30 aug 2022
18M HPI: 10 mos PTC started self-harming (4x) due to perceived inability to live up to parental expectations. thoughts prior to self-harm "I am fat" which is contrary to reality (saw him on video cam), leading to lowered appetite.
i thought of referring him to psychiatry but I found out it was one of our psychiatrists who referred him for psychotherapy, saying that his case is not psychiatric.
i was considering the possibility of body dysmorphic disorder (under obsessive-compulsive and related disorders), but criterion D rules out "concerns with body fat or weight".
what i forgot to ask was criterion A. PHYSICAL weight loss* defined for adults as "less than minimally normal". B. is PSYCHOLOGICAL -- "intense fear of gaining weight or becoming fat".
to code:
F50.01 restrictive type -- c/o diet, fast &/or excessive exercise
F50.02 -- c/o bing eating or purging
*severity is c/o BMI
