In the majority of cases the severe and voluntary malnutrition accompanied by the typical delusion of being fat and resistance to gain weight make the diagnosis very clear. Malnutrition due to organic causes in adolescents usually has an obvious reason and the patients want to improve their nutrition. Hypothalamic tumors may rarely present with severe loss of appetite.
The differential diagnosis should include the anor-exoid syndromes. In pure anorexia nervosa the weight loss is due only to restrictive eating habits and exercise. Some anorexic patients may start bin-ging and inducing vomiting, in which case their condition is called bulimarexia.
In some cases, anorexia nervosa is secondary to a serious, underlying psychiatric illness, with the weight loss being only an added problem. A particular diagnostic and therapeutic dilemma may occur for young women with personality disorder or chronic schizophrenia and anorexia nervosa.
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