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Treatment Report 

Background of Talaihla Smith Case Study

This is the case study of an adolescent named Talaihla Smith who lives with her mother and a younger brother who is probably on the autistic spectrum. Her father left the three of them when she was nine and has re-partnered and only spend some holidays with Talaihla. This girl is admitted in the emergency department following the compliant by her mother that she has consumed many pills from the bathroom cabinet. She is dissatisfied with her body since she has hit puberty because she has been body-shamed several times. She states that her life sucks since she has started her high school.

She hates her body because everyone body shames her for being fat and ugly. This has such an impact on her that she has left eating food especially dinner. Occasionally when she sneaks out to the refrigerator for some late nights snacks, she makes herself vomit to throw the food out of her body. This explains that she has an eating disorder due to body dissatisfaction (Neff, 2016). She frequently skips dinner and even does not eat her lunch on most of the days because of the fear of getting fat.

Some 6 months back, she had cut herself on thighs due to some incident that took place in a party that she attended. She did not disclose much information on this event. She completely decided to kill herself when she saw a picture of a boy that she liked kissing some other girl on the social media from the party that she was not allowed to go to. Following this decision, she consumed a handful of pills and she also posted this picture with a goodbye message on social media. This indicates the mental health issue of suicidal ideation and self- harm because she admitted that she occasionally thinks about suicide though she does not have any clear plan (Tomas- Aragones & Marron, 2016).

She has some behavioural issues as she was not behaving well and was also not cooperating with the triage nurse. Since she has started to go to high school, she does not talk to her best friend from primary school. Most of the days she locks herself up in her room and refuses to come out. All this indicates the third key mental health issue of social isolation (Rahimi- Ardabili et al., 2018). This could be because she has been body-shamed so she wants to keep herself away from everyone. Her mother was well aware that she had fallen out with her best friend.

The additional information that the health practitioner should obtain should be of the incident from the party that made Talaihla cut herself on thighs as it was the first attempt of self- harm. This information can be obtained from her friends who attended the party and they should be asked of her behaviour with other friends at high school so that other behavioural issues can be well examined. This information is important because the mother states that she is a bit of drama queen but still has some good time with family over a movie. This information will help in learning about her nature and behaviour in front of the friends who bully her for her body.

 Formulation of Talaihla Smith Case Study

A psychosocial formulation is very important in this case to explain and guide the appropriate treatment and the follow- up that is beneficial for the patient and her family members.

The adolescents are very conscious of their body image and the way they look because they are surrounded by people who judge them based on their looks. Some individuals are very hard on themselves following this because they have a natural tendency to be better looking and to grow faster and stronger which most of the times severe mental health consequences especially when it is related to the physical appearance. The adolescents who have been portrayed with the fat jokes because of them being overweight are the victim of self- doubt that is called as body shaming (Wanniarachchi et al., 2020).

This is a form of bullying where humiliation is expressed for the other person's body and sizes that result in severe emotional trauma especially amongst the adolescents. There is a conventional notion of beauty that forces the people to body shame other and self and this results in the deep-seeded self- esteem issues. The formulation based on body dissatisfaction due to body shaming will help in guiding the treatment that can be well understood both by the patient and the family members (Veale et al., 2017).

The body dissatisfaction is strongly correlated with the symptoms of bulimia nervosa that is an eating disorder and also with the suicidal ideation. This body dissatisfaction is also associated with the key mental health issue of social isolation (Rufino et al., 2018). The eating disorder of bulimia nervosa is strongly considered as a prospective risk factor for suicide among adolescents. The bulimia nervosa is a binge eating disorder that is followed by the purging and this predicts the suicide ideation in the adolescents who have body dissatisfaction.

According to this study, the symptoms of bulimia nervosa and body dissatisfaction are the true risk factors for suicidal ideation in adolescents (Stice et al., 2017). The same is the case with Talaihla because she presents some symptoms of bulimia nervosa that is when she binge eats some snacks at night, she makes herself vomit. She is highly dissatisfied with her body and looks and this is the reason that she wants to kills herself. This is the psychosocial formulation of the adolescents that makes them the victim of key mental health issues like eating disorder, self- harm, suicidal ideation and social isolation.

