A 28yo business executive presents at the GP asking for some help because she has been arguing
with her boyfriend frequently. She is worried about her weight, and she thinks she may be fat.
She has been on a diet and lost 7 kgs in the last 2 months on purpose. She is eating less. She
used to do a lot of exercise. Now she says she’s feeling down, has some insomnia and feels tired
and without energy. She has not showed up at work. She is worried because recently she got a
loan to buy a luxury car. She can’t be fired. She complains about her low mood. She thinks this is
weird because she used to be extremely productive. She used to work showing an excellent
performance at the office. She even received compliments from her boss. How, she says her
boyfriend is angry because her apartment is a chaos. Usually she spends a lot of time cleaning it,
even upto 3 AM. She liked it to be perfect, but not it’s a mess. On exam: BMI=23, no other signs.
What is the most probably dx?
a. Anorexia nervosa
b. Bipolar disease
c. Binge eating disorder
Ans. The key is B. Bipolar disorder. [Now she is depressed but before hypomanic which makes the likely dx of bipolar disorder].