title: [Chronic inflammatory bowel disease or psychogenic eating disorder - Case 1/2012. Interdisciplinary challenges in clinical diagnosis and treatment].
abstract: METHODS
  A 33-year-old female patient with chronic anorexia nervosa was admitted for inpatient psychosomatic treatment after a recent severe weight loss. In addition, an inflammatory bowel disease had been suspected in the past 4 years. The patient was convinced that the weight loss had purely organic reasons. She reported frequent diarrhea after meals. Also laxative abuse was suspected because of melanosis coli.
  
  
  METHODS
  An MR Sellink showed no evidence for actual intestinal inflammation. No increased inflammation parameters were found in blood tests. Diarrhea could not be proved by investigation of excrements or a symptom diary.
  
  
  METHODS
  Treatment consisted of a multimodal approach with focus on cognitive behavioural therapy. Treatment revealed eating disorder specific cognitions, fears and behaviour. A partial acceptance of gastrointestinal symptoms and weight loss as eating disorder symptomatology could be achieved.
  
  
  CONCLUSIONS
  Diagnostics and treatment of chronic anorexia nervosa are complicated by a coincidental (or suspected) organic intestinal disease. Gastrointestinal problems are common in eating disorders. Organic symptoms are often difficult to distinguish from psychosomatic symptoms. Somatic fixation complicates treatment of eating disorders.
authors.affiliation: Abteilung Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Germany. michaela.muthig@med.uni-tuebingen.de
authors.forename: M
authors.initials: M
authors.lastname: Muthig
authors.forename: S
authors.initials: S
authors.lastname: Becker
authors.forename: K E
authors.initials: KE
authors.lastname: Giel
authors.forename: C
authors.initials: C
authors.lastname: Kortüm
authors.forename: J
authors.initials: J
authors.lastname: Kuprion
authors.forename: S
authors.initials: S
authors.lastname: Zipfel
authors.forename: M
authors.initials: M
authors.lastname: Teufel
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D054368:Laxatives / Q000009:adverse effects; D008548:Melanosis / Q000139:chemically induced; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D015431:Weight Loss
chemical_list: D054368:Laxatives