Diana's Struggle With Bulimia Nervosa

Princess Diana, a member of the Great Britain royal family, struggled with Bulimia nervosa. Her parents lacked emotional support and raised her in an unstable and argumentative environment before they separated. Although she was raised in a pompous atmosphere, Diana was well-liked and socially aware of her privilege. The distress caused by her family led her to manifest control in different ways such as being neat, a compulsive talker, and a socializer. Her marriage had comparable features to her childhood which led her to gain control by binging and purging food.

Helping her gain a sense of self-control of her feelings and life. She started counseling but refused to take the medications prescribed when she found out she was pregnant. After she gave birth to her first child her bulimia subsided but with the absence of Charles soon after she gained postpartum depression and the bulimia relapsed. Chronically depressed, Diana tried therapy that analyzed her dreams but found no help. While suicidal thoughts transpired, Charles’ continued downgrading her self-esteem, and the media increased coverage of her sickly appearance, which exacerbated her bulimia.

The third attempt at therapy was achieved where she went every week which progressed into her recovery.

The early years of a child’s life are the most pivotal time for the development of identity and self-image. Failure of caregivers’ appropriate responses to a child’s needs deprives the developing child of the essential groundwork for acquiring their own body identity, with a discriminating perceptual and conceptual awareness of their functions (Natenshon, 2019).

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Diana’s childhood had a rocky start when her parents made her feel guilty for the death of her brother, forcing her to dress up and act the way they wanted her to be instead of embracing her individuality leaving Diana with little control. Issues of personal control have been proposed to play a central role in the etiology and maintenance of eating disorders (Froreich, Vartanian, Grisham, Touyz, 2016). During her teenage years, Diana noticed that she could gain weight easily and took precautions to diagnose voiding alcohol and smoking. If she saw that she was gaining weight she would cut back on eating. She had a hard time restraining herself from sweets. When her grandmother died she and a friend escaped gorging on food, relying on food for comfort. There are extreme and often life-threatening behaviors that consist of either consuming too little or too much food typically stemming from intrusive obsessive thoughts. The sense of helplessness or lack of control they experience during binge periods ultimately gives way to obsessions of physical sickness and self-disgust afterward (Yaryura-Tobias & Neziroglu, 1983). This became a problem when Diana first started binging and purging due to her feeling isolated and started crying all the time because of all the pressures and demands of the media and the royal family. Diana’s waistline went from 29 inches to 23 inches before her wedding. She reported that she purged four to five times a day during her honeymoon. After the wedding, Diana continued to vomit after eating with the continued pressure from the press. The DSM-5 criteria to diagnose Bulimia Nervosa is a recurrent episode of binge eating within 2 hours of a larger than normal amount of food than most individuals would eat in a similar period. There were many instances when Diana would have evenings where she would eat a whole steak and kidney pie or consume a pound of candy and a large bowl of pudding. The DSM-5 states that recurrent inappropriate compensatory behaviors such as vomiting to prevent weight gain qualify to be diagnosed. An interview with Diana would be good to collect any medical history in her family to see if there are any other cases of mental disorders that could show comorbidity in eating disorders. An interview would also be beneficial to see how Diana speaks of herself and other people present in her life to get an idea of the influence of her surroundings. A psychologist should also get a background on her childhood to see if there were any occasions or instances that negatively affected Diana’s overall well-being. Based on the information present in the case study evidence suggests that the pathophysiological mechanism that can be best explained for Diana’s eating disorder is due to the lack of control throughout her life, her toxic relationship with Prince Charles, and the demands of the public, press and, royal family to look and act a certain way.

Environmental factors that could have induced her eating disorder can be witnessed in her relationship with Charles. Watching the instability of both her parents may be the reason she ended up settling for Prince Charles. Charles was similar to her father who was emotionally abusive and silent and unresponsive when others were distressed due to his actions. Charles resembled her mother in a way where he was demanding and made her feel isolated, ed by being distant on many occasions. The relationship between Diana and Charles lacked emotional support and had the potential to harm Diana’s mental health. For instance, Prince Charles’ frequent comments regarding her weight, and his comments on how to look, act, and work toward the future have likely played a role. There was one time when Charles called Diana chubby, which triggered her to induce vomiting to lose weight. In Diana’s case, her focus on success and hard work, as well as her concern regarding external appearances, has likely added to her drive to fit in with the pressure of the British media to be thin. Additionally, the royal family may have similar attitudes regarding body image, and dietary restraint in regards to keeping a thin physique. Biological factors include her sister was also diagnosed with an eating disorder, anorexia nervosa. In The Relationship Between Eating Disorders and OCD Part of the Spectrum (2009) Numerous studies have now shown that those with eating disorders have statistically higher rates of OCD (11% – 69%). Given the high level of comorbidity between eating disorders and obsessive-compulsive disorder (Diana’s tendency to gain control by being neat and talking compulsively) and the potentially common risk/maintenance factors for the two disorders, she was already more susceptible to obtaining an eating disorder. Diana’s older sister was also diagnosed with the eating disorder Anorexia Nervosa, thus increasing her risks. There is an increased risk of getting an eating disorder if one of your first-degree relatives such as siblings, parents, or children has a disorder. Studies of families have found that having a first-degree relative (like a parent or sibling) with an eating disorder increases a person’s risk of developing an eating disorder (Risk Factors, 2018). A child with a genetic susceptibility to develop addictions, depression, and clinical eating disorders, having been exposed to neurobiological effects of chronic early parent/child attachment disturbances, becomes vulnerable to the onset of AN or BN in later life (Natenshon, 2019). Diana’s father was also known to have episodes of rage and a drinking problem. The Links Between OCD and Abuse (2019) states that alcohol use disorders are among the most common substance abuse disorders associated with having a diagnosis of OCD.

It is suggested that Cognitive Behavioral Therapy (CBT) would be the best option for Diana’s treatment. This would allow Diana to work through her emotions and feelings behind why she feels the need to binge and purge. Cognitive-behavioral therapy could help focus on identifying and altering dysfunctional thought patterns, attitudes, and beliefs, which may trigger and perpetuate the person’s pattern of harmful eating behaviors. Diana could also be put on antidepressants such as (SSRIs). She was unsuccessful in the past with drug treatment but that was because she was pregnant. It is likely that if Diana does not get pregnant again that she is likely to recover with the combination of both CBT and antidepressants. There is the opportunity for potential relapses if Diana continues any form of relationship with Princes Charles because he is toxic and can trigger Diana’s negative emotions and feelings about herself.