A 20-Year-Old College Student Comes to the Office Due to Fatigue

A 20-year-old college student comes to the office due to fatigue and decreased exercise tolerance.  She says, "I used to run 5 miles every day, but for the past month I get out of breath after running 3 miles.  I need to keep running so I don't get any fatter than I already am."  The patient also reports difficulty concentrating in class, depressed mood, constipation, and abdominal bloating.  Her appetite is normal, but she admits to occasionally forcing herself to vomit to prevent weight gain.  Physical examination is significant for dry skin, painless bilateral parotid swelling, pharyngeal erythema, and hypoactive bowel sounds.  Temperature is 36.2 C (97.2 F) , blood pressure is 100/60 mm Hg, pulse is 62/min, and respirations are 16/min.  BMI is 17.5 kg/m².  Which of the following is the most likely diagnosis?

A) Anorexia nervosa
B) Body dysmorphic disorder
C) Bulimia nervosa
D) Hypothyroidism
E) Irritable bowel syndrome
F) Major depressive disorder

Correct Answer:

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