Ricky is a 32-year-old Caucasian male being admitted to inpatient treatment. He is engaged and cohabitates with his partner of five years, Li, who is 25 years of age. Ricky and Li are both aspiring actors and musicians. This is Ricky's 2^nd time being admitted to an inpatient treatment just in the last 3 years. He was previously admitted for anorexia nervosa, restrictive subtype. He was last released from treatment 9 months ago after he raised his BMI from 16 to 17.5.

During the initial assessment this new treatment, you inquire about his symptoms to better understand current diagnosis. Ricky has been unable to maintain a job due to frequent absences and reported low energy levels and a lack of concentration. He was most recently fired from her job after being caught stealing the food in their work's communal kitchen. He reports being a failure and has a very low self-esteem. Ricky said that he has been eating large amounts of food at least twice a day, for most days for the past 6 months. Through further questioning it becomes clear he is eating larger amounts of food for a normal person. Prior to the bingeing behaviors he had a long history of restrictive eating, that has turned into more bingeing and purging. He has intense fears of getting fat and gaining even an additional pound because of his career. However, his ability to restrict food has become more difficult, which has made him feel very out of control. He reports the more he tries to get back on his "diet" the more he ends up having episodes of binge eating. Because he feels so guilty for home much, he has eaten he then turns to purging through hours of exercise to make up for the intake of so many calories. Ricky also reports he has been feeling very down and this had more recently turned into suicidal thoughts, but she has no history of attempts. When questioned further you can determine that Ricky has no identified plan or time frame and does not wish to act on these thoughts.

Ricky reports to the medical team that he has been smoking more than a pack of cigarettes a day to help decrease his appetite. Additionally, to help with her purging behaviors he has been abusing laxatives, which has led to serious abnormalities with his electrolytes. Tests reveal that he has hypokalemia, which is the result of potassium loss, indicated by low K+ levels in the blood). He is also told by the medical team that he is putting himself at risk for gastrointestinal issues due to his purging behaviors. He also presents with excessively dry skin and brittle nails. At the time of entering treatment, Ricky is 5'11'' and 136 lbs.

Discussion Questions:

1. What DSM V criteria does Ko meet, based on the case summary? Provide specifics on how you determined this.

1. What diagnosis would you rule out and why?

1. Ultimately, what Diagnosis would you assign Ko and subtype do you believe she meets criteria for? Why? (Make sure to include severity level)

1. What medical consequences are identified in this case example?