A 14-year-old female presents to the ED with her mother with the chief complaint of constipation and abdominal discomfort. Symptoms have been ongoing for several months but have gotten worse over past week. She is an avid runner and tries to stay hydrated. She has not had a menstrual period for the past 3 months. She experienced menarche at age 13. Vital signs include a HR 50, BP 85/40 T 38.5. Blood work shows negative BHCG, potassium of 3.2 mEq/L, hemoglobin at 11g/dl and normal liver enzymes. All the following are clues to a possible diagnosis of eating disorder in this patient EXCEPT: