Suicide is the leading cause of death in patients diagnosed with anorexia nervosa, contributing to around 20% of cases (Thornton, Welch, Munn‐Chernoff, Lichtenstein, & Bulik, 2016). The issue is especially concerning, as the patient is a 16-year-old female showing the signs of an eating disorder. Thornton et al. (2016) report that individuals living with the disease are at almost 20% higher risk of dying from suicide compared to the general female population between 15 and 34 years of age. The possible reason for it is that this group of people has repeated exposure to pain due to restrictions associated with anorexia nervosa and the decreased pain sensitivity.
Bulimia nervosa is a related disease that can be associated with severe acid-base and electrolyte alterations (Westmoreland, Krantz, & Mehler, 2016). The most likely electrolyte abnormality in patients with bulimia nervosa associated with self-induced vomiting is the deficiency of serum potassium. The cause of such an outcome is that repeated vomiting can lead to severe dehydration and the increased renal absorption of bicarbonate and sodium, as the body tries to retain water (Mehler & Rylander, 2015). This, in turn, results in low serum potassium values and metabolic alkalosis.
The indications for medical hospitalization of a patient with an eating disorder include acute weight decline with food refusal, the need in supervision during and after all meals, and poor or very poor motivation to recover associated with the preoccupation with intrusive repetitive thoughts (National Eating Disorders Association, 2018). The patient presented in the case study does not show all of these symptoms. However, she shows the weight loss of 9 kg (20 lbs.) per year, which is a significant concern.
As the teenage patient reports feeling healthy, has good grades, is interested in sports and eating healthy, it is possible to say that she is not likely to have a major depressive disorder, one of the common causes of weight loss (“Unintentional weight loss,” 2019). At the same time, the weight loss by 20 lbs. is a significant concern, which may be a symptom of an eating disorder. As the teenager does not report feeling too fat or too thin, the presence of such an illness may also be considered unlikely, as there is no change in the menstrual periods, too. However, it is necessary to check whether the patient may be lying about her symptoms because bulimia and anorexia nervosa are the most likely diagnoses for this case (“Unintentional weight loss,” 2019).
The differential diagnosis for such a case includes several illnesses. The six possible conditions that can cause excessive weight loss in an adolescent include:
- Anorexia nervosa, associated with malnutrition (Westmoreland et al., 2016);
- Bulimia nervosa, related to purging behaviors;
- Major depressive disorder, which may be manifested in many symptoms, including weight loss (“Unintentional weight loss,” 2019);
- Hyperthyroidism or overactive thyroid (“Unintentional weight loss,” 2019);
- Hypothyroidism or underactive thyroid;
- Cancer (“Unintentional weight loss,” 2019).
Although both bulimia nervosa and anorexia nervosa are caused by the patient’s inappropriate perception of body shape, the former disease is most likely to present with a normal physical exam compared to the latter (Johns Hopkins Hospital, 2019). The reason for it is that individuals showing signs of anorexia nervosa are engaged in self-starvation, which can cause severe weight loss. At the same time, patients living with bulimia nervosa typically are at a normal weight or above (Johns Hopkins Hospital, 2019). Thus, the diagnosis of bulimia may require a more in-depth assessment of the patient’s health state.
References
Johns Hopkins Hospital. (2019). Frequently asked questions about eating disorders. Web.
National Eating Disorders Association. (2018). Level of care guidelines for patients. Web.
Thornton, L. M., Welch, E., Munn‐Chernoff, M. A., Lichtenstein, P., & Bulik, C. M. (2016). Anorexia nervosa, major depression, and suicide attempts: Shared genetic factors. Suicide and Life‐Threatening Behavior, 46(5), 525-534.
Unintentional weight loss. (2019). Web.
Westmoreland, P., Krantz, M. J., & Mehler, P. S. (2016). Medical complications of anorexia nervosa and bulimia. The American Journal of Medicine, 129(1), 30-37.