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SCENARIO:
You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the
psychiatric unit last night after assessment and treatment at a local hospital emergency
department (ED) for “blacking out at school.” She has been given a preliminary diagnosis of
anorexia nervosa. As you begin to assess her, you notice that she has very loose clothing, she is
wrapped in a blanket, and her extremities are very thin. She tells you, “I don’t know why I’m
here. They’re making a big deal about nothing.” She appears to be extremely thin and pale, with
dry and brittle hair, which is very thin and patchy, and she constantly complains about being
cold. As you ask questions pertaining to weight and nutrition, she becomes defensive and vague,
but she does admit to losing “some” weight after an appendectomy 2 years ago. She tells you that
she used to be fat, but after her surgery she didn’t feel like eating and everybody started
commenting on how good she was beginning to look, so she just quit eating for a while. She
informs you that she is eating lots now, even though everyone keeps “bugging me about my
weight and how much I eat.” She eventually admits to a weight loss of “about 40 pounds and I’m
still fat.
1. How is the diagnosis of anorexia nervosa determined?
Answer: The diagnosis of anorexia and nervosa is typically determined by healthcare
professionals, like doctors or psychiatrists, based on a person’s symptoms and behaviors. To be
diagnosed with anorexia nervosa, someone usually has an intense fear of gaining weight and a
distorted view of their body shape or size. The individual physically may be fit and their weight
and height may also be adequate based on their age; however mentally they believe they are not
fit, which lead to missing meals, and eating a meal and forcefully throwing up and usage of
maladaptive methods. Other signs might include excessive exercising, constantly thinking about
food or using methods to try to lose weight. These are some ways its determined if the patient is
suffering from anorexia nervosa.
2. Identify eight clinical symptoms of anorexia nervosa. Place a star or asterisk next to those
that J.M. has.
*Being very scared of gaining weight.
Seeing themselves as fat even if they’re fit or thin for their age.
*Eating very little leads to losing a lot of weight.
Thinking a lot about food, calories, and diets.
*Exercising a lot, even when tired or hurts.
*Not realizing how serious being underweight is.
*Avoiding being around food or eating with others.
Doing things like cutting food into tiny pieces or moving it around on the plate.
3. What other disorders might occur along with anorexia nervosa?
Depression: When the patient feels that they are not fit and even with the weight they have lost
its still not enough to satisfy their needs, this can lead to feeling sad, hopeless, or losing interest
in things they used to enjoy.
