Primary Care of the Psychiatric Mental Health Client II

Eating Feeding Disorders Case Study

Alice is a 10-year-old girl in a gifted and talented school who you, the PMHNP, assume care for following a referral from her PCP for suspected anxiety symptoms. The PCP was concerned that anxiety symptoms may be interfering with her appetite, as it was also reported that Alice had drifted below the 10th percentile for weight.

During the initial interview, Alice’s mother states that Alice’s eating difficulties started at age 9, when she began refusing to eat and reporting a fear that she would vomit. At that time, her parents sought treatment from her pediatrician, who continued to evaluate her yearly, explaining that it was normal for children to go through phases. At age 9, Alice was above the 25th percentile for both height and weight (52 inches, 58 pounds), but by age 10, she had essentially stopped growing and had dropped to the 5th percentile on her growth curves (52.5 inches, 55 pounds).

The only child of two professional parents who had divorced 5 years earlier, Alice lived with her mother on weekdays and with her nearby father on weekends. Her medical history was significant for her premature birth at 34 weeks’ gestation. She was slow to achieve her initial milestones but by age 2 was developmentally normal. Yearly physical examinations had been unremarkable except for the recent decline of her growth trajectory. Alice had always been petite, but her height and weight had never fallen below the 25th percentile for stature and weight for age on the growth chart. Alice was a talented student who was well liked by her teachers. She had never had more than a few friends, but recently she had stopped socializing entirely and had been coming directly home after school, reporting that her stomach felt calmer when she was in her own home.

For the prior year, Alice had eaten only very small amounts of food over very long durations of time. Her parents had tried to pique her interest by experimenting with foods from different cultures and of different colors and textures. None of this seemed effective in improving her appetite. They also tried to let her pick restaurants to try, but Alice had gradually refused to eat outside of either parent’s home. Both parents reported a similar mealtime pattern: Alice would agree to sit at the table but then spent her time rearranging food on her plate, cutting food items into small pieces, and crying if urged to eat another bite.

When asked more about her fear of vomiting, Alice remembered one incident, at age 4, when she ate soup, and her stomach became upset and then she subsequently vomited. More recently, Alice had developed fear of eating in public and ate no food during the school day. She denied any concerns about her appearance and said that she had first become aware of her low weight at her most recent visit to the pediatrician. When educated about the dangers of low body weight, Alice became tearful and expressed a clear desire to gain weight.