Anorexia Nervosa Chronic Social Anxiety

Hospitalised under the Mental Health Act. Is now under the care of a MH practitioner, but finds it very difficult to speak to the practitioner as she associates her as being responsible for putting her in hospital. X will crawl into a ball, will not speak and becomes distressed. There is a draft care plan under review which was issued on xxxx Once completed, X will have a lot of support and care available.

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X cannot cook or prepare a meal due to the severe strain this has on her mental health. She struggles around food due to feelings of guilt, associated with her Anorexia. She cannot not peel or chop vegetables nor be around food. X cannot prepare a meal due to her great aversion to food. X mum has to cook and prepare all meals and ensure the food has nutritional value, with vitamins and minerals which X body needs, at her lowest her weight dropped to XX so the needs the nutrition to build her back up.

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X does not eat due to anorexia. Since discharged from hospital she has had a regimented routine of meals and times which her mum prepares and gives to her. The routine is, breakfast, snack, lunch, snack, dinner and snack. Mum has to sit beside her to ensure she eats the meal and that none of the food has been disposed of in bins or purged and vomited. X cannot eat in front of anyone else, other than her mum. Mealtimes are a very stressful process. X natural reaction is to avoid eating and spends a lot of time curled up in a ball in the corner of her room afterwards. Mum will try to motivate and encourage her to eat but this can be extremely difficult. It is important to add that although X eats some at the moment, it is because of this continuous supervision and because she feels she has to eat. She still has an obsession with her appearance and continues to feel overweight.

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Mum has to administer X medicine, she has a dosette box which is kept safe and secure and mum monitors her medication closely to ensure every dose is taken and X does not purge the medicine. Although X takes her medication, she suffers frequent low, fluctuating moods to the extent of self harming, although this is not happening at the moment, she still has thoughts of this and is aware her mum will check her body daily. Medication needs to be kept securely in an unreachable space. X has suffered from suicidal thoughts many times, although these haven't been acted on, this remains a concern for her mum. Her emotional state and mood requires constant supervision.

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X needs encouragement to leave her room to wash. She suffers with low mood and lacks motivation. She wears oversized clothes, as seeing herself makes her feel incredibly low with negative thoughts of how she looks, and believes herself to be overweight. The bathroom door has no lock in place, this is to ensure that mum can monitor her to make sure she isn't self harming, even though everything hazardous has been removed from the bathroom, from razor blades to bleach, as she could potentially try to harm herself. Due to her low blood pressure X has a tendency to become dizzy and fall over, so she needs help while in the shower. Mum washes her back and hair because of the severity of X fatigue she is unable to hold her arms up for very long Although X has been discharged from hospital, she is very fatigued and often complains of having little to no energy. Quite often, bathing is too much for her and she will need to rest afterwards.

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X is able to use the toilet without difficulty. The restriction of food has caused some problems in the past with her digestive system where she has been unable to go to the toilet, but at the moment she is able to use the toilet without difficulty.

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X needs prompting and encouragement to dress. Her mum tries to encourage her to do this but it causes a lot of upset so it has to be done in a careful manner. She continues to feel negative regarding her appearance, and believes she is very overweight. This is a continuous battle within her mind. X wears loose comfortable clothing such as oversized hoodies and loose lounge wear as she believes that when she eats something she can feel her legs becoming bigger. She suffers severe fatigue, which also makes it very difficult to get dressed. As well as being bullied, X frequently took time off school which evidences her struggles with having the motivation and energy to get up, and dress daily.

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X struggles to communicate and is diagnosed with chronic social anxiety. She was bullied in school, taking a lot of time off, increasing her anxiety. She finds being in groups very challenging, which has contributed towards her social anxiety. She feels people are judging and laughing at her. The majority of her time is spent in her room, where she curls up into a ball in a corner. There are good days, when X speaks with her mum, communicates some sentences and smiles, but most days she does not speak. She can go 2-3 hours without saying anything, only then saying yes or no. When she is feeling worse about her appearance she isolates herself from everyone. This has impacted her education and development. When hospitalised, it took X several weeks before she was able to communicate with a medical professional, support was available to help develop and maintain friendships with others that were hospitalised but she struggled to do this. Mum continues to support and speak to X daily in a bid to try and help her communicate.

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X finds it difficult to read, she missed a substantial period of time from school due to anorexia. She has had tests which showed below average in terms of cognitive abilities. Quite often, when trying to read X will show signs she is feeling weak, tired and is unable to focus. She has to have things explained to her several times whilst reading before she can fully understand what they mean.

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X has no friends or social life. She stays at home and isolates herself in the bedroom due to social anxiety so mixing with others makes this very difficult. She associates being around groups of people with being bullied at school. X does not like large crowds of people and doesn't mix with others easily, she worries that she is being judged and laughed at. X becomes incredibly anxious around strangers and worries about being seen by people she knows. X has recently started to attend group classes, it is suggested she attend 3-4 days per week. X finds it very difficult to be around people, especially girls. She is one of two girls in her class which is easier for her to manage. Her social anxiety has impacted her education. X finds it very difficult to speak with her care co-ordinator and psychiatrist, associating them with the feeling of resentment after being hospitalised under the Mental Health act.

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X is unable to make any budgeting decisions for herself. Her mum controls all finances, and makes all budgeting decisions, however simple they may seem due to X continuous fatigue and state of mind.

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X struggles and finds it very difficult to go out. It requires a lot of motivation and encouragement for her to leave the bedroom, and substantial encouragement to leave her home and cannot go anywhere without her mum. X could not plan a journey anywhere due to severe anxiety, mum tries to encourage her to go out, at least once a week but this can be difficult. X worries about being seen by bullies she went to school with, this causes panic attacks when in crowded places even if its somewhere familiar, so mum has to plan the journey and route making sure it is secluded. X attempted shopping with her mum to buy some clothing but was unable to do this, she suffered a panic attack and had to be taken home. This set her back, where she remained in her room for some time. X has been going to a new school for one day a week with a view to increase but her mum has been accompanying her and staying with her, as X would not go there or stay without her.

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X suffers with low energy, and fatigue which can affect how far she can walk. Some days she can be crawling and holding onto banisters and rails, barely managing 20 metres. On better days, she can walk up to 50 metres with encouragement, providing it is somewhere secluded and has a low risk of her bumping into anyone she knows. Mum encourages her to go out for walks, on better days X is able to walk to the river and come home, but is still very fatigued afterwards and often needs to rest. On bad days, X will not leave her room, does not move from the corner of her room where she spends hours curled up in a ball. X suffers with severe low mood, not speaking to anyone during this time.

We would like to request a home assessment with someone trained in mental health. We would like it noted that X did not speak to mental health professionals when hospitalised and finds it very difficult to speak to new people.