Nicole” is a ten-year-old female, presenting to

Nicole” is a ten-year-old female, presenting to your clinic with a history of 42 lbs. of weight loss, poor intake, and medical instability. These symptoms present in the context of Nicole’s fears regarding eating and potentially choking on food. Nicole was also diagnosed with celiac disease. Approximately 8 months prior to treatment, Nicole felt unwell at Christmas dinner after eating what she felt was spoiled turkey. Prior to weight loss and medical instability, Nicole had been meeting with a therapist for a little over two years for low self-esteem and hopelessness. Due to these symptoms Nicole had difficulty socializing with peers and making friends at school. Therapy had helped minimally, and parents denied any major improvement in these symptoms over the past two years. They had considered changing therapists, but this had been put on hold while the family was dealing with Nicole’s acute medical state. Following this experience, Nicole’s anxiety escalated, and she began experiencing an increase in physical and emotional symptoms related to eating. Anxiety surrounding mealtimes and food increased and she began reporting and increase in stomachaches and headaches. Nicole’s family trialed dietary changes to see if they could rule out some dietary causes to Nicole’s symptoms. The family also brought Nicole to the pediatrician, who ordered allergy and celiac testing. Over the course of this time the patient lost 32% of her overall body weight. Her symptoms continued to worsen, and she barely ate any solid food due to anxiety and fear that she would choke on her food. Patient’s diet primarily consisted of oatmeal, smoothies, and pudding. If she did eat any solid food, she would chew very careful and slowly to avoid choking. Patient began showing physical symptoms of malnourishment such as thin/brittle hair, abdominal distension, cold intolerance, and yellowing skin. Nicole’s level of energy had significantly decreased, and she complained of feeling fatigued.Post your diagnosis and reasons.

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