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Luk & Agoha (2014) - clinical case study - Coggle Diagram
Luk & Agoha (2014) - clinical case study
AIM
To describe the experience of a Chinese-American adolescent girl with anorexia nervosa using a case study design from multiple perspectives, particularly considering culture.
METHODS
A single case report is used to bring an understanding of a complex issue, extending experience and/or adding strength to what is known through previous research.
Sample
- Amy was a 15-year-old, Chinese-American adolescent female.
1)
she was
diagnosed at 13
she showed
severe calorie restriction
and
excessive exercise,
having a
BMI of 11.8.
She had developed
amenorrhea
and
cold intolerance
and had
body image distortions
2)
Once she stabilised she was
transferred to an inpatient child psychiatric unit
where she was involved with a
mixture of individual therapy, group therapy, daily weigh ins and monitoring of meals.
3)
She was
discharged from a 3 month hospitalisation
and
readmitted within 6 months
as she
couldnt maintain body weight
. She did not eat the food her mother/ family prepared and she
made her own meals
. There was a difficult relationship between her and her mother.
4)
After her
third hospitalisation
, Amy was assigned an
in-home therapist
who regularly visited with a
nutritionist
and
psychiatrist (weekly)
. The in-home therapist was of the
same cultural background
and helped with the tension around family meals.
5)
10 months after discharge, Amy
visited China
. She
discontinued her SSRIs
and the support from therapists was withdrawn. Her
BMI was higher on return
and her progress continued from this point.
ANALYSIS AND CONCLUSIONS
Amy’s struggle with her mother, food refusal are consistent with the developmental theories of anorexia as a
product of a need for independence and control
. .
In their interactions,
maternal nurturance and warmth were often lacking
, and Amy’s perception of her mother was one of her being
overbearing and controlling
Amy did not express a desire for thinness verbally or non-verbally in any of her therapy sessions
her reasons for not eating often centred around her disgust with the food options that her mother offered.
Amy was also well-accepted by her peers.
Mumford et al.’s (1991)
concept of ‘
culture clash
’ explains, in part, that perhaps Amy was experiencing conflicting cultural norms: those of her peers and local community, and those of her parents.
As she decidedly chose to
reject her ancestral culture
through her rejection of her family’s food and food rituals; this may have worsened her already tense conflict of gaining autonomy and independence from her parents as Amy symbolically rejected her parents’ love and care.
Amy’s treatment was tailored to address each of the above issues comprehensively. .
Under the watchful eye of her nutritionist she was held accountable for more balanced food choices and meals.
This worked in conjunction with the in-home therapist who was able to transverse the cultural divide and make treatment recommendations practical in the home setting
EVALUATION
Generalisability
narrow sample - lacks generalisability
Reliability
case study is too unique and is about their life so is individualistic - lacks reliability
triangulation used - improves reliability
Validity
triangulation
Potential bias - Patients are likely to be studied closely by one or multiple researchers. This means the researchers tend to get to know the patient very well
amy may not divulge all info
Ethics
As a case study, confidentiality was maintained in not printing Amy’s full name.