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Anorexia nervosa
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Binge eating disorder
Body dysmorphic disorder
Bulimia nervosa
Malingering
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This patient with excessive concerns about weight, dysmorphic body image, and decreased BMI most likely has anorexia nervosa.Anorexia nervosa is an eating disorder characterized by dramatically decreased food intake and weight loss. Patients may also engage in excessive exercise or other energy expenditure methods in order to compensate for food intake. It typically presents in young women with a body image disturbance. Patients will present with a reduced BMI and severe dietary restriction as well as constipation, fatigue, weakness, amenorrhea, depression, hair loss, and an emaciated, frail appearance. The condition can be quite deadly because of electrolyte abnormalities and metabolic derangements.Westmoreland et al. review the evidence regarding the diagnosis and treatment of eating disorders. They discuss how inpatient treatment may be required in order to stabilize the patient if the patient experiences severe complications. They recommend having a multidisciplinary team to help treat these patients.Figure/Illustration A is a clinical photograph demonstrating a hand with excessively skinny fingers and no signs of calluses (red circle). These findings are consistent with anorexia nervosa.Incorrect Answers:Answer 2: Binge eating disorder is characterized by eating large amounts of food over a short period of time and a lack of control over the rate or quantity of food intake. Patients also have feelings of disgust, depression, or guilt after eating.Answer 3: Patients with body dysmorphic disorder are preoccupied witha physical defect that is either nonexistent or slight. Patients will engage in repetitive behaviors or mental acts at some point during the illness course to deal with this perceived deformity, including mirror checking, skin picking, or excessive grooming.Answer 4: Bulimia nervosa typically presents with episodes of binging followed by purging behaviors such as vomiting or laxative use. Patients will typically have calluses of the dorsal hand and parotid enlargement from vomiting.Answer 5: Malingering occurs when patients seek medical care for secondary gain, such as a monetary benefit or time off work. These patients actively seek medical care and would not be resistant to intervention or care.Bullet Summary:Anorexia nervosa presents with excessive concerns about weight as well as a low BMI.
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