title: [Difficulties in adressing purging behaviour in the treatment of a patient with anorexia nervosa].
abstract: METHODS
  We report on a 24-year-old patient with secondary amenorrhoea, underweight (BMI 15,0 kg/m²), and a fear of weight gain, who used laxatives, diuretics, excessive sport and human chorionic gonadotropin (hCG) for weight regulation.
  
  
  RESULTS
  On physical examination, cachexia, bradycardia, lanugo hair on face and back, and cyanosis of hands and feet were observed. In the laboratory findings, leukopenia, recurrent low potassium and an elevated mean corpuscular volume (MCV) were remarkable.
  
  
  METHODS
  We diagnosed anorexia nervosa, binge/purging type (AN-BP). We treated the patient for seven weeks in a multimodal setting specific for patients with eating disorders. She gained 3.9 kg (11% of her initial weight). Special challenges included the complications of her laxative abuse as well as her distinct body image disturbance. With knowledge of her background, we understood this misuse of hCG.
  
  
  CONCLUSIONS
  Purging behaviour should be questioned in detail in patients with eating disorders, because purging methods are not always reported right away and are accompanied with great shame. However, purging behaviour can be very dangerous to one's health. Using a hCG diet (Hollywood diet) is a rare purging method in patients with anorexia nervosa.
authors.affiliation: Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Klinik, Universitätsklinikum Tübingen, Germany. katharina.keifenheim@med.uni-tuebingen.de
authors.forename: Katharina Eva
authors.initials: KE
authors.lastname: Keifenheim
authors.forename: Katrin Elisabeth
authors.initials: KE
authors.lastname: Giel
authors.forename: Elisabeth Johanna
authors.initials: EJ
authors.lastname: Leehr
authors.forename: Sandra
authors.initials: S
authors.lastname: Becker
authors.forename: Klaus
authors.initials: K
authors.lastname: Mörike
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
mesh_terms: D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000009:adverse effects*; D004639:Emetics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D054368:Laxatives / Q000009:adverse effects*; D008487:Medical History Taking / Q000379:methods*; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D004639:Emetics; D054368:Laxatives