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 aligns perfectly with the DSM-5 diagnostic criteria for Anorexia Nervosa.
• Key features include a significantly low body weight (BMI ~13.5), an intense fear of gaining weight (believes she is 'fat'), and a severe disturbance in body image.
• Physiological signs like hypotension (82/50 mm Hg) and amenorrhea ('irregular menstrual periods') are common medical complications resulting from starvation.
• The refusal to eat and malnourishment are behavioral manifestations of the disorder's core psychopathology.

Why Other Options Were Wrong

• Option A: Bulimia nervosa is incorrect because it is characterized by binge-eating followed by compensatory behaviors (like purging). Patients with bulimia are typically of normal or slightly above-normal weight, not severely underweight like this patient.
• Option B: Schizophrenia is a psychotic disorder. While food refusal can occur, it is usually due to paranoid delusions (e.g., believing the food is poisoned), not an intense fear of gaining weight or a distorted body image.
• Option C: Reactive depression can cause changes in appetite and weight loss. However, it does not typically involve the core features of Anorexia Nervosa: an intense fear of becoming fat and a distorted perception of one's body.

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 and suicide. Nurses must recognize the signs of medical instability (e.g., severe hypotension, bradycardia, electrolyte imbalances) which necessitate immediate hospitalization.
• Management is multidisciplinary, involving medical stabilization, nutritional rehabilitation (often with a registered dietitian), psychotherapy (like CBT or family-based therapy), and psychiatric medication management.
• Patient safety is paramount. This includes refeeding syndrome monitoring, suicide risk assessment, and creating a structured, supportive environment for meals.

How to Approach the Question

• First, analyze the patient's demographic and presenting complaint: a young female with signs of severe malnutrition.
• Calculate the Body Mass Index (BMI) to objectively quantify her weight status. A BMI of ~13.5 is a critical finding.
• Identify the cluster of key signs and symptoms: severe low weight, hypotension, amenorrhea, food refusal, and a distorted body image ('convinced she is fat').
• Evaluate each option against this clinical picture. The patient's symptoms are a textbook match for the diagnostic criteria of Anorexia Nervosa.
• Rule out other options by identifying the missing key features. For example, the absence of binge-purge cycles rules out bulimia, and the absence of psychosis rules out schizophrenia as the primary cause.

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: BMI of ~13.5 kg/m2 indicates extreme severity of underweight.
• Clinical cues: The statement 'convinced she is fat' despite emaciation is a classic sign of the profound body image distortion central to Anorexia Nervosa.

Question ID

QD8i6nsGd4jhVIQLYcRZM

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 312-314

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