K is a 26 year old female who presented to the clinic stating that she had “lost control” of her eating. She reported episodes of consuming large quantities of food (such as a pint of ice cream, 3 candy bars and 6 donuts in over a one hour period of time), followed by feelings guilt and shame. She admitted to taking laxatives as a method of “getting rid” of the food and avoiding weight gain. She stated that she typically started the day vowing to herself that she would only eat 500 calories that day. By the afternoon, however, she was ravenous and consumed with thoughts about high caloric foods. Usually on her way home from work (K worked as a 3rd grade teacher), she would experience a great sense of tension and would stop at a grocery store or fast food restaurant and purchase large amounts of sweets and carbohydrates. Once home, she would secretly consume the food quickly, removing all traces of the food so her husband would not see what she had done. She would then feel “defeated” and would take laxatives. She stated that her husband had recently confronted her on the large number of laxatives she had in the house and she had broken down and told him that she was taking more laxatives than recommended to avoid weight gain. He reportedly told her that he loved her whether she was fat or thin, but K stated that despite his reassurances, she was very fearful of weight gain. She indicated that when she felt thin and the scale indicated that her weight was under 130 pounds, she was happy. However, K reported that if the scale indicated she weighed over 130 pounds, this information would “ruin” her day and she would constantly think about how fat she was and how awful she looked. It should be noted that K is 5’3”. K reported an average of 5 over-eating episodes, followed by laxative use, a week for the last 6 months. She reported similar episodes (averaging 3 over-eating episodes a week) starting at the age of 18, when K went away for college. K denied self-induced vomiting or over exercise.
When asked about her moods, K reported feeling sad most days. She reported feelings of fatigue, and low self esteem. She reported a pattern of these symptoms for the last 2 ½ years, with never a period of more than two weeks without these symptoms. K stated, “I don’t know why I feel sad, I have a great husband, a good job, and a good life.” A history of mania or hypomania was denied.
Finally, K mentioned one other concern. She stated that she had been experiencing uniform numbness in her right hand, in the area of the hand covered by a glove. At her husband, insistence, she saw her doctor, who could find no physical reason for the numbness. The doctor implied that the etiology might be psychological. This symptom caused concern, as the hand affected was K’s writing hand. Currently she was finding herself unable to write on the white board at her job. She stated that she had gotten around this by giving verbal or typed instructions to her pupils, but the numbness had resulted in some impairment at work. The hand numbness had persisted for 1 month.
When asked about current stressors, K reported that she was up for a promotion at work. The new job would entail over seeing of all the teachers in the 3rd grade (5 teachers). She said she was excited about the prospect of a new position, but felt somewhat uncomfortable thinking that she would supervise teachers who were older than she and who had more classroom experience. She stated that the principal and a school board member would be observing her class as part of the interview process for the new job.
1. What diagnosis (or diagnoses) does K fit?
2. What are the criteria for the diagnosis (or diagnoses)?