Rosh Psychiatry Board Practice Exam

In the context of diagnosing anorexia nervosa, which belief is critical for the patient?

1. The patient has no appetite

2. The patient is currently underweight

3. The patient believes she is currently overweight

4. The patient engages in excessive physical activity

The correct answer is: The patient believes she is currently overweight

In diagnosing anorexia nervosa, a critical component is the patient's self-perception, particularly their belief about their body weight. Individuals with anorexia nervosa often have a distorted body image, leading them to believe they are overweight, even when they are significantly underweight. This perception is a hallmark of the disorder and is essential for establishing the diagnosis. The patient's conviction of being overweight drives their behaviors, such as extreme food restriction, which contributes to the low body weight characteristic of anorexia nervosa. This belief can persist despite evidence to the contrary, making it a key focus in both diagnosis and treatment. The other elements, such as a lack of appetite or engagement in excessive physical exercise, are relevant but do not encompass the critical aspect of self-perception that is central to anorexia nervosa. While being underweight is a diagnostic criterion, without the patient's belief about their weight and appearance, the full context of the disorder is incomplete. Therefore, understanding the patient's belief that she is overweight is foundational in the diagnostic process for anorexia nervosa.