CASE STUDY: Nancy's life centers around food. She traces her obsession back to her childhood where there was a lot of discord in her family. She found that eating calmed her and helped her deal with the stress. When she began gaining weight, her mother teased her saying that no one would like her if she were fat. As a result, her thoughts of eating and her body image tended to dominant her thinking. When she was in high school she read an article about a young woman who engaged in binge eating then caused herself to vomit.

Although she knew it was quite risky, she began experimenting with the technique. It quickly became an ingrained habit that she's been using for the last 17 years. Like many people with this disorder, she is concerned about her appearance. Nancy remains concerned about gaining weight. She exercises compulsively each day and sometimes fasts for protracted periods.

Nancy worries about how her eating disorder is affecting her family. In particular, her 12-year-old son has developed poor eating habits and was deemed over weight for his age by his pediatrician. Nancy is concerned that she has passed her eating disorder onto her son.

Based on the information in the case study, address the following questions:

1. How would you address the issue of eating disorders from a systems perspective, if you were the therapist working with this woman and her husband as a couple, or seeing the whole family in therapy?

2. How would you incorporate the DSM-5 and the relational codes into the assessment phase with this couple or family? What other diagnostic or assessment processes would you use?

3. How do larger systems impact the development of eating disorders? These systems might include sociocultural background, family of origin (that is, the family a person grew up in), current relationship dynamics, and the influence of the media. How would you take these factors into consideration when working with this client in individual, couples, or family therapy?