61 Anorexia Nervosa

Name: Giselle Vasco

Source: Skinny by Ibi Kaslik (book, 2004)

Background Information

Giselle Vasco is a twenty-one year old, Caucasian female of Hungarian decent. She was the first born of two daughters after her parents, Thomas and Vesla, immigrated to the United States in the early 1970’s to escape the communist repression of their country. Giselle’s younger sister Holly is eight years behind her in age but, much like her sister, has a very grounded and intellectual personality. They both stand approximately five feet, eleven inches tall and have a very close relationship. Giselle and Holly are both considered accomplished in their own rights, even at young ages with Giselle enrolled in medical school and Holly being acknowledged as a “stand-out athlete” at her high school. At the present time, Giselle is home from medical school, taking a leave of absence to clear her mind and regroup her life. She is working at a hospital in the mental health ward as a companion to many patients. It is described that, after her first love had left, Giselle became a callous lover who would frequently sleep around – trusting nobody with her heart. This stayed a constant until she met her current boyfriend, Solomon (Sol), who desperately loves Giselle.

Both sisters however, are plagued by the fact that their father had recently passed away due to a heart attack. In the midst of this tragic loss, both sisters struggle in the grieving and coping processes respectively. Giselle and her father always had a rocky relationship that stemmed from a time before she was even born. Thomas questioned the faithfulness of his wife in the frequent suggestions that Giselle may not be his biological daughter. This was an obstacle that was battled through from Giselle’s birth up until her father’s death-and even after. The relationship between the girls and their mother, however, seems to be solid.

Giselle acknowledges that when she was her sister’s age (approximately 14) one of her primary focuses was to discover ways to “be smaller.” It is presumed that Giselle, and the entire Vasco family for that matter, were a religious group. At one point, Giselle asks for God’s forgiveness after lying to her mother about her weight at the time. Giselle also acknowledges that she would masturbate in upwards of six times a day and would drink only lemon water. In lieu of her desire to “be smaller,” Vesla would frequently take Giselle to see the doctor regarding her weight, often against her wishes. There is no mention of a history of drug or alcohol use by Giselle.

Description of the Problem

As mentioned earlier, while in high school, Giselle’s mother would constantly bring her to the doctor to check up on her weight. Giselle would do things like put rocks or weights in her pockets to tip the scale at 120 pounds, as opposed to the 95 that she weighed. Her lack of a proper diet surrounds her potential diagnoses. Holly describes her sister’s systematical approach to the dinner table as Giselle would figure out ways to clear her plate without digesting a single bite of food (i.e. dropping food on the floor, pretending to use the restroom and flushing portions of her meal). Aside from a lack of food toward her diet, Giselle would only drink lemon water.

Sexually, Giselle is not what you would call repressed. She became very sexually ambiguous after the departure of her first love. Also, as discussed earlier, Giselle would spend much of her time locked in her room, masturbating up to six times per day.

On a relational level, Giselle and her father always struggled with the speculation the she may not be his biological daughter. We go on to discover that this is indeed true. This made it hard for them to ever truly salvage a meaningful father-daughter relationship.


In my personal opinion, Giselle’s diagnosis would be as follows: Axis I, Anorexia Nervosa, Binge Eating/Purging Type (307.1) and Axis IV, Problems with Primary Support Group.

Criteria needing to be met for above Axis I diagnosis as follows (from DSM IV-TR):

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
    • Over the course of years, Giselle would consume an insufficient diet consisting of little or no food and lemon water, putting her at a weight that was below 85 percent than expected for her height. She constantly resists the cautions of her mother and doctor in regard to her weight.
  2. Intense fear of gaining weight or becoming fat, even though underweight.
    • Giselle exhibits this behavior in her everyday way of thinking. Even though she is of above average height, she intensely pursues a body weight that is unhealthy for her to maintain. Also, she takes extreme measures to ensure that her body weight stays exceedingly low and, in turn, dangerous to her general well-being.
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
    • Although she is what is considered underweight, Giselle is indifferent to this fact and yearns to continue to lose dangerous amounts of weight. She evaluates herself as being “too big” but seems to have a partial awareness that she is ill-she may not be in denial.
  4. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
    • Symptoms of this nature were not discussed; however details about her sexual history and excessive masturbation are mentioned.

Accuracy of Portrayal

Although it may not be glaringly clear, should the average person read this book, they would find a fairly accurate portrayal of the onset and manifestation of the eating disorder Anorexia Nervosa. I say that it may not be clear, in large part, due to the fact that this work is narrated by two individuals (both sisters) as almost two different stories. Not only is Giselle’s case of Anorexia a prevalent point in the novel, but so is the poor relationship between Giselle and her father as well as the family dynamic after their father’s death. There were, however, some very accurate descriptions of what behaviors would be exhibited from an individual with this disorder. Her constant dilemma on how to trick those around her into believing she was eating a healthy diet is quite common in individuals with Anorexia. Giselle also references her constant hunger, although she denies it to those around her. Her cold and clammy hands as well as constant fatigue are also associated features of Anorexia that allude to her problem. With that being said, I feel that the book does an exceptional job of portraying an individual with Anorexia Nervosa.


In treating Giselle for her disorder, the treatment team would focus their attention around two main goals: (1) To help Giselle gain weight and (2) To address Giselle’s psychological and environmental issues. A major step in treatment, as in the treatment of any disorder, would be to make sure that Giselle is aware that she has a problem. The most widely used form of treatment for this disorder is family and group therapy, which cannot be utilized to its full potential should the patient not admit that he/she needs help. In Giselle’s case, her sister and mother would play a very significant role in treatment. As a clinician, you would like to see Giselle’s family encouraging her on a regular basis, reinforcing the fact that she looks fine the way she is (while eating a normal diet), and that it is not necessary for her to exhibit these unhealthy behaviors. More specifically, I believe that Giselle’s sister Holly should be utilized as best as possible during treatment as they have always had a very strong bond and friendship. If anyone would be able to aid in “breaking through” to Giselle about her disorder, I think it would be her little sister.

Self-help groups are also successful in the treatment of those with Anorexia. Treatment for Giselle should include regular group meetings with individuals who have experienced the same negative outcomes in their lives due to the disorder. The thought here is that by discussing the topic of Anorexia among those who have it, Giselle will be afforded the opportunity to become more educated on the subject and, eventually put herself in a position where she is aware of the harm she is causing her body. Over time, between family therapy and self-help group therapy, hopefully a certain sense of cognizance will begin to develop with Giselle in regard to the harm she is causing herself-this will hopefully lead to a change in attitude and eventually behavior.


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