Behavioral Science

156 Deja Review: Behavioral Science
What is Eating Disorder Not Otherwise
Specified (NOS)?
A grab-bag of disordered eating that
does not meet criteria for Anorexia or
Bulimia. This includes:
• Purging behavior without true binge
eating
• Anorexia criteria without amenorrhea
• Restricting type anorexia without
significant weight loss (ie, no binge
eating/purging to meet bulimia
criteria)
• Bulimia criteria except at a lower
frequency than required for
diagnosis
• Chewing and spitting out large
amounts of food
• Binge eating without purging
behavior
CLINICAL VIGNETTES
A 17-year-old woman comes to your office complaining of fatigue. Upon careful
examination you see erosion of the enamel on her molars. You check an electrolyte
panel and find her to be hypokalemic.
What are the possible psychiatric disorders that may be present?
This patient may have anorexia nervosa, bulimia nervosa, or eating disorder NOS.
How do you distinguish anorexia nervosa and bulimia nervosa?
To distinguish these disorders you would need to know her body weight vs her
ideal body weight.
What is the likely cause of her hypokalemia? If you took an arterial blood gas,
what would you expect the pH to be?
Her hypokalemia is likely due to recurrent vomiting—this will also cause a
metabolic alkalosis (think loss of stomach H + ), so you would expect her pH to be
high (alkalemic).