Here follows a discussion of Lori’s situation, specifically her eating disorder and potential co-occurring alcohol-use disorder, along with some suggested treatment goals and service providers.
Lori has developed an eating disorder (ED), specifically bulimia nervosa (BN) as defined by the American Psychiatric Association (APA) (2013). For the last few months she has indulged in binge eating at least twice per day at home and with friends, with each episode followed by inappropriate compensatory behaviors to prevent weight gain. This frequency meets the criteria for severe or perhaps even extreme BN as it appears in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013). Her behavior is likely driven by low self-esteem …show more content…
The fact that she has found other girls who share her issues supports the peer cluster theory described by McWhirter, McWhirter, McWhirter, & McWhirter (2013), in which deviant peer cluster groups “normalize, support, and encourage a wide range of deviant behaviors” (p. 342). There is a group of three underage girls who drink and use laxatives for dangerous purging, a potential legal or ethical dilemma which should probably be addressed through the school counselor. This could be the most challenging aspect of Lori’s case because, if not handled tactfully, could cause her to be blamed for getting the other girls in trouble and to have her reputation at school damaged. This would devastate her already low self-esteem. A good school counselor may be able to treat it as an opportunity to educate young people about the dangers of eating disorders, alcohol use, how unrealistic body ideals are presented by society, and so forth. This is where Lori and her friends could become involved in group therapy, community outreach programs, or peer support groups. As a last resort, Lori could be encouraged to set a goal of making new friends although it might be counterproductive to present this as a punitive
Lori has developed an eating disorder (ED), specifically bulimia nervosa (BN) as defined by the American Psychiatric Association (APA) (2013). For the last few months she has indulged in binge eating at least twice per day at home and with friends, with each episode followed by inappropriate compensatory behaviors to prevent weight gain. This frequency meets the criteria for severe or perhaps even extreme BN as it appears in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013). Her behavior is likely driven by low self-esteem …show more content…
The fact that she has found other girls who share her issues supports the peer cluster theory described by McWhirter, McWhirter, McWhirter, & McWhirter (2013), in which deviant peer cluster groups “normalize, support, and encourage a wide range of deviant behaviors” (p. 342). There is a group of three underage girls who drink and use laxatives for dangerous purging, a potential legal or ethical dilemma which should probably be addressed through the school counselor. This could be the most challenging aspect of Lori’s case because, if not handled tactfully, could cause her to be blamed for getting the other girls in trouble and to have her reputation at school damaged. This would devastate her already low self-esteem. A good school counselor may be able to treat it as an opportunity to educate young people about the dangers of eating disorders, alcohol use, how unrealistic body ideals are presented by society, and so forth. This is where Lori and her friends could become involved in group therapy, community outreach programs, or peer support groups. As a last resort, Lori could be encouraged to set a goal of making new friends although it might be counterproductive to present this as a punitive