed to reject her parents in order to fit into the culture of the surroundings
– her parents allowed her to have more freedom in China
– which led to a great herself of self-determination and autonomy
– she became more secure in herself and her appearance
– as seen in her proud showing of her studio pictures
– with fewer family and cultural barriers
– Amy was able to progress developmentally
– to achieve more independence
– and a more secure sense of identity
AN Case study Luk and Agoha (2014)
gen -
The studies a case study and there’s only one participants
which is the 15 year old Chinese American female called Amy
whose diagnosed with anorexia nevosa and has a BMI of 11.8kg/m²
Therefore they’re unable to generalize the results of the study (that is the experience of an anorexia patient with their treatments) to study on anyone else
due to the possible individual differences and anomalies in this individual
or for over cultures that are not Chinese American
therefore it’s only generalizable due to being only one participant and also ethnocentric
so – gen for Luk and Agoha 2014
AN Case study Luk and Agoha (2014)
reliability -
Due to being a case study
it is unique and therefore has low reliability
case studies like Amy are unique due to the individual differences of their situation and their condition
such as in Amy’s case for families food and Culture
not wanting to eat it
and not being the same as the local One
conflicting with Amy resulting her not eating and the developing anorexia which is very unique
specific conditions and factors such as those of Amy’s cannot be replicated in future case studies due to being so specific and unique for Amy
resulting in the case study of luk and Agoha 2014 having low Reliability
AN Case study Luk and Agoha (2014)
+ reliability + in valid (triangulation, lots of measures and shows consistancy of those measures for treatments)
Triangulation was used making it reliable and valid
Triangulation via daily weighings and monitering of meals as well as individual and group therapy will all done at once to obtain multiple different versions of data
and using all of them to support one another
and show the experience of Amy as a patient with anorexia during treatment
The multiple sets of results and data make luk and Agoha 2014 internaly valid
Daily gathering of data with multiple measures and tests allows for this triangulation to show
the consistency of findings showing the experience and what is done during treatment for patients with anorexia nevosa such as amy
making luk and agoha 2014
high in reliability too due to the daily measurements of different measures showing consistency in monitoring of the patients conditioned during treatments
AN Case study Luk and Agoha (2014)
application thing + conclusion
In conclusion this study demonstrates the experience and treatment of a real-life anorexia patient
it also suggests another cause of anorexia other than a Desire for thinness and an overall distorted Body Image, despite Luk and Agoha 2014 claiming she has one then later stating it was due to:
– not wanting to eat the food given to her by her parents with whom she had a tense relationship
– this was symbolic of the Clash of the culture shown with her family and the local culture which she has adapted to
– resulting in her not eating
the findings of this study can be useful
as it shows that anorexia doesn’t always occur due to a desires but may occur to situational factors such as
not wanting to eat the same food as the rest of your family because of straining relations
and relations with crossing the families culture with the local culture they habe adopted sybolysed by the food
such as Amy
This study finds a different cause of AN then Body Image dissatisfaction
meaning that this different cause of AN can be treated more suitably than the traditional version
by going to therapy designed to tackle the situational factors that may be causing it
Or in Amy’s case by using with agreeable meals that the parent and child who also agree on and both eat which treats Amy’s not wanting to eat parents food due to it conflicting with the local culture that she has adopted
this kind of treatment can also be done on others with AN who have similar causes
AN Case study Luk and Agoha (2014)
high valid objective data
Luk and Agoha 2014 is highly valid due to using objective data which is measures of body weight with BMI being body weight and height which are both objectively measured with centimeters and kilograms
it’s therefore objective and not a subjective measurement of data that’s not been misinterpreted therefore making it valid
AN Case study Luk and Agoha (2014)
low validity SDB
There may be social desirability bias
As Amy may not want 2 show her true feelings and Reasons Why they’ve developed this disorder
as they may feel that it has a stigma
For example the real reason why she has developed anorexia may not be due to aforementioned factors on
not wanting to cross the local culture she’s adopted with her family’s culture at home
and the straining of her relationship and family as well as not liking the food
while in Fact the real reason why she’s developed it
– is a desire of thinness shown by obsessive calorie counting and having Body Image distortions
It may be that she does not want to state this as it would make their parents worry as it is unhealthy
Also amy may say they have a different cause other than desire of thinness
[which is part of the DSM diagnosis of anorexia as Amy is diagnosed it would mean that he would in fact have this]
To possibly make the experimenters like them more (due to making them feel like they have discoverd a new AN cause)
Due to this social desirability bias possibly distorting the reasons given by Amy for her developing anorexia nervosa not being true
It invalidates the data and conclusion that this is the experience of an anorexia patient as the data given is invalid therefore making the research of Luk and Agoha 2014 invalid
AN Case study Luk and Agoha (2014)
+ eco + mundane realism (real)
The study by Luk and Agoha 2014
had high ecological validity due to being the real treatment of a real anorexia patient
in real life
inside of a child / Adolescent psychiatric units and home being given real treatments
Also the study has high Mundane realism
As there were real group, individual and Home Therapies
as well as real measurements
and a real nutritionalist
Both of these factors mean that the experience of this anorexic patient and treatment can be applied to real life as both the therapies and patient treatment itself occurred any real life situation
Also the possibilities of situational and cultural factors causing anorexia can also apply in real life if this is also true
Therefore giving this study by luk and Agoha 2014 with Amy
high ecological validity and mundane realism
AN Case study Luk and Agoha (2014)
ethics +
There are ethical considerations taken during the study
as a case study confidentiality was maintained in not printing Amy’s full name
and she was given the right to withdraw data probably
and parental consent and you’ve ascent was also obtained
as an anorexia patient Amy is a vulnerable person and therefore ethical guidelines would have been stuck to
It is highly likely there was protection from harm especially when in the hospital setting
making this study by Luk and Agoha 2014 (with amy) highly ethical
