Question

A 22 year old first year law student comes to the physician with amenorrhea for the past four months. The patient admits having been under a great deal of stress adjusting to the academic burden of law school, but did finish her first semester with a 3.7 GPA. Upon questioning, she acknowledges eating large amounts of food such as an entire large pizza when she is feeling stressed. She feels guilty after she eats, however, and forces herself to vomit it all up. The rest of the time, she eats a "normal diet" of salads and granola. Physical examination reveals an extremely thin female, with height is 69 in. (175 cm), weight is 103 lbs. (47 kg). There is diffuse fine hair growth on the extremities and mild erosion of the enamel of the anterior teeth. A callus is present on the dorsal surface of the index and middle fingers of the patient's right hand. TSH is within normal limits. A urine pregnancy screen is negative. Which of the following is the most appropriate diagnosis in this patient?

A. Anorexia nervosa
B. Obsessive-compulsive disorder
C. Borderline personality disorder
D. Bulimia nervosa
E. Hyperprolactinemia

Answer 1

The patient with symptoms of binge eating followed by purging and physical signs of significant weight loss is best diagnosed with Bulimia nervosa, an eating disorder characterized by such behaviors.

Step-by-step explanation:

The most appropriate diagnosis for the 22-year-old law student presenting with amenorrhea, stress-induced binge eating followed by self-induced vomiting, and physical signs such as thinness, fine hair growth on extremities, and enamel erosion is Bulimia nervosa. This eating disorder is characterized by recurring episodes of binge eating with compensatory behaviors such as vomiting to prevent weight gain. Unlike anorexia nervosa, individuals with bulimia nervosa usually maintain a normal weight or may be overweight, but this patient's extremely low weight is a manifestation of her purging behaviors and severe restriction during non-binge periods, showing that eating disorders can often have overlapping symptoms and need a comprehensive evaluation for accurate diagnosis.