When Cannabis Hyperemesis Was Mistaken for an Eating Disorder | Research

The takeaway

A case report described a 22-year-old woman whose cannabinoid hyperemesis syndrome was initially confused with eating disorder purging, complicated by her actual history of anorexia nervosa and her initial denial of cannabis use.

Clinicians treating eating disorders and anyone interested in the diagnostic challenges of CHS.

CHS was initially attributed to the patient's known eating disorder history

What the researchers found

This case report highlighted a diagnostic overlap between cannabinoid hyperemesis syndrome (CHS) and eating disorders. A 22-year-old woman with a documented history of anorexia nervosa (binge-purge type), major depression, and OCD presented with episodic vomiting that was initially attributed to her eating disorder.

The correct diagnosis of CHS was complicated by three factors: her genuine history of an eating disorder made clinicians attribute the vomiting to purging behavior; she initially denied cannabis use; and the episodic nature of CHS can mimic cyclic vomiting patterns seen in eating disorders.

Collateral history from family and a positive drug screen ultimately confirmed the CHS diagnosis.

Why it matters

As both cannabis use and eating disorder awareness increase, clinicians may encounter patients where these conditions overlap or mimic each other. Missing a CHS diagnosis in an eating disorder patient could lead to inappropriate treatment, while missing an eating disorder in a CHS patient could delay needed care.

The numbers in context

Patient age: 22. Diagnoses: anorexia nervosa (binge-purge type), major depressive disorder, OCD, migraine, and CHS.

How the study worked

This was a clinical case report published in the International Journal of Eating Disorders, describing the diagnostic process, clinical presentation, and implications for eating disorder clinicians.

What this study cannot tell us

Single case reports cannot establish diagnostic guidelines or generalize to all patients. The coexistence of anorexia nervosa and CHS in this case may be uncommon. The case does not clarify whether CHS and eating disorder behaviors can mutually reinforce each other.

How to read the evidence

This is a single case report illustrating a diagnostic pitfall. It provides awareness but cannot establish prevalence or diagnostic guidelines.

When this study was published

Published in 2016. Both CHS awareness and eating disorder screening have evolved since then.

The bigger picture

This case represents a growing awareness that CHS can present in clinical contexts where other explanations for vomiting are readily available, leading to missed diagnoses. The increasing prevalence of both cannabis use and eating disorders makes this overlap clinically relevant.

Questions still open

How common is the co-occurrence of eating disorders and CHS? Should all patients presenting with episodic vomiting be screened for cannabis use?

Common questions

How can doctors tell CHS apart from an eating disorder?

Key distinguishing features of CHS include relief from hot bathing (pathognomonic), failure of standard antiemetics, episodic pattern not linked to body image concerns, and resolution with cannabis cessation. Drug screening and honest disclosure of cannabis use are essential for correct diagnosis.

Can someone have both an eating disorder and CHS?

Yes, as this case demonstrates. A patient can have a genuine eating disorder history and also develop CHS from cannabis use. The conditions can coexist and complicate each other's diagnosis and treatment.

Read the original research

Cannabinoid hyperemesis syndrome masquerading as an eating disorder.

The International journal of eating disorders, 49(8), 826-9

View on PubMed ↗Publisher’s paper ↗

Citation

Brewerton, Timothy D; Anderson, Odette. (2016). Cannabinoid hyperemesis syndrome masquerading as an eating disorder.. The International journal of eating disorders, 49(8), 826-9. https://doi.org/10.1002/eat.22515