Differential Diagnosis

• Single most likely diagnosis
  • Binge eating disorder: This is the most likely diagnosis because the patient reports episodes of overeating large amounts of food in a short period, followed by strict dieting and exercise, without inducing vomiting. The frequency and amount of food consumed during these episodes, as well as the lack of purging behaviors, align with the diagnostic criteria for binge eating disorder.
• Other Likely diagnoses
  • Major depressive disorder: Although the patient had a previous major depressive episode, her current symptoms of irritability without changes in sleep or appetite might suggest a mild depressive episode or a different condition. However, given her history, it's essential to consider the possibility of another depressive episode.
  • Adjustment disorder with disturbance of conduct: The patient's overeating and subsequent strict dieting and exercise could be seen as maladaptive behaviors in response to stress, such as the broken engagement. However, this diagnosis is less likely given the specific pattern of overeating and compensatory behaviors.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Bulimia nervosa: Although the patient denies inducing vomiting, it's crucial to rule out bulimia nervosa due to the potential for severe medical complications, such as electrolyte imbalances and gastrointestinal problems. The patient's behavior of overeating followed by strict dieting and exercise could be a variant of bulimia nervosa without purging.
  • Major depressive disorder with suicidal ideation: Given the patient's history of a major depressive episode, it's essential to assess for suicidal ideation, even if the current symptoms seem mild. Suicidal ideation can be a deadly condition if missed.
• Rare diagnoses
  • Night eating syndrome: This condition is characterized by excessive eating at night, often with a sense of loss of control. Although the patient's episodes of overeating are not specifically described as occurring at night, it's a rare condition that could be considered if other diagnoses are ruled out.
  • Orthorexia nervosa: This condition involves an excessive preoccupation with healthy eating, which could lead to restrictive eating patterns. Although the patient's behavior seems more focused on overeating and compensatory behaviors, orthorexia nervosa could be a rare consideration if the patient's strict dieting and exercise are motivated by an unhealthy obsession with healthy eating.