There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.

Anorexia nervosa remains challenging to treat and difficult to prevent. Nearly 5% of affected individuals die of this disease and 20% develop a chronic eating disorder. Anorexia nervosa may be associated with several medical complications of varying severity, including dysfunction of the renal system. Though there are some reports of renal failure in patients with anorexia nervosa, few reports are available concerning patients who required maintenance dialysis. We report a case of a patient with long-term untreated anorexia nervosa-binge eating/purging type who started psychiatric treatment when in a life-threatening situation (renal failure requiring dialysis), with unsuccessful weight recovery while on dialysis and died of septicaemia. The mechanisms that seem to be involved in the development of end-stage renal disease in this patient and the challenges associated with her treatment are reviewed. Patients with anorexia nervosa should be carefully monitored to discover the subtle manifestations of early renal failure.

We present a case of Cotard's syndrome in a 50-year-old female patient with no known prior history of medical or psychiatric illness. The patient went to the emergency department accompanied by a family member. She had been experiencing progressive depressive symptoms for 2 months. The patient presented with sadness, anhedonia, fatigue, insomnia, apathy, feelings of self-depreciation, and emotional instability, which was not related to any life-events. In the previous week, she started to feel hopelessness and anger; she also believed that her body was putrid. The mental state examination revealed depressive mood associated with psychomotor retardation, ruminative thoughts of death, delusional ideas of ruin, nihilistic delusions concerning her own body, and absence of insight. Physical and neurological examination, basic blood investigations, cerebral computed tomography, illicit drug screening, and electroencephalography showed no relevant alterations. There was no personal history of substance misuse.