An extremely thin preadolescent is being assessed by the nurse. Which client statement should the nurse identify as being consistent with that of a person with anorexia nervosa?

Choice A rationale This statement reflects a classic symptom of anorexia nervosa known as body image disturbance or distortion. Individuals with this condition have a profound fear of gaining weight and perceive themselves as being overweight or fat, even when they are severely underweight. This distorted self-perception drives the restrictive eating and weight-loss behaviors. Choice B rationale Stating a desire to gain weight but being unable to is more consistent with a medical cause for weight loss or a chronic illness with resulting cachexia, or possibly a lack of nutritional knowledge. A key feature of anorexia nervosa is the intense fear of weight gain and a refusal to maintain a minimally normal weight, not an inability to gain weight. Choice C rationale While interest in modeling may be a motivation for some to maintain a certain physique, it is not a core diagnostic feature of anorexia nervosa. The central psychopathology of anorexia is the fear of gaining weight, body image distortion, and behaviors to prevent weight gain, not merely a career aspiration. Choice D rationale This statement, which expresses a fear of being poisoned, is a symptom of delusional thinking and is more consistent with a severe mental illness such as paranoid schizophrenia. While comorbid conditions can occur, intense fear of poisoning is not a defining or consistent diagnostic criterion for anorexia nervosa.