Promotion strategies
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For this patient, it would be important to focus on “nutrition and the relationship between good nutrition, health, and a positive body image” (Burns et al., 2019). Because the patient is asking about diet pills when she is already looking thin and frail, it is important to emphasize on healthy eating habits, limiting the sugar intake as well as caffeinated drinks, and lastly to not skip any meals. This patient should be encouraged to following healthy paths to weight management. Body dysmorphic disorder (BDD) is described as “a preoccupation with perceived defects in physical appearance, as well as avoidance and repetitive behaviors, causing distress and impairment (Rautio et al., 2022). This condition can severely impact the teenager’s education as well as social development, and it can be associated with severe levels of psychiatric comorbidities, poor insight, psychiatric treatment refusal, as well as suicidal behaviors. It seems that this patient is experiencing these symptoms on top of her depression.
Social media is an enormous component to BDD. In the last couple decades, bullying has been very prevailing, and many children and teenagers are affected. Different types of bullying exist, such as body shaming and fat shaming, and can have a great negative influence on one’s own perception of their body image, leading to low self-esteem and BDD. Social media may be a trigger to the teenagers who already are predisposed to the disorder, and could therefore worsen the symptoms (Body Dysmorphic, 2022).
At this point, I would not feel comfortable prescribing this patient any diet pills. Once I have evaluated the patient and I am more informed on her situation from the questions I will be asking her, I believe a referral to therapy is advised so that she can receive the proper care. During therapy, a deeper understanding can be communicated through the use of cognitive behavioral therapy (CBT). This type of therapy added to an antidepressant, such as SSRI, can greatly increase outcomes. Additionally, the patient should be encouraged to continue participating in family activities and social gatherings, encourage the parent to show their child unconditional love, to be patient and supportive, to maintain a positive and close relationship, to be a good role model and a good listener. The main advice to the parent of a child with BDD is to not be critical of their child, but rather to encourage them to receive professional help (Body Dysmorphic, 2022).
Additionally to referring the child to psychiatry and therapy, I would also refer the child to a nutritionist. Sometimes patients, especially teenagers, may be falsely informed on foods and food groups and they do not necessarily know the right foods to eat. Focusing on protein and vegetables, while limiting portions and not skipping meals is of great importance and the patient should be thoroughly educated on it. Lastly, education about incorporating a light workout routine may be complementary to the healthy diet.
References
Adolescent medicine: Routine screening [The University of Chicago]. (2020).
https://pedclerk.bsd.uchicago.edu/page/adolescent-medicine-routine-screening
Body dysmorphic disorder (BDD) and youth. (2022). Mental Health America. https://www.mhanational.org/body-dysmorphic-disorder-bdd-and-youth
Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Elsevier.
Rautio, D., Gumpert, M., Jassi, A., Krebs, G., Flygare, O., & Monzani, B. (2022). Effectiveness of multimodal treatment for young people with body dysmorphic disorder in two specialist clinics, Behavior Therapy, 53, 1037-1049.
Youth risk behavior surveillance system (YRBSS). (2022). Centers for Disease Control and Prevention