Question

Name: Bianca, 26, F, Family: Single, lives alone, Occupation: Law clerk, Presenting problem: Dehydration.

Bianca considers herself to be an overachiever. She graduated at the top of her class and landed a job at a prestigious law firm right out of school. To her friends and family, she says that her success comes from hard work and focusing on her career. Inwardly, though, Bianca believes her success is strongly tied to her appearance. Her body mass index (BMI) is 20, which is considered ideal, but one of her biggest fears is that she'll gain a lot of weight and somehow lose everything she's worked so hard for. Throughout high school, Bianca felt that in addition to excelling in her studies, she needed to look successful. She began strictly controlling what and when she ate. This type of diet proved to be highly stressful and difficult to maintain. In her words, "Probably two or three times a week, I'd slip up and just gorge on whatever fatty or sweet food we had in the house." These episodes were followed by guilt and vigorous workout sessions. In college, Bianca continued to restrict what she ate and began the habit of exercising rigorously. When social and academic pressures felt overwhelming, Bianca often broke down and binged on brownies, king-sized candy bars, and bags of potato chips (which she kept hidden) at night, only after making sure that her roommate had left. This pattern persisted through college and law school and continues today. Given the demanding nature of her job, it is not surprising to hear that she has at least one, and as many as four, bingeing episodes each week.

Every binge episode plays out the same way. Consuming junk food (again, hidden in her bedroom) starts off as pleasurable, but even after painful fullness sets in, Bianca finds herself unable to stop eating. Afterward, she feels so shameful about her behavior that she forces herself to vomit. When her throat is too sore or she is unable to vomit, she takes large amounts of laxatives to eliminate as many calories as she can. Additionally, she will engage in prolonged exercise sessions following a binge. These generally consist of a 3- or 4-hour high-intensity workout during the early morning ("before anyone else is up," according to Bianca) and a shorter evening workout. Bianca had a particularly severe bingeing session last night and was relieved when the laxatives took effect this morning. She was in the middle of a strenuous exercise routine when she collapsed and was taken to the emergency room. She was diagnosed with severe dehydration and is currently receiving intravenous fluids. Lab tests revealed that she also had dangerously low levels of certain electrolytes. The attending physician noted that Bianca had swollen salivary glands, halitosis, eroded teeth, and callused hands. Suspecting a potential eating disorder, she referred Bianca for a psychiatric evaluation.

1. The ER physician who treated Bianca based her suspicion of an eating disorder on various observations. Which of the following best explains why the doctor thought this was plausible?

1. The irritated throat and enlarged salivary glands were consequences of repeatedly making herself vomit.
   B- She shows signs of having other psychological disorders, many of which have high comorbidity with eating disorders.
   C- She is severely underweight and appears to be malnourished, suggesting that her calorie intake is highly restricted.

2. Some of the symptoms associated with various eating disorders are listed in the following table. In the Present column, indicate which symptoms are clearly present in Bianca's case. Check all that apply. (Engages in purging after all forms of eating, Consistently eats only minimal amounts of food, Regularly eats a higher-than-normal amount of food in a short period, Cycle of binge eating and purging occurs at least once per week, Cessation of menstruation (amenorrhea))
3. According to the full diagnostic criteria listed by the DSM–IV–TR for eating disorders (not just the symptoms highlighted in the previous question), Bianca appears to meet the criteria for a diagnosis of    (bulimia nervosa, anorexia nervosa, binge-eating disorder.)

Answer 1

The doctor thought this was plausible because

A- The irritated throat and enlarged salivary glands were consequences of repeatedly making herself vomit.

She was taking laxative along with her over eating, this may be the consequence of her dehydration and the symptoms which she showed.