History of Suicide Attempts and/or Self-Injurious Behaviors

History of Suicide Attempts and/or Self-Injurious Behaviors
Patient Initials: L.R. Gender: M/F/Transgender Female Age: 25 Race: American Ethnicity: Caucasian
Reason for Seeking Health Care: "I have an intense fear of getting fat, but my family insisted that I looked weak and malnourished, so I had to go here."
HPI: Five months prior to consultation, the patient joined local pageantry, and she was told that she needed to lose weight to have the bikini body requirement. Hence, the patient started to eat only approximately 500 to 1000 kilocalories daily and did not eat carbohydrate- and fat-rich foods. The patient also engaged in extreme workouts that lasted for 5 hours daily and practiced this seven times a week. The patient lost 15 kilograms in three weeks, which was in time for her pageant. She eventually won the crown and was hailed the best swimsuit attire.
Four months prior to consultation, the patient continued her diet and extreme workouts. However, due to her fear of gaining weight, she reduced her calorie intake to 500 to 700 daily. Her friends expressed their concern over her crash diet but did not listen to them because she thought she was still fat, despite her family and friends telling her that her body was significant enough for any competition. She continued this lifestyle until she lost another 10 kilograms in just a month.
Three months prior to consultation, the patient started to eat less than 200 kilocalories during weekdays and only drank water during weekends. She states that she feels hungry most of the time but refuses to eat, even when her mother cooks her favorite food, because she does not want to get fat. She wanted to maintain her body and reduce her weight even more. Her parents expressed their concern over her drastic weight reduction because, according to them, she looked "pale and thin like a corpse." However, the patient did not believe them and told them that the diet was still insufficient.
Two months prior to consultation, the patient almost stopped eating for four consecutive days, only having water to fill her stomach. After the fourth day, the patient was brought to the emergency room for loss of consciousness. The attending physician stated that the patient suffered from non-diabetic hypoglycemia and iron deficiency anemia and opted to hospitalize the patient for total parenteral nutrition due to the patient's refusal to eat and blood transfusion. She was then referred to the psychiatry department, but the patient refused to follow the management. She was then diagnosed with anorexia nervosa, restricting type, moderate, and was provided psychosocial support and psychotherapy, for which the patient did not comply after being discharged. The patient did not think that the condition was severe and claimed that she had seen many models even thinner than her and wanted to achieve such an appearance.
Interim history revealed the persistence of the patient's mindset and lifestyle and the refusal to avail of the outpatient treatment for anorexia.
A few hours prior to consultation, the patient was forcedly brought by her parents to the psychiatry department of our institution due to her persistent lifestyle. The parents claimed that the patient did not believe that her body was already t...