Your history taking with Alice and her mother gives you the following information:
- The history is obtained from Alice's mother. Alice remains uncommunicative during the consultation, refusing to speak about eating or her weight.
- For the past three months, Alice has been eating poorly, reducing her meat intake and other protein-containing foods. She has expressed a desire to eat a more ‘healthy‘ diet and has stopped eating any snacks between meals. This behaviour appeared to follow an episode of gastroenteritis.
- There is tension at the family meal table. For example, Alice's father gets very angry with her because she cuts the fat off the meat. Alice's sister also is distressed by the arguing at these times.
- Past 2 weeks: Alice has felt too tired to participate in school sports.
- No urinary symptoms, tachycardia, muscle fatigue or heat intolerance.
- Currently bowel action every two days, very firm. Loose stool only with gastroenteritis three months earlier, no other episodes. No blood or mucous in stool. No vomiting reported since gastroenteritis, none since a pre-schooler.
Past history
- No previous major illnesses.
- Gastroenteritis while on a family skiing trip 3 months ago; resolved after one week.
Reproductive history
- Menarche at age 13 years.
- Has not menstruated for the past three months.
- Alice is not sexually active.
Personal History
- Age 14 years 6 months In Year 9 at school.
- Lives at home with her parents and her 19 year old sister, who is a university student.
- Father - project manager.
- Mother - does not work outside the home.
School Progress
- Has been achieving well academically at school.
- Until two weeks ago Alice was very involved in school tennis, cross country running and aerobics. Now 'too tired'.
- Past month - missing about one day per week at school.
- Several other teachers have also noted that Alice has not been well.