Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by a pathological fear of weight gain and usually excessive weight loss. There are two subtypes of anorexia nervosa: restricting type and binge eating–purging type.

Anorexia Nervosa is triggered by mental processes. This disorder is identified with an incidence of about 6 / 100.000.

Presentation

Anorexia nervosa patients present physical symptoms as well as behavioural and emotional symptoms.

Physical signs and symptoms of anorexia are [7]:

  • Severe weight loss
  • Emaciated appearance
  • Extreme fatigue
  • Insomnia
  • Dizziness or fainting
  • Bluish discoloration of the fingers
  • Weak hair
  • Amenorrhea
  • Dry skin
  • Extreme discomfort in cold conditions
  • Bradycardia or tachycardia
  • Hypotension
  • Dehydration
  • Edema
  • Osteoporosis

Emotional and behavioural symptoms associated with anorexia nervosa include:

  • Rejection of meals
  • Hiding hunger
  • Excessive fear of gaining weight
  • Dishonesty when discussing how much food has been consumed
  • Frequent, strenuous, or compulsive exercise
  • Signs of social withdrawal
  • Constant experimentation with food
  • Irritability
  • Constant display of uninterest
  • Lack of interest in sexual activities
  • Use of herbal products, laxatives, etc. 

Workup

Although there is no clear evidence to show that any particular treatment for anorexia nervosa works better than others, evidence shows that early intervention and treatment often prove effective in handling of the condition [9]. In general, anorexia nervosa treatment is focused on addressing these three main areas:

  • Restoration of the individual to a healthy weight
  • Treatment of psychological disorders related to the ailment
  • Reduction or eradication of behaviours responsible for the disorder in the first instance

Treatment

Treatment of this condition requires a physical, social and psychological assessment of the individual by health professionals, especially an eating disorder specialist. This assessment is important to decide the most suitable care plan to follow.

Generally, treatment of the condition will involve a combination of psychological therapy and individually tailored advice on eating and nutrition. This will help the patient gain weight safely.

Psychiatrists, specialist nurses and dietitians contribute at different stages to the treatment of anorexic individuals. The treatment is done on an outpatient basis except in serious cases where the individual must be treated in a hospital or specialist eating disorder clinics.

Prognosis

The prognosis of anorexia nervosa varies. Morbidity rates often range from 10 to 20% with only 50% of patients being able to recover fully. Of the remaining, 20% remain emaciated while another 25% still present thin body. The remaining either dies of starvation or become overweight [6].

However, mortality following complications as a result of starvation is far less frequent in patients with anorexia nervosa as death arising from suicide which is the chief source of mortality incidence. Suicide attempts are higher in people with a history of artificial inducement of physical pain, drug use, and laxative use.

Etiology

Anorexia nervosa is as a result of a complex interchange between social biologic and psychological factors [3]. It affects more women than men and in women it is mostly seen in adolescents.

Patients who develop anorexia nervosa often display a relatively high incidence of premorbid anxiety disorders. Since most cases of anorexia nervosa are seen within the pubescent years, experts believe that exertion of control over body weight and food consumption is the adolescents attempting to make up for what is seen as absence of selfhood and autonomy.

Some predisposing factors in eating disorders include:

  • Female sex
  • Difficulty discussing negative emotions
  • Low self-esteem
  • Family history of any kinds of eating disorders 
  • Perfectionistic personality
  • Difficulty resolving conflict

Maternal encouragement of weight loss (actively or passively) is also a risk factor for anorexia nervosa especially when the disorder is seen in children. The possibility of genetic predisposition has been pointed out following reported cases of anorexia nervosa in twins and triplets.

In individuals with anorexia nervosa, there is a lifelong incidence of anxiety, depressive disorders as well as obsessive-compulsive disorder. Systemic lupus eythematosus and congenital adrenal hyperplasia are common disorders associated with anorexia nervosa.

Epidemiology

The condition is seen in all developed countries and cuts across all socioeconomic classes. It occurs worldwide around the same rates of incidence of 0.3 to 1% in women and 0.1 to 0.3% in men. It is also seen in developing countries like China and Brazil [4].

Sex distribution
Age distribution

Pathophysiology

A standard case of anorexia begins with a young individual mildly overweight or normal weight going on a diet or exercise regime with a plan to lose weight. Following the initial positive results, he or she receives compliments from peers or family. This is deemed high reward by the individual and makes it difficult for them to stop this behaviour as soon as an ideal weight is achieved [5].

Malnutrition as a result of self-starvation brings about protein deficiency and a disruption of multiple organ systems including the cardiovascular, renal, gastrointestinal, neurologic, endocrine, integumentary, reproductive and hematologic systems.

