A 17 year old girl is brought by her parents, who are concerned about her behavior. During the last 6 months, she has limited her energy intake to ~1500 calories per day, while also exercising for 2 hours on a daily basis. She had lost 10 kg of weight during this period. She says that this was in order to 'stay in shape and be attractive'. Further questioning reveals that she is extremely fearful of becoming fat, and feels that she does not put in enough effort to remain slim. She is annoyed that her parents are worried about her, and denies experiencing any physical symptoms, except for oligomenorrhea for the last 3 months. Her medical and surgical histories are unremarkable. However, her family history is significant for bulimia nervosa in an older sister, which was treated successfully. There is no history of smoking, drinking, or use of controlled substances. She is in the 11th grade, and reports doing well in school. Her parents add that she has been a perfectionist since a very young age. A complete blood count, serum electrolytes, and urinalysis are all normal.
The ECG is in sinus rhythm, with a rate of 48 bpm. No other abnormalities are noted.
The liver profile is significant for an ALT of 115 U/L (normal < 60). All other indices are within normal parameters. The ultrasound scan is unremarkable.
Serum Amylase is within normal parameters.
The T score is -1.0