The development theory that can be used to build this formulation for guiding the treatment of the mental health issues identified in Talaihla is Erickson's psychosocial developmental theory. Stage five that is identity vs role confusion is that stage for adolescents aged 12- 18 years (Cote, 2019). This stage of this theory states that the adolescents search for a sense of self and personal identity as a result of which they thrive for learning who they are and are highly conscious of their body image. They are more concerned about their career, family, relationship and body image.

This is a major stage of development where the body image of them changes with their growth (Crocetti, 2017). The adolescents might feel very uncomfortable about their body for a specific period that is until they can adapt and grow in those changes. The people like Talahila who have been bullied for the body at this stage leads to mental health disorders because they do not adapt into their body changes and this failure to establish a sense of identity creates a pressure of them and also creates a feeling of unhappiness.

The risks of self- harm and suicide can be assessed by asking a few more questions from the patient about how frequently they get this ideation and what plan do they have for self- harm. These risks can be best mitigated with the appropriate treatment plan that will address this mental health issue of suicide and self- harm along with the issues of eating disorder and self- isolation (Perez et al., 2018). The risks of suicide and self- harm can be mitigated by counselling and other educational techniques that can be administered by the health practitioners for the benefit of the patient. The treatment plan below aims to address these issues followed by the information on follow- up and the support that will be given to the patient.

Treatment plan for Talaihla Smith Case Study

The patient Talahila can be safely discharged following the treatment plan.

Identified issues

Assessment

Intervention

Desired outcomes

Time frame

Eating disorder (Bulimia nervosa)

Complete physical examination; BMI and other vital signs; eating behaviour (Bould et al., 2020)

Cognitive behavioural therapy; to help the patient in normalizing the eating pattern and identification of their negative belief and behaviour of eating so that they can be replaced with the healthy eating patterns (Lewer et al., 2017). CBT is a very effective technique that aims to alter the behaviour of the patient by addressing their cognitive impairment that is related to the fear of eating and getting healthy and overweight in this case.

Normal eating habit; relying on positive eating habit. No fear of weight gain or becoming fat that will make her eat less or indulge in inappropriate eating habits.

2- 4 weeks of cognitive behavioural therapy (2 sessions per week).

Risk of self- harm and suicidal ideation

By asking the relevant questions related to the patient's psychiatric history, identification of the factors that increase the risk of suicidal ideation and using suicide assessment scale (Oktan, 2017)

Counselling sessions; they will make the patient understand the beauty of life and the body image (Perkins & Brausch, 2019). This will better address the self- doubt issues that lead to suicidal ideation. The patient will feel safe and will better discuss all the concerns related to her body image. The safe interventions are important for patients who are at high risk of suicide and self- harm behaviour.

No self- harm following an incident related to the body shaming, positive outlook on self- looks and the body. Body satisfaction can be achieved with effective counselling sessions. This will also make the patient identify the events that drive her mind to self- harm and the way she should react in those instances so that her mental peace can be maintained.

4 weeks

Social isolation

The mental health issue of self- isolation can be assessed by assessing the social network, social behaviour and the social capital of the patient. The family will be asked questions on how she spends the time with family members, her behaviour with guests and neighbours and so on (Altman et al., 2017). These questions will help health practitioners in understanding the social behaviour of the patient and her willingness of socialization because the symptoms show that she has self- isolated and does not behave well with some of her friends.

The issue of self- isolation can be addressed by cognitive behavioural therapy and supported socialization technique. The cognitive-behavioural therapy can be used to alter the behaviour of the patient in a manner that they start to socialize and this also involves altering the other behaviours that have led them to become the victim of social- isolation (Sagar & Gupta, 2018).

She does not self- isolate herself and gets back to her friends. The desired outcome is increased socialization by the patients and she makes everything fine with her primary school best friend because she has fallen apart with her. She will start to get indulged with everyone and will construct her socialization abilities for social recreation groups and peer support groups.

