APPROACH OF A PRIMARY CARE PHYSICIAN TO EATING DISORDERS: A CASE PRESENTATION
A 22 year-old female patient complaining of binge eating and self-induced vomiting visited our out-patient clinic by her own interest. At the first interview, besides eating disorders and depression, dissociative symptoms were also diagnosed. Although her medical and psychosocial history included early loss of his father, family dissociation, lack of social and economic support and decrease in self-esteem, there was no problem with her school success. The patient was told to duplicate the SSRI class antidepresant drug dosage (fluoxetine tb. 40 mg/day) combined with a low dose antipsychotic drug (olanzapine tb. 5 mg/day) which had been prescribed a month ago in a psychiatric hospital, but used irregularly. At the second interview, history taking was completed assessing risk factors for eating disorders. At the same day a psychiatric consultation was organised in order to confirm the diagnose of major depressive disorder and bulimia nervosa and to evaluate the patient concerning hysteric personality, dissociative disorder, sexual abuse, and suicidal intention probabilities. After two months of drug and psychotherapy, the patient had passed her final exams at school, was working at a part-time job which we had arranged for her, and had moved to a new apartment with her mother who was divorcing with her stepfather. By discussing this case, history taking, steps to be taken by a primary care physician and multi-disciplinary approach to eating disorders in primary care will be revised.