Psychiatrymiddle twist
A 24-year-old primary school teacher is referred because of painless swelling at the angles of both jaws over four months. She is 165 cm tall and weighs 61 kg, and says she has never been underweight. There is loss of enamel from the inner surfaces of her upper incisors and firm calluses over the knuckles of her right index and middle fingers. She is preoccupied with her shape and describes episodes of eating far more than she intends. Serum potassium is 3.0 mmol/L (3.5-5.2). Which one of the following is the most likely diagnosis?