Differential Diagnosis
- Single most likely diagnosis:
- Eating Disorder, Not Otherwise Specified (ED-NOS) or Other Specified Feeding or Eating Disorder (OSFED), specifically Atypical Anorexia Nervosa. The patient's distorted body image, restrictive eating patterns, self-induced vomiting, and significant weight-related concerns are characteristic of an eating disorder. The fact that she has irregular periods, which she attributes to her diet, further supports this diagnosis.
- Other Likely diagnoses:
- Anorexia Nervosa: Although the patient does not mention significant weight loss, her restrictive eating patterns, fear of gaining weight, and distorted body image are all consistent with anorexia nervosa. The self-induced vomiting and avoidance of high-calorie foods also support this diagnosis.
- Bulimia Nervosa: The patient's self-induced vomiting at least once a week and restrictive eating patterns could also be indicative of bulimia nervosa. However, the frequency of bingeing and purging episodes may not meet the full criteria for this diagnosis.
- Body Dysmorphic Disorder (BDD): The patient's preoccupation with her body image and perceived flaws, as well as her repetitive behaviors (e.g., checking her reflection), could suggest BDD. However, her eating habits and weight-related concerns seem to be more prominent.
- Do Not Miss diagnoses:
- Pregnancy: Although the patient reports never being sexually active, it is essential to rule out pregnancy, especially given her irregular periods. A pregnancy test should be performed to confirm or exclude this possibility.
- Thyroid Disorder: Hypothyroidism or hyperthyroidism can cause changes in appetite, weight, and menstrual regularity. Although less likely, it is crucial to consider and rule out these conditions.
- Diabetes Mellitus: Uncontrolled diabetes can lead to weight loss, changes in appetite, and menstrual irregularities. Although the patient's symptoms do not strongly suggest diabetes, it is essential to consider and rule out this condition.
- Rare diagnoses:
- Prader-Willi Syndrome: This rare genetic disorder is characterized by hyperphagia, obesity, and short stature. Although the patient's symptoms do not align with this diagnosis, it is essential to consider rare conditions, especially if the patient's symptoms do not respond to treatment for more common conditions.
- Other rare eating disorders, such as Pica or Rumination Disorder, could be considered if the patient's symptoms do not fit with more common eating disorders. However, these conditions are less likely given the patient's presentation.