4-5 weeks

Communication of Talaihla Smith Case Study

To: General practitioner

Cc: mental health agency, social support agency

Subject: Talahila’s discharge summary and follow- up plan

Respected sir

The patient Talahila has been discharged after the assessment of some mental health issues that are self- isolation, self- harm, suicidal ideation and eating disorder (bulimia nervosa). In the treatment plan, she was given Cognitive behavioural therapy for her eating disorder and self- isolation. She was given a session of counselling for suicidal ideation and she has been recommended that she has to abide by all the sessions up to 6 weeks. She was discharged after the improvement in her mental health status and the follow- up will be taken after every session of CBT and counselling. The follow- up will also be taken from her best friend from primary school and her family members for her behaviour.

The patient's wellbeing can be maintained if she adapts with the changes in her body and accepts herself the way she is. She will be educated on self- acceptance and CBT will help her in achieving these goals. She will be recommended to attend her follow- up sessions in which the status of her current mental health will be assessed and the treatment will be continued accordingly. He lifestyle changes include increased socialization, abiding by healthy eating habits and not indulging into self- doubt.

Hoping for good mental health and well- being

Thank you

References for Talaihla Smith Case Study

Altman, J. K., Zimmaro, L. A., & Woodruff-Borden, J. (2017). Targeting body compassion in the treatment of body dissatisfaction: A case study. Clinical Case Studies16(6), 431-445.

Bould, H., Broome, M. R., Park, R. J., Noonan, K., Munafo, M., Penton-Voak, I., & Woods, A. (2020). The Outfit Choice Task as a novel method for measuring body dissatisfaction in women with eating disorders and healthy controls.

Côté, J. E. (2019). Eriksonian Theory. The Encyclopedia of Child and Adolescent Development, 1-10.

Crocetti, E. (2017). Identity formation in adolescence: The dynamic of forming and consolidating identity commitments. Child Development Perspectives11(2), 145-150.

Lewer, M., Kosfelder, J., Michalak, J., Schroeder, D., Nasrawi, N., & Vocks, S. (2017). Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: A pilot study. Journal of Eating Disorders5(1), 43.

Neff, K. D. (2016). Does self-compassion entail reduced self-judgment, isolation, and over-identification? A response to Muris, Otgaar, and Petrocchi (2016). Mindfulness7(3), 791-797.

Oktan, V. (2017). Self-harm behaviour in adolescents: body image and self-esteem. Journal of Psychologists and Counsellors in Schools27(2), 177-189.

Pérez, S., Marco, J. H., & Cañabate, M. (2018). Non-suicidal self-injury in patients with eating disorders: prevalence, forms, functions, and body image correlates. Comprehensive Psychiatry84, 32-38.

Perkins, N. M., & Brausch, A. M. (2019). Body dissatisfaction and symptoms of bulimia nervosa prospectively predict suicide ideation in adolescents. International Journal of Eating Disorders52(8), 941-949.

Rahimi-Ardabili, H., Reynolds, R., Vartanian, L. R., McLeod, L. V. D., & Zwar, N. (2018). A systematic review of the efficacy of interventions that aim to increase self-compassion on nutrition habits, eating behaviours, body weight and body image. Mindfulness9(2), 388-400.

Rufino, K. A., Viswanath, H., Wagner, R., & Patriquin, M. A. (2018). Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders. Comprehensive Psychiatry84, 22-25.

Sagar, R., & Gupta, T. (2018). Psychological aspects of obesity in children and adolescents. The Indian Journal of Pediatrics85(7), 554-559.

Stice, E., Yokum, S., Rohde, P., Shaw, H., Gau, J. M., Johnson, S., & Johns, A. (2019). Randomized trial of a dissonance-based transdiagnostic group treatment for eating disorders: An evaluation of target engagement. Journal of Consulting and Clinical Psychology87(9), 772.

Tomas-Aragones, L., & Marron, S. E. (2016). Body image and body dysmorphic concerns. Acta Dermato-Venereologica96(217), 47-50.

Veale, D., Phillips, K. A., & Neziroglu, F. (2017). Challenges in assessing and treating patients with body dysmorphic disorder and recommended approaches. Body Dysmorphic Disorder: Advances in Research and Clinical Practice, 313.

Wanniarachchi, V. U., Mathrani, A., Susnjak, T., & Scogings, C. (2020). A systematic literature review: What is the current stance towards weight stigmatization in social media platforms?. International Journal of Human-Computer Studies135, 102371.

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