Prevention

There's no guaranteed way to prevent anorexia nervosa or other forms of eating disorders [10].

Summary

Anorexia nervosa refers is an eating disorder where patients try their best to keep their body weight as low as they can [1]. They achieve this by severely restricting the amount of food they eat and vomiting after meals. They also engage in excessive exercising.

This condition develops as a result of anxiety about the shape of the body and weight and fear of becoming fat. Anorexic individuals often have a false image of themselves [2]. This makes they feel they are fat when in reality, they may be perfectly normal.

Anorexia is seen both sexes and peak age for the condition is 16 to 17 years.

Patient Information

Anorexia nervosa refers to an eating disorder which causes people be overly obsessed with their weight and what they consume. In such people, the focus is on trying to maintain body weight that is well below what is deemed normal for their height and age and they achieve this by starving themselves or exercising excessively.
People who have this problem make the mistake of equating thinness with self-worth.

This condition is difficult to overcome but with the right treatment and psychotherapy, the individual can return to a normal eating habit and also reverse any damages already caused by the condition.

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References

  1. Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. Mar 14 2005;165(5):561-6.
  2. Eisler I, Simic M, Russell GF, Dare C. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry. Jun 2007;48(6):552-60.
  3. Morris J, Twaddle S. Anorexia nervosa. BMJ. Apr 28 2007;334(7599):894-8.
  4. Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. Jan 2009;18(1):131-45.
  5. E Grange D. The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry. Oct 2005;4(3):142-6.
  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  7. Keel PK, McCormick L. Diagnosis, assessment, and treatment planning for anorexia nervosa. In: TheTreatment of Eating Disorders: A Clinical Handbook, Grilo CM, Mitchell JE (Eds), The Guilford Press, New York 2010. p.3.
  8. Andersen, AE, Yager, J. Eating disorders. In: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, Volume I, Ninth Edition, Sadock, BJ, Sadock, VA, Ruiz P (Eds), Lippincott Williams & Wilkins, Philadelphia 2009. p.2128.
  9. Weider S, Indredavik MS, Lydersen S, Hestad K. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa. Int J Eat Disord 2014.
  10. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61:348.

