Facing an eating disorder: A case of body dysmorphic disorder and avoidant/restrictive food intake disorder

Abstract

Eating disorders can be notoriously difficult to diagnose and treat. This patient is an 18-year-old female who presents to care severely underweight and notably cachexic. For a number of years, she had experienced depressive symptoms, anxiety, and continued loss of appetite. She denied purposefully restricting foods, recognized that she was thin, and denied a fear of gaining weight. She was admitted to a disordered eating unit for refeeding and during her inpatient stay disclosed that she had a long-standing “hatred of face.” Ultimately, she received the diagnoses of avoidant/restrictive food intake disorder and body dysmorphic disorder. This case highlights the importance of differentiating body dysmorphia, seen in body dysmorphic disorder, and distorted body image, as seen in anorexia nervosa. This differentiation is significant as the treatment approaches to these distinct diagnoses are not the same.

The mediating effect of dysmorphic concern in the association between avoidant restrictive food intake disorder and suicidal ideation in adults

“…Our study reveals a notable link between higher avoidant restrictive eating and dysmorphic concerns in agreement with the existing medical literature that has indicated a discernible association between ARFID and BDC [ 12 ]. This linkage stresses the potential interplay and shared psychological aspects between these two distinct yet interrelated conditions.…”

“…This linkage stresses the potential interplay and shared psychological aspects between these two distinct yet interrelated conditions. While ARFID diagnostic criteria typically exclude body image distortions [ 5 ], individuals with ARFID symptoms may still exhibit body image concerns [ 12 , 27 ]. An illustrative case study featured a nine-year-old with severe malnutrition, wherein the patient's positive perception of her small size and emphasis on thinness was influenced by social media beauty standards and societal praise.…”

“…Subsequently, she received diagnoses of both ARFID and BDC. This case exemplified a clinical instance where ARFID and BDC co-occurred, suggesting a potential interplay between difficulties related to food intake and body image perceptions [ 12 ]. Recent research suggests that there is a common co-occurrence of BDC alongside eating disorders [ 28 ].…”

“…Similarly, ARFID is not related specifically with body weight or shape disturbance experiences. There is evidence that ARFID may co-exist with BDC (e.g., [ 12 ]). Indeed, psychiatric comorbidities are known to be prevalent in ARFID patients.…”

“…On the other hand, an investigation showed that depression, one of the main causes of suicide [ 14 ] can be caused by BDC and self-hate, which may, in turn, lead to loss of appetite and profound malnutrition eventually resulting in the diagnosis of ARFID [ 12 ]. Furthermore, body dysmorphic symptoms have consistently been shown to be linked to a potential risk of suicidal ideation in adolescence and emerging adulthood [ 15 ].…”