Evaluate the following patient scenarios and match each clinical presentation to its most accurate DSM-5 psychiatric diagnosis within the eating disorder spectrum.
- A 24-year-old graduate student with a of is evaluated for severe hypokalemia. She reports recurrent episodes of consuming excessively large amounts of high-calorie foods, immediately followed by self-induced vomiting. Despite her emaciated appearance, she insists she is overweight and needs to lose more fat.Anorexia nervosa, binge-eating/purging type
- A 22-year-old retail worker with a of is evaluated for bilateral parotid gland hypertrophy and dental enamel erosion. She frequently eats excessively large meals and subsequently uses enemas to prevent weight gain. She expresses intense fear of becoming obese.Bulimia nervosa
- A 27-year-old accountant with a of is evaluated for progressive weight loss. He restricts his diet entirely to liquid nutritional shakes due to a profound fear of vomiting, which began after a severe bout of viral gastroenteritis. He is highly distressed by his weight loss and desires to gain weight.Avoidant/restrictive food intake disorder
- A 35-year-old teacher with a of is evaluated for depression. She describes recurrent episodes of rapidly consuming large quantities of snacks until uncomfortably full, typically when experiencing work-related stress. She feels intense shame and disgust with herself afterward but takes no measures to counteract the caloric intake.Binge-eating disorder
Answer
Patient 1 matches Anorexia nervosa (binge-eating/purging type); Patient 2 matches Bulimia nervosa; Patient 3 matches Avoidant/restrictive food intake disorder (ARFID); Patient 4 matches Binge-eating disorder.
Correct matching requires systematic evaluation of weight, behaviors, and cognitions. Patient 1's low BMI (<18.5) and body image distortion classify her as having Anorexia nervosa, despite the bulimic behaviors. Patient 2 exhibits identical compensatory behaviors but maintains a normal weight, correctly diagnosing Bulimia nervosa. Patient 3 has significant weight loss but lacks body image distortion, pointing to ARFID resulting from a fear of vomiting. Patient 4 exhibits binging without compensatory behaviors, which is characteristic of Binge-eating disorder.
Step-by-Step Solution
Key Concept
The differentiation of eating disorders relies heavily on objective weight parameters (BMI thresholds), the presence or absence of compensatory behaviors, and the underlying motivation for dietary restriction (body image distortion versus aversive food responses).