Robert D. Kirkcaldy Thomas J. Kim Caroline P. Carney
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Acute nausea and vomiting are often self-limited or easily
treated. Persistent vomiting, however, poses diagnostic and
therapeutic challenges for the primary care physician. In
addition to gastrointestinal, neurologic, and endocrine
disorders, the differential diagnosis includes psychiatric
illnesses, such as eating and factitious disorders.
We present the case of a 52-year-old woman referred to the
Tulane University Internal Medicine/Psychiatry clinic with
persistent daily vomiting for 8 years despite repeated medical
evaluations. The vomiting was of sufficient severity to require
intensive care unit admission for hematemesis. A dually trained
internal medicine-psychiatry house officer obtained further
history and identified that the woman experienced an intrusive
thought that urged her to vomit after each meal. Resisting the
urge resulted in intolerable anxiety that was relieved only by
vomiting. Obsessive-compulsive disorder (OCD) was diagnosed
according to DSM-IV criteria. Initiation of escitalopram with
titration to clinical response resulted in full symptom
resolution and meaningful quality of life improvement.
Pertinent literature was reviewed using 2 methods: (1) an
English-language MEDLINE search (1966-February 2004) using the
search terms vomiting and (chronic or psychogenic or psychiatric), and obsessive-compulsive disorder and
(primary care or treatment); and (2) a direct search of
reference lists of pertinent journal articles.
A review of psychiatric etiologies of vomiting and primary
care aspects of OCD is presented. Primary care clinicians are
strongly encouraged to consider psychiatric etiologies, including
OCD, when common symptoms persist or present in atypical ways.
Such disorders can be debilitating but also responsive to
treatment.
Prim Care Companion J Clin Psychiatry 2004;6(5):195-198
https://doi.org/10.4088/PCC.v06n0503
© Copyright 2004 Physicians Postgraduate Press, Inc.