Abnormal eating or exercising behaviour

Specialties > General practice

Differential Diagnosis Schema 🧠

Eating Disorders

Anorexia Nervosa: Restriction of energy intake, fear of weight gain, distorted body image.
Bulimia Nervosa: Binge eating followed by compensatory behaviors (vomiting, laxative use), normal weight or overweight.
Binge Eating Disorder: Recurrent episodes of binge eating without compensatory behaviors, often leads to obesity.
Avoidant/Restrictive Food Intake Disorder (ARFID): Avoidance of food due to sensory characteristics or aversive consequences, leading to significant weight loss or nutritional deficiency.

Obsessive-Compulsive and Related Disorders

Obsessive-Compulsive Disorder (OCD): Repetitive behaviors or mental acts aimed at preventing or reducing distress, may include obsession with body image or diet.
Body Dysmorphic Disorder: Preoccupation with one or more perceived defects or flaws in physical appearance, which are not observable or appear slight to others.

Endocrine Disorders

Hyperthyroidism: Increased appetite, weight loss, hyperactivity.
Diabetes Mellitus: Weight changes, polydipsia, polyuria, particularly in poorly controlled cases.

Gastrointestinal Disorders

Celiac Disease: Malabsorption, weight loss, diarrhea, bloating.
Inflammatory Bowel Disease (IBD): Weight loss, abdominal pain, diarrhea, fatigue.
Chronic Pancreatitis: Steatorrhea, malnutrition, weight loss.

Psychiatric Disorders

Depression: Appetite changes (increased or decreased), weight loss or gain.
Anxiety Disorders: Nausea, lack of appetite, increased energy expenditure.
Schizophrenia: Disordered eating patterns, bizarre dietary behaviors, negative symptoms leading to poor self-care.

Key Points in History 🥼

Presenting Symptoms

Weight Loss: Consider anorexia nervosa, hyperthyroidism, celiac disease.
Weight Gain: Consider binge eating disorder, hypothyroidism, depression.
Binge Eating: Consider bulimia nervosa, binge eating disorder.
Purging Behaviors: Suggestive of bulimia nervosa, consider electrolyte imbalances.
Exercise Intolerance: Consider over-exercise associated with anorexia nervosa or bulimia nervosa, or possible endocrine causes.
Abdominal Pain: Consider gastrointestinal causes such as celiac disease or IBD.
Menstrual Irregularities: Often seen in anorexia nervosa, hyperthyroidism.

Background

Past Medical History: Look for history of eating disorders, psychiatric conditions, gastrointestinal disorders.
Drug History: Note any use of appetite suppressants, laxatives, or medications affecting weight.
Family History: Check for family history of eating disorders, obesity, psychiatric conditions.
Social History: Assess dietary habits, exercise routines, impact of peer pressure or media, history of trauma or abuse.

Possible Investigations 🌡️

Laboratory Tests

Full Blood Count (FBC): May reveal anemia, infection, or other underlying conditions.
Electrolytes: Monitor for imbalances, particularly in cases of purging.
Thyroid Function Tests (TFTs): Check for hyperthyroidism or hypothyroidism.
Liver Function Tests (LFTs): Assess for hepatic dysfunction, which may occur in severe malnutrition.
Glucose: Important in assessing for diabetes mellitus or hypoglycemia.
Celiac Serology: Consider in cases of weight loss, diarrhea, or unexplained gastrointestinal symptoms.

Imaging and Special Tests

Electrocardiogram (ECG): Assess for arrhythmias, electrolyte disturbances, prolonged QT interval.
Bone Density Scan (DEXA): Consider in cases of prolonged anorexia nervosa or amenorrhea to assess for osteoporosis.
Upper GI Endoscopy: Consider in cases with severe gastrointestinal symptoms suggestive of structural disease.
MRI Brain: Rarely indicated but may be useful if neurological symptoms are present, to rule out organic causes.

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