I have no appetite and feel sick when i eat

I think it is important to discuss mental health in the first visit for chronic issues because it normalizes the relationship between mental and physical health. My initial assessment of a patient with recurrent abdominal pain includes a physical and mental health evaluation and initial laboratory studies ( Table 1). She also had a prolonged history of gradual weight loss and depressed mood over the past 2 years. When I first met this patient, she had a one-month history of abdominal pain and early satiety. Her physical examination was normal, with the exception of left upper quadrant tenderness. She reported dissatisfaction with her thin appearance and denied intentional weight loss, fear of weight gain, purging behaviors, or laxative use. Specifically, she received initial grief counseling when she lost her mother, and she restarted counseling 2 years ago. She intermittently received counseling for depression over that time period, but she was never prescribed medications. This had been a concern for 4 years, since her mother died of renal cancer. At the time of presentation, the patient was struggling with depressed mood characterized by low energy, low motivation, anhedonia, and irritability but no suicidal ideation or sleep disturbance. She continued to have regular menstrual periods. Per the patient and by chart review, she had a gradual 20-lb weight loss over the previous 2 years. She reported soft, daily bowel movements and denied nausea or vomiting. Her father noticed her eating pattern and encouraged her to take Ensure supplements, which she tolerated. She reported feeling hungry and early satiety with the inability to finish most meals, with greasy foods eventually causing more severe symptoms. She described intermittent periumbilical discomfort and pressure throughout the day and particularly at night when going to sleep. The patient is a 16-year-old previously healthy girl who presented to her primary care physician with a one-month history of decreased appetite and abdominal pain.

I have no appetite and feel sick when i eat