Luk and Agoha (2014) Flashcards
AIMS
- To describe the experience of a Chinese-American adolescent girl with anorexia nervosa using a case study design from multiple perspectives, particularly considering culture.
METHODS
- A single case report is used to bring an understanding of a complex issue, extending experience and/or adding strength to what is known through previous research.
- This is a single case study consisting of a retrospective review of one Chinese-American adolescent girl with anorexia nervosa and her experiences.
After receiving parental consent and youth assent (consent from the child), inpatient and outpatient charts were reviewed.
SAMPLE
- Amy was a 15-year-old, petite Chinese-American adolescent female. Diagnosed at 13 she showed severe calorie restriction and excessive exercise, having a BMI or 11.8. She had developed amenorrhea and cold intolerance and had body image distortions.
Condition
- Her condition had to be stabilised with re-feeding and then she was transferred
to the inpatient child/adolescent psychiatric unit for further care, where she underwent regular individual therapy, group therapy, daily weigh-ins and monitoring of meals. - Amy was discharged after a 3-month hospitalisation when goal weight was reached and she was at a BMI of 17.25kg/m2. She was subsequently readmitted twice within six months for being unable to maintain her weight.
- After the 3rd hospitalisation Amy was assigned a home therapist, regular visits with nutritionist and weekly psychiatric visit.
Family background
Family dynamics for meal times were significant for Amy behaving in a child-like manner toward her father and being highly argumentative with her mother who she described as too ‘traditional’ and ‘annoying’. Her mother accompanied her to outpatient appointments, where communication was often tense. Amy
often seemed annoyed with her mother’s queries and promptings to maintain caloric intake. She would become emotional in outbursts toward her mother, complaining that she did not want to eat at home because her mom would do things like keep bread in the freezer and insist on whole milk rather than patient’s preference of soy milk. Amy refused to eat meals with her family, reporting that she did not like the food they ate and preferred to make her own dinners.
Recovery
Recovery: As in-home services decreased, Amy showed herself as competent in being able to consistently make it to appointments on her own. She continued to refuse meals with her family, opting to prepare her own meals at home. Amy was determined to find a job and was successful in gaining a part-time position at a local cookie store. As treatment progressed, she was able to maintain a BMI above 18.5kg/m2 and reported an episode of menstrual bleeding fifteen months post-discharge.
Conclusions
- Amy’s struggle with her mother, food refusal and developmental stage are consistent with the developmental theories of anorexia as a product of a need for independence and control.
- In their interactions, maternal nurturance and warmth were often lacking, and Amy’s perception of her mother was one of her being overbearing and controlling.
Amy did not express a desire for thinness verbally or non-verbally in any of her therapy sessions; her reasons for not eating often centered around her disgust with the food options that her mother offered. - Amy was also well-accepted by her peers. Mumford et al.’s (1991) concept of ‘culture clash’ explains, in part, that perhaps Amy was experiencing conflicting cultural norms: those of her peers and local community, and those of her parents. As she decidedly chose to reject her ancestral culture through her rejection of her family’s food and food rituals; this may have worsened her already tense conflict of gaining autonomy 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 comprehensively. Under the watchful eye of her nutritionist she was held accountable for more balanced food choices and meals. This worked in conjunction with the in-home therapist who was able to transverse the cultural divide and make treatment recommendations practical in the home setting.
- After 10 months of outpatient treatment, Amy visited China with her family. While there, she no longer needed to reject her parents in order to fit in to the culture of her surroundings.
- Her parents allowed Amy to have more freedom in China, which led to a greater sense of self- determination and autonomy. Amy 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 achieving more independence and a more secure sense of identity.
