What do you make of the amount of time Tina spends on schoolwork and studying?

Question

DSM Diagnosis
307.1 Anorexia Nervosa, Restricting Type, Severe
300.3 Obsessive-Compulsive Disorder, With Poor Insight
V61.20 Parent-Child Relational Problem
Loss of menses, low heart rate (confirmed by medical report)
Her BMI for her weight and height is 16.6, which indicates the specifier “Moderate.”

Rationale
The primary diagnosis is Anorexia Nervosa, Restricting Type.
A. Tina has lost 18% of her body weight from an already petite size.
B. She has an intense fear of gaining weight or becoming fat, even though she is underweight.
C. Tina has a distorted view of the way she looks and body weight and shape unduly influence her self-evaluation. She also denies the seriousness of her current body weight, despite medical symptoms.
Tina has restricting type because she has not engaged in binge eating or purging.
The diagnosis of OCD requires either obsessions or compulsions. Tina performs compulsions related to getting herself ready in the morning and studying at night. She is driven to do these behaviors according to rules about “perfection.” The behaviors are aimed at reducing distress and are clearly excessive (taking 90 minutes to get ready in the morning and studying six to seven hours at night). As well as being time consuming, the morning rituals cause family conflict. However, Tina does not tend to see these behaviors as unreasonable. Although the insight criterion (the person recognizes that the compulsions are excessive or unreasonable) is not applicable to children, Tina has been given the specifier, With Poor Insight.
The V code, Parent-Child Relational Problem, has been given because of the family conflict that may have contributed to Tina’s symptoms and because improved family relations will be critical for the recovery of Tina’s disorder.
Because of Tina’s age, she is not under consideration for a personality disorder. However, treatment is essential as she seems to be at risk for Obsessive Compulsive Personality Disorder.

Additional Information Required
It is not clear from the case study how Tina self-identifies in terms of her ethnicity, which is an important aspect of her developing an identity. Her parents’ level of social support is also important to establish, as well as their possible involvement in religion.

Answer 1

The studying behaviors could also be classified as compulsions under OCD. She is driven to study and spend time in schoolwork so that she is “perfectly” prepared. The behaviors are aimed at preventing the dreaded event of being less than “perfect” and are clearly excessive. Fleetingly, Tina recognizes that the compulsions are unreasonable. The behaviors are time consuming in that she studies for six to seven hours a day, which prevents her from engaging in other age-appropriate activities, such as socializing.