Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 14-year-old girl in the fourth month of her freshman year of high school lives in a two-parent household with a younger brother and has a relatively large extended family that lives close by. In middle school, she was described by teachers as "fretful." She worried a great deal about getting assignments in on time and would occasionally voice concerns about the health and well-being of her older relatives.
At the start of high school, she maintained good grades, tried out for the track and field team, and developed several close friendships. However, she has lost interest in school, had trouble sleeping, lost her appetite and a small amount of weight, and quit the track team.
Her friends report that she is not communicating much. Her teachers describe missed assignments, and her parents state that she stays in her bedroom after school and for most the weekend. When her parents ask her about her behavior, she reportedly responds that "it's nothing" or that they should "just leave her alone."
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Cite this: A Withdrawn 14-Year-Old With Weight Loss and Sleep Problems - Medscape - Jun 09, 2020.