Thursday, September 30, 2010

Differential Diagnosis

  • There are other medical conditions that mimic the signs and symptoms of anorexia nervosa. For instance, a characteristic sign is weight loss which can also be due to type 1 diabetes, primary and secondary hypothyroidism, neoplasias, superior mesenteric artery syndrome and malnutrition.
  • During diagnosis, it is essential to rule out mental disorders such as body dysmorphic disorders and body perception alteration.
  • There are isolated cases of phagophobia (fear of food), social phobia (inability to eat in public), and globus hystericus (a foreign body feeling in the pharynx that prevents swallowing.
  • To rule out bullimia nervosa, consider any gastrointestinal or systemic conditions that include:
  1. Repeated vomiting
  2. Polyuria (excessive urination)
  3. Diarrhea
  • Patients are frequently seen by a physician involuntarily and this makes it difficult to obtain data for a precise diagnosis.
  • The key is that purgative behaviours in bullimia are caused by the patient.
  • Relatives should be questioned regarding behaviours associated with vomiting (going to restroom after eating) and whether diuretics and laxatives have been found in patient's belongings without prescription.
  • Physical marks that may indicate bullimia instead of anorexia
- Russel's sign- knuckle scarring from constant contact with incisor teeth to induce vomiting
- Parotid hypertrophy from chronic vomiting
- Destruction of tooth enamel

Other conditions that may be confused with aneroxia because they all lead to weight loss as well:
  • Addison's disease- a rare disorder of the adrenal cortex which results in hypocorticolism leading to weight loss
  • Emetophobia- anxiety disorder characterized by intense fear of vomiting. Patients withdraw from situations which in their perception make them feel nauseous such as not touching food with hands.
  • Body dysmorphic disorder- a somatoform disorder whereby the patient excessively ruminates over an actual or perceived physical flaw. The patient becomes obsessed over her body image and yearns for a perfect body.

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