Case history
Case history
A 15-year-old girl, accompanied by her mother, presents to her primary care physician with a history of fatigue and sleeplessness for 6 months' duration. The doctor notes the patient is quite petite and is wearing an oversized, baggy dress. There are no physical findings, but, during the exam, the patient is reluctant to step on the scale, mentioning that she is sure she has gained too much weight since her last visit, and that she ought to spend more time exercising at the gym. She is weighed and is found to be 88% of the minimum weight requirements for her age and height. Her mother is concerned as her daughter has been eating little and exercising daily, and seems uninterested in her friends.
Other presentations
As with females, males tend to present in adolescence and early adulthood, although diagnosis may occur after a longer illness duration than is typical for females. In a study of 135 males receiving treatment for eating disorders at an academic medical center, patients reported feeling ashamed of assignment to a culturally identified "female" disorder, often seeking help only late in disease development.[3] Males with AN are more likely to be preoccupied with being insufficiently muscular or lean; excessive exercise is more common among males than among females.[4]
Patients who present with subthreshold and atypical symptoms are categorized as having an "other specified eating disorder" in the Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5-TR). For example, a patient who meets all of the criteria for AN but is at a normal or above normal weight would receive the diagnosis of atypical AN, which is briefly described in the section on "other specified eating disorders" in DSM-5-TR.[1]
Use of this content is subject to our disclaimer