Eating Disorder

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍eating disorder symptoms

Concerns about weight and body shape: ‍yesno, described as ‍overweightunderweightdistorted body image

Current weight: ‍ ‍kglbs

BMI: ‍

Weight changes over the past ‍ ‍months: ‍gainedlost ‍ ‍kglbs

Attempts to control weight: ‍none, ‍dieting, ‍fasting, ‍laxatives, ‍diuretics, ‍vomiting, ‍excessive exercise



Associated symptoms: *Try using right-click for negatives*

‍preoccupation with food

‍fear of gaining weight

‍feeling of loss of control during eating

‍eating in secret

‍eating large amounts of food

‍use of compensatory behaviors after eating

‍distorted body image

‍anxiety

‍depression

‍insomnia

‍irritability

‍suicidal thoughts, ‍persistentintermittent, ‍withwithout a plan, ‍withwithout intent to act

‍menstrual irregularities

‍dental problems

‍throat soreness

‍swollen salivary glands

‍fatigue

‍dizziness

‍cold intolerance

‍hair loss

‍dry skin

‍brittle nails



Contributing factors:

‍body image dissatisfaction

‍history of dieting

‍perfectionism

‍history of trauma or abuse

‍peer pressure related to appearance

no history of: ‍depression, ‍anxiety, ‍substance abuse

no use of: ‍antidepressants, ‍antipsychotics, ‍stimulants, ‍steroids

no family history of: ‍eating disorders



Psychosocial history:

Stress level: ‍lowmoderatehigh

Recent life changes: ‍none

Social support: ‍adequateinadequate

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

,

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Eating Disorder ‍likelysuspectedpossible

DDx: anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, avoidant/restrictive food intake disorder, eating disorder due to a general medical condition, substance-induced eating disorder, depression, anxiety disorders, obsessive-compulsive disorder, personality disorders, thyroid abnormalities, diabetes mellitus, malignancy, chronic infections, autoimmune disorders, adrenal insufficiency, Cushing syndrome





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍TSH, ‍cortisol, ‍calcium, ‍magnesium, ‍phosphate, ‍zinc, ‍vitamin D, ‍vitamin B12, ‍folate

- ECG

- Bone density scan

- Psychological assessment

Treatments:

- Nutritional counseling

- ‍Nutritional rehabilitation

- ‍Psychotherapy

- ‍Medications for comorbid conditions

- ‍Medications for symptom control

Further care:

- Referral to dietitian

- Referral to eating disorder specialist

- Referral to psychologist

- Referral to psychiatrist

- Follow-up in ‍ ‍weeksmonths

- Return if condition worsens or if new symptoms develop such as rapid weight loss, electrolyte imbalance, or cardiac symptoms