Anorexia Nervosa: The Daily PANCE Blueprint

The answer is D. Anorexia nervosa, restricting type

Restriction to a significantly low body weight, an intense fear of gaining weight, and a distorted experience of one’s own body is anorexia nervosa — and because there is no bingeing or purging, this is the restricting type. Note what the DSM-5 changed and what boards still test: amenorrhea is no longer required, though it is common and reflects hypothalamic suppression of GnRH. The physical findings are all the body slowing itself down to survive starvation: bradycardia and hypotension, cool mottled skin, hypothermia, and lanugo — that fine downy hair — along with amenorrhea and osteopenia from low estrogen. Management is multidisciplinary: nutritional rehabilitation and weight restoration first, with psychotherapy (family-based treatment is first-line for adolescents), and medical admission for severe bradycardia, hypotension, marked electrolyte derangement, or a very low weight. The complication you must know is refeeding syndrome: as carbohydrate returns, insulin drives phosphate, potassium, and magnesium into cells, and the resulting hypophosphatemia can cause cardiac failure, arrhythmia, seizures, and death. Refeed slowly, replace electrolytes, and monitor phosphate daily. No medication is approved for anorexia itself — and bupropion is contraindicated in eating disorders because of seizure risk. Separating the distractors: bulimia nervosa occurs at a normal or higher weight with recurrent binge-purge cycles, parotid enlargement, dental erosion, and Russell sign on the knuckles; ARFID involves food avoidance from sensory aversion, fear of choking, or lack of interest, without any body-image disturbance; depression causes appetite loss but not a drive for thinness; and hyperthyroidism would give tachycardia and heat intolerance rather than a pulse of 44.