Question: Martha is a 19-year-old adolescent who has been on and off diets for the past two years since she started college a year early. She thinks about food constantly and binge eats takeout meals from fast food restaurants on campus late at night.

Martha is a 19-year-old adolescent who has been on and off diets for the past two years since she started college a year early. She thinks about food constantly and binge eats takeout meals from fast food restaurants on campus late at night. The binge eating episodes have become so expensive that Martha’s parents have addressed her overspending, which has led her to begin shoplifting and stealing money to support the bingeing.

Currently, Martha has been binge eating at least three times a week over several months. This episode followed the breakup of a stormy relationship with her high school boyfriend. She is beginning to gain weight even though she restricts food between bingeing episodes and induces vomiting afterward to control her weight. In the past, she has used laxatives and diuretics to rid herself of calories but did not like the side effects of constipation then. Martha’s eating problems began when she started college and was living in a dormitory with a self-serve cafeteria.

As a child, Martha had difficulty controlling snacks between meals and would get into arguments with her parents, who threatened to put a lock on the refrigerator. Martha’s weight has fluctuated by 10 to 20 pounds within several months. She is secretive about the binge eating, which is difficult to manage because she lives in a quad with other students. She plans the late-night episodes and often walks downtown through unsafe neighborhoods to consume the food and vomit.

Martha fears gaining weight because she is on scholarship with the volleyball team. She often goes days without eating. She has begun using cigarettes and cocaine with a new acquaintance for the euphoric and appetite suppressing effects. She has also been using alcohol sometimes to get to sleep. She has had problems with insomnia for many years.

Martha has been having headaches, muscle cramps, and fatigue for several days and has not been going to volleyball practice. She is being seen by the nurse practitioner in the health clinic with whom she confides that she “feels horrible and needs some help.” Physical exam and labs show serum potassium at 3.0 mEq/L, BUN:creatinine ratio > 30, volume depletion, scarring on the dorsum of the right hand, dental caries, and enamel erosion.

Questions:

After viewing the patient information, address the following:

1. What important information is missing from the case study?
2. Discuss normal developmental achievements and potential vulnerabilities.
3. What precipitating factors could be contributing to the current symptoms?
4. What is the differential diagnosis?
5. Describe the etiology of the primary diagnosis.
6. How should physiologic complications be monitored and assessed?
7. What are the usual nonpharmacologic therapies that would help?
8. What medications could help and why?
9. Identify safety risks and how they should be dealt with in the treatment plan.

Include current supportive evidence in your responses to the questions above using two current scholarly sources and National guidelines should also be considered with treatment plans.