A 19-year-old female is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5'4" tall and weighs 35.8 Kg . She appears dehydrated and malnourished. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had irregular menstrual periods for the past one year. She is convinced she is fat and refuses food. The nurse suspects that she is a case of?

1. A

   Bulimia nervosa

2. B

   Schizophrenia

3. C

   Reactive depression

4. D

   Anorexia nervosa

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

• The patient's presentation includes the core diagnostic features of Anorexia Nervosa: restriction of energy intake leading to a significantly low body weight, an intense fear of gaining weight, and a disturbance in body image.
• A calculated BMI of approximately 13.5 kg/m² (35.8 kg / 1.63m²) is well below the threshold for severe thinness (less than 16.0 kg/m²), confirming a 'significantly low body weight'.
• The patient's conviction that she is 'fat' despite being emaciated demonstrates the profound body image distortion central to the diagnosis.
• Physiological signs like hypotension (82/50 mm Hg) and amenorrhea (irregular periods for a year) are direct consequences of the severe malnutrition and starvation associated with Anorexia Nervosa.

Why Other Options Were Wrong

• Option A: Bulimia nervosa is characterized by recurrent episodes of binge eating followed by compensatory behaviors (like purging). Patients with bulimia are typically of normal or slightly above/below normal weight, not severely underweight as seen in this case.
• Option B: Schizophrenia is a psychotic disorder. While it can involve bizarre beliefs about food (e.g., that it is poisoned), it does not feature an intense fear of gaining weight or a distorted body image focused on being 'fat'. The patient's thoughts are organized around weight and shape, not psychosis.
• Option C: Reactive depression can cause weight loss due to a decreased appetite. However, it does not typically involve the intense fear of gaining weight or the distorted body image that are the defining characteristics of Anorexia Nervosa.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Diagnosis of eating disorders based on clinical presentation in acute care settings.
• Anorexia Nervosa has the highest mortality rate of any psychiatric disorder due to medical complications (like cardiac arrest) and suicide. Early identification and intervention are critical.
• Management requires a multidisciplinary team including physicians, nurses, dietitians, and mental health professionals to address the complex medical and psychological aspects of the illness.
• Nurses play a vital role in monitoring for refeeding syndrome, a potentially fatal shift in fluids and electrolytes that can occur in malnourished patients receiving artificial refeeding. This requires careful monitoring of electrolytes, especially phosphate.

How to Approach the Question

• First, analyze the patient's demographic and clinical data. Note the age (19), gender (female), vitals (hypotension), and physical state (underweight, dehydrated).
• Calculate the Body Mass Index (BMI) to quantify the degree of underweight. Height: 5'4" (approx. 1.63m), Weight: 35.8 kg. BMI = 35.8 / (1.63 * 1.63) ≈ 13.5 kg/m². This is severely underweight.
• Identify the core psychological symptoms: The patient 'is convinced she is fat' (distorted body image) and 'refuses food' (fear of weight gain/restrictive behavior).
• Synthesize the findings: Severe underweight + distorted body image + fear of weight gain + amenorrhea is the classic presentation of Anorexia Nervosa.
• Evaluate the other options to confirm they are a poorer fit. Bulimia involves normal weight and binging. Schizophrenia involves psychosis. Depression lacks the specific body image distortion.

Concept Tested & Keywords

• Concept Tested: Diagnosis of eating disorders based on clinical presentation.
• Stem keywords: 19-year-old female, unconscious, hypotension, underweight, dehydrated, malnourished, irregular menstrual periods, convinced she is fat
• Lead-in keywords: suspects that she is a case of
• Clinical cues: A calculated BMI of approximately 13.5 kg/m² indicates severe underweight, a cardinal sign of Anorexia Nervosa.
• Clinical cues: The combination of a distorted body image ('convinced she is fat') with severe weight loss and food refusal is the hallmark of Anorexia Nervosa.

Question ID

QD8i6nsGd4jhVIQLYcRZM

Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 58-60

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1503-1505, 1511-1513