Section 1: Brief Summary
Portia de Rossi was born in Australia, and she is an actress who began her profession at the early age of 12 as a fashion model. At that tender age, she began to focus obsessively on losing weight. She had a restrictive food intake through her diet, which restricted her from having a healthy body weight. This resulted in her having 82 lb., which was 85% less than her average body weight. She had a lot of fear of weight gain. After unsuccessful weight loss, she began bingeing and purging. At age 25, when she got her dream job, she had intense pressure to be thin, whereby she was bingeing and purging frequently. One incident on a commercial she was to shoot catapulted her to what would be diagnosed as anorexia.
Portia views herself as fat even though she had less weight due to a distorted point of view on her weight and body image. She only put her focus on getting thin, which she did. However, she thought she could not be anorexic since she had 100 pounds. At 25, she had only 82 lb. Her weight continued to plunge due to vigorous exercise and fewer calories intake. During filming, she ran into extreme difficulties as the scenes required excessive energy use, which she didn’t have, and soon collapsed on set. At the hospital, she was diagnosed with anorexia nervosa, liver cirrhosis, and lupus. Thus, she began her journey towards recovery. Her treatment regimen included taking a hormone replacement pill, seeing a therapist, and taking antidepressants to reduce her obsession with food. She also began eating what she desired rather than restricting her cravings.
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Section 2: Actual Assessment
Demographic Information
Portia de Rossi was born in Australia. She is a female who is a lesbian. She was diagnosed with cirrhosis of the liver, lupus, and osteoporosis. She had an eating disorder known as anorexia nervosa.
ii. Presenting Problem
Portia de Rossi struggled with an eating disorder whereby she almost starved herself to death to be thin. She had an obsession with her weight, and she would restrict her diet severely or not eat at all to lose weight. She tried using dietary pills without success and resulted in bingeing and purging. Portia loved acting as it allowed her to escape from herself for a while. She also had immense pressure to be thin in addition to the pressure she felt of blending into the Hollywood crowd. Moreover, she was faced with realizing that she was homosexual and was fearful of what the public would say after finding out her sexuality which made her have feelings of insecurity. She was later diagnosed with lupus, liver cirrhosis, and osteoporosis.
She undertook a diet by a nutritionist to help her healthily lose weight, and she reset her calories intake in a lower amount than what was recommended by her nutritionist. Thus, she continued to lose weight lowering her goal weight. She also worked out vigorously to lose weight.
IV. Symptoms
Being underweight.
Fear getting fat even though she is not.
Negative perception concerning her weight.
Fatigue.
Binge and purge.
Restricting the intake of food severely through starvation and dieting.
Excessive exercising.
Use of laxative spills.
lying about the amount of food she has consumed
V. Case Formulation
Portia de Rossi had a relentless pursuit of thinness and a distorted body image whereby she viewed herself as fat even though she was underweight.
Also, she had a strong fear of increasing her weight, tenacious food intake reduction resulting to enormously low body weight, bingeing and purging which is a behavior that does not allow weight gain. She had obsessive rules and concerns about body shape, weight, and dieting.
Expectations from people made her obsess more about weight loss.
VI. DSM-IV Multiaxial Assessment
Axis I: Eating disorder.
Axis II: None
Axis III: liver cirrhosis, lupus, osteoporosis .
Axis IV: Threats of job loss, fear of gaining weight.
G.A.F.: 52
VII. Treatment Plan
Overall treatment plan: The plan was to stabilize Portia’s de Rossi weight loss, eradicate purging/ binge eating behaviors, start a weight restoration process, use therapy to help her get over her low self-esteem, , correct her negative patterns of thought and help her in the development of prolonged behavioral changes. ( Murphy et al., 2010) . The treatment would involve:
Taking hormone replacement pills
Seeing a therapist
Taking antidepressants to reduce her food obsession
Psychotherapy
It involves therapy that concentrates on the behavior change (behavioral therapy) and thinking (cognitive therapy) of an individual with anorexia nervosa. The therapy comprises of methods of developing the right behavior and attitudes towards weight and foodstuffs. Moreover, the treatment included “methods to enable the patient change how she perceived challenging circumstances.
Cognitive-behavioral therapy included addressing the distorted attitudes and views concerning appearance, shape, and weight by practicing modifications in her behaviors ( Murphy et al., 2010) . It also involved the employment of behavioral techniques, which included the systematic exposure to forbidden foods and establishing a regular pattern of eating while simultaneously addressing cognitive aspects of anorexia nervosa like a disturbance in the experience of weight and shape and motivation for change.
Portia would need to be engaged in the treatment plan, which would encourage her to be involved in the treatment by assessing the disorder. This would help by encouraging her to take ownership of the treatment. Next, the therapy session would include a personalized visual presentation of the processes that appeared to favor her eating problem. It starts with Portia’s wishes to change her binge eating and purging problem. This would help Portia realize that her behaviors are understandable and maintained by mechanisms that are open to change.
The therapist should also establish real-time self-monitoring whereby there is a recording of events, behavior, feelings, and thoughts that Portia experiences. The process is introduced in the first session of the therapy and continues to occupy a central and vital role throughout the treatment process. The therapist should explain the significance of self-monitoring that identifies progress and helps the patient comprehend the eating problem well ( Murphy et al., 2010) . Moreover, it would help Portia be more aware of what was happening now so that she would take the initiative to change her behavior.
The therapist should help Portia check her weight once a week, which would help her plot out an individualized weight graph. This would enable the therapist to educate her on interpreting the scale numbers, which might be otherwise misinterpreted. Additionally, it would provide Portia with the necessary data about her weight when her eating habits change. Also, it would make her see the significance of maintaining the processes of avoiding excessive or avoidance of excessive body weight. The therapy would teach her about eating and weight as it would help her regulate her weight. It would also teach her about laxatives ineffectiveness, vomiting, and diuretics as a means of weight loss.
Additionally, Portia should establish a regular eating pattern which would be beneficial for the success of the treatment. It would help in displacing binge eating and purging as it would structure her days since she was underweight and would introduce snacks and meals that can be gradually increased in size. In the initial treatment session, Portia would be necessitated to eat three meals per day plus two snacks with an interval of four hours. She would also be necessitated to confine her eating to the snacks and meals. Moreover, eating should not be accompanied by compensatory behavior such as the misuse of laxatives and self-induced vomiting. The treatment plan, if followed, should be able to help Portia control her weight and lead an everyday life.
Reference
Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. The psychiatric clinics of North America , 33 (3), 611.
