Management Strategies and Ethical Consideration in Treating Anorexia

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Create a case presentation

Ava is a 16 year old female that presents with her mother today with concerns of very low weight. Today’s vitals: Heart rate 90, Blood Pressure 94/62, BMI 16.

Ava is a above average student; she is involved in multiple sports and extracurricular activities at school. She currently is participating in cross country. She lives with both of her parents, and two younger brothers. Her parents are very competitive and push her for academic and athletic achievements. She is very close with a older female cousin that has been combating anorexia for the past 6 years.

When interviewing Ava without her mother present on feelings, daily routines and diet a few areas of concern presented. She tries to eat a larger supper when she is home with her family, but usually not able to finish half of her meal. She leaves early for pre-school activities and skips breakfast daily. During the school day she focus on water intake, she frequently will have a sweet hard candy treat in the afternoon before cross country practice. She pushes herself in her practices and if she does not reach a certain goal during, she will go workout before she goes home for the night. By the end of cross country, she is hopeful that she will meet her weight goal of a few less pounds, she is afraid of gaining weight and losing her friend group. Talking about meal time she notices that she can sometimes get short of breath and have a fast heart rate.

Based on the case, select management strategies you would recommend. Provide support from a scholarly source to support your decision.

Basis for management strategies for treatment of anorexia include therapy and supervised weight gain. Pharmacological treatment of underlying mental health issues including anxiety, depression and phobias can improve positive outcomes. Psychotherapy is one of the main treatments for eating disorders with modalities in cognitive behavioral therapy, family-based therapy, and talk therapy. Other strategies aimed at improving remission and improved overall health can include nutritional counseling and adolescent focused psychotherapy (NHS, 2021).

Describe a minimum of two referrals you would make for the client and include your rationale.

One of the most important first steps in treatment for a patient with diagnosis or features of anorexia nervosa is referral to psychotherapy. Some of the techniques aimed at improvement include behavioral management to change behavior around food restrictions and associations. Other behavioral goals aimed at changing excessive physical activity and other compensatory behaviors. Family- based treatment is the gold standard for adolescent treatment. Three phases therapist guide families through treatment include, weight restoration, return responsibility to the patient, and lastly establishing a healthy identity (Muratore & Attia, 2021). Other psychotherapy modalities that may be useful include cognitive behavioral therapy and mechanism based behavioral treatments.



Along with psychotherapy and family-based therapy methods utilizing a dietitian in the treatment process may be beneficial for adolescents and their families. In 97% of counselors that were leading family-based therapy had referred to dietitian as part of the treatment team and plan. This referral consult to a dietitian by therapy can have mixed reviewed as there is limited resources and evidence with dietitian guide for intervention (Leonard, Koenigs, & Norton, 2019). Thought benefit for using a dietitian in treatment course for a patient with anorexia can help with meal planning skills and introduce to a variety of options for gaining all needed necessary daily nutritional requirements. Key features include balance and positive choices.



Analyze one ethical or legal consideration related to the treatment of a client with your assigned diagnosis.

A legal aspect between provider, parents and patient regarding treatment of anorexia nervosa can have a lot of gray area when it comes to involuntary treatment. Some adolescents may continue to decline in overall health with severe illness that require intervention before permanent health complications or death happen. Involuntary intervention can be necessary life saving measures by parents as a sign they care. The patient often sees this involuntary commitment as form of punishment that should be short acting or prohibited (Clausen, 2020). Involuntary treatment can have a focus on nutritional replacement and preserving organ function or reversing organ shutdown. As well as co-occurring psychiatric symptoms and general mental health functioning with intensive psychotherapy.



Evaluate the potential role of the family in the treatment of a client with the assigned diagnosis. What additional support may be necessary if the client’s family is unwilling or unable to participate in treatment?

Eating disorders gold standard for treatment is incorporating some sort of family-based therapy into the treatment plan. This role families have in their loved one’s recovers can mean big changes in their normal routine. Patients’ role in therapy are more responsible for weight restoration and monitoring the child’s eating reverting to the “helicopter parent”. Others in the household including siblings’ part in treatment is a position for support if appropriate (Sheldon-Dean, & Le Grange, 2023). If there are not supportive or engaged parents or guardians that will take on the family-based therapy roles additional support include strong sense of needing some self-help skills and surrounding peer support system can be crucial.







Reference



Clausen, L. (2020). Perspectives on involuntary treatment of anorexia nervosa. Frontiers in Psychiatry, 11, 533288.



Leonard, C. R., Koenigs, L. M. P., & Norton, C. (2019). The Utilization of Nutrition Services in Family-Based Treatment by Members of the Society for Adolescent Health and Medicine in the care of Adolescents with Anorexia Nervosa. N/A.



Muratore, A. F. & Attia, E. (2021). Current therapeutic approaches to anorexia nervosa: State of the art. Clin Ther. 2021 Jan; 43(1): 85–94. doi: 10.1016/j.clinthera.2020.11.006



NHS. (2021). Treatment- anorexia. NHS. https://www(dot)nhs(dot)uk/mental-health/conditions/anorexia/treatment/#:~:text=Treatment%20for%20anorexia%20usually%20involves,lost%20a%20lot%20of%20weight.



Sheldon-Dean, H. & Le Grange, D. (2023). Family- based treatment for eating disorders. Child Mind Institute. https://childmind(dot)org/article/family-based-treatment-for-eating-disorders/