Paranoia? Anorexia? Body Dysmorphic Disorder?

It was first suspected that she has Othello Syndrome (morbid jealousy, case study here). When she came, she just split from her boyfriend and was having suicidal thoughts. The mother said she was constantly checking on the boyfriend, his phones, his whereabouts, his friends etc (similar to the case here). She was also hearing voices, very bad-tempered, having very unstable mood and insomnia.

Few days after she started taking anti-depressant and anti-psychotic medicine, she called up and asked if she could take weight loss pill “L*** B***”, she said it helps to lose body fat only, will not lead to diarrhea. So she was told ok to take this weight loss pill along with her medicine.

Few weeks later, the mother called and questioned us, why we allowed patient to take weight loss pills. Mother said patient has been taking the pills, along with laxative pills (for constipation) excessively, she could take over 20 tablets a day, and purging herself (to vomit). She’s in fact only 43 kgs when she first came to see us, she doesn’t need to lose any weight. But our position is to tell patient that the weight loss pill is safe to be taken with our medicine, but that’s obviously based on the fact that patient is taking it accordingly. It’s not our position to advice patient regarding her weight (we can do so, but we can’t stop her). It also important to note here that if the pill will cause diarrhea or vomit then it won’t be suitable to take with medicine.

So mentally she’s got much worse, as she wasn’t regular with the medication, plus all those means that she’s using to lose weight, her body probably couldn’t take in any of those medicine. She got more sensitive and paranoid, always thinks that people are talking about her, especially when she is out. At one point they had to admit her into hospital for drips as she was taking too much of those pills. After the discharge she finally realized what harms those pills are doing to her body and brain.

So she stopped purging and trying to lose weight. She’s given up on the idea of losing weight. But few days ago she came back for review, now she’s considering rhinoplasty (plastic surgery on the nose)! Almost obsessed about going for it…

Paranoia, anorexia nervosa and body dysmorphic disorder are undeniably inter-related and co-morbid, but does one move from one to another?

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