  • A new treatment of anorexia nervosa - PJ Dally, W Sargant - British Medical Journal, 1960 - bmj.com
  • Anorexia nervosa - J Yager, AE Andersen - New England Journal of Medicine, 2005 - Mass Medical Soc
  • A cumulative review of the range and incidence of significant adverse events associated with acupuncture - A White - Acupuncture in Medicine, 2004 - aim.bmj.com
  • Anorexia nervosa in diabetes mellitus. - CG Fairburn, JM Steel - British medical journal, 1980 - ncbi.nlm.nih.gov
  • Fluid levels of immunoreactive corticotropin-releasing hormone in anorexia nervosa: relation to state of nutrition, adrenal function, and intensity of depression - WH KAYE, HE GWIRTSMAN, DT GEORGE - Journal of Clinical , 1987 - Endocrine Soc
  • A controlled study of the EEG in anorexia nervosa - AH CRISP, GW FENTON, L Scotton - The British Journal of Psychiatry, 1968 - RCP
  • 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study - AR Lucas, CM Beard, WM O'Fallon - Am J , 1991 - Am Psychiatric Assoc
  • Importance of body weight history in the occurrence and recovery of osteoporosis in patients with anorexia nervosa: evaluation by dual X-ray absorptiometry and bone - M Hotta, T Shibasaki, K Sato, H Demura - European journal of endocrinology, 1998 - eje.org
  • Aplastic anemia in cats—clinicopathological features and associated disease conditions 1996–2004 - DJ Weiss - Journal of Feline Medicine and Surgery, 2006 - jfm.sagepub.com
  • Acute gastric dilatation in anorexia nervosa - KP Jennings, AM Klidjian - British medical journal, 1974 - bmj.com
  • Amenorrhea in anorexia nervosa: examination of the critical body weight hypothesis. - JR Falk, KA Halmi - Biological psychiatry, 1982 - ukpmc.ac.uk
  • Anorectal dysfunction in constipated women with anorexia nervosa - G Chiarioni, G Bassotti, A Monsignori - Mayo Clinic , 2000 - Elsevier
  • 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study - AR Lucas, CM Beard, WM O'Fallon - Am J , 1991 - Am Psychiatric Assoc
  • Altered serotonin activity in anorexia nervosa after long-term weight restoration: Does elevated cerebrospinal fluid 5-hydroxyindoleacetic acid level correlate - WH Kaye, HE Gwirtsman, DT George - Archives of General , 1991 - Am Med Assoc
  • A sequential analysis of the effect of selective positive reinforcement in modifying anorexia nervosa - H Leitenberg, WS Agras, LE Thomson - Behaviour Research and Therapy, 1968 - Elsevier
  • 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study - AR Lucas, CM Beard, WM O'Fallon - Am J , 1991 - Am Psychiatric Assoc
  • Anorexia and the heart. Results of studies to assess effects. - DS Moodie - Postgraduate medicine, 1987 - ncbi.nlm.nih.gov
  • Acid-base and electrolyte disturbances in anorexia nervosa. - SE Warren, SM Steinberg - The American journal of psychiatry, 1979 - ukpmc.ac.uk
  • Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa - PW Gold, W Kaye, GL Robertson - New England Journal of , 1983 - Mass Medical Soc
  • Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance - NT Godart, MF Flament, Y Lecrubier, P Jeammet - European Psychiatry, 2000 - Elsevier
  • Anorexia nervosa and sudden death. - JM Isner, WC Roberts, SB Heymsfield - Annals of internal , 1985 - ukpmc.ac.uk
  • Anorexia nervosa and bulimia nervosa in British blacks. - NL Holden, PH Robinson - The British Journal of Psychiatry, 1988 - RCP
  • A cognitive-behavioral approach to anorexia nervosa - DM Garner, KM Bemis - Cognitive Therapy and Research, 1982 - Springer
  • Anorexia nervosa in Hong Kong: a Chinese perspective - S Lee - Psychological Medicine, 1991 - Cambridge Univ Press
  • A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease - D Fouque, K Kalantar-Zadeh, J Kopple, N Cano - Kidney , 2007 - nature.com
  • A meta-analysis of heart rate and QT interval alteration in anorexia nervosa - S Lesinskiene, A Barkus, N Ranceva - World Journal of , 2008 - informahealthcare.com
  • Anorexia nervosa among children and adolescents - TJ Silber - Advances in pediatrics, 2005 - Elsevier
  • Effects of the 5‐hydroxytryptamine 3 receptor antagonist ICS 205‐930 on gastric emptying and antral motor activity in patients with primary anorexia nervosa. - G Stacher, H Bergmann - British journal of , 2012 - Wiley Online Library
  • Abnormal gastric emptying in primary anorexia nervosa. - S Holt, MJ Ford, S Grant, RC Heading - The British Journal of Psychiatry, 1981 - RCP
  • An evaluation of trace metals, vitamins, and taste function in anorexia nervosa. - RC Casper, B Kirschner, HH Sandstead - The American Journal , 1980 - Am Soc Nutrition
  • Anorexia nervosa, anorexia, inanition, and low basal metabolic rate - JM Berkman - The American Journal of the Medical Sciences, 1930 - journals.lww.com
  • An immunological assessment of patients with anorexia nervosa. - JA Golla, LA Larson, CF Anderson - The American journal , 1981 - Am Soc Nutrition
  • Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa - PW Gold, W Kaye, GL Robertson - New England Journal of , 1983 - Mass Medical Soc
  • Anorexia nervosa--diagnosis, aetiology, and treatment. - D Hartman - Postgraduate medical journal, 1995 - pmj.bmj.com
  • Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings - E Abella, E Feliu, I Granada, F Millá - American journal of , 2002 - ajcp.ascpjournals.org
  • An evaluation of family therapy in anorexia nervosa and bulimia nervosa - GFM Russell, GI Szmukler, C Dare - Archives of general , 1987 - Am Med Assoc
  • , and the comparison of this procedure with other tests of pituitary and adrenal function. II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. - J Landon, FC Greenwood, TC Stamp - journal of Clinical , 1966 - ncbi.nlm.nih.gov
  • Anorexia nervosa with psychiatric observations - L Rahman, HB Richardson - Psychosomatic , 1939 - Am Psychosomatic Soc
  • Anorexia nervosa—clinical features and long term follow-up - JF Seidensticker, M Tzagournis - Journal of Chronic Diseases, 1968 - Elsevier
  • Accidental hypothermia - NA Hanania, JL Zimmerman - Critical care clinics, 1999 - Elsevier
  • A Case Report of an Anorexia Nervosa Patient With End‐stage Renal Disease Due to Pseudo Bartter's Syndrome and Chinese Herb Nephropathy Requiring - K Wada, T Shinoda - Therapeutic Apheresis and Dialysis, 2008 - Wiley Online Library
  • Case Study: An Integrated Medical and Psychiatric Approach to Conversion Symptoms in a Four-Year-Old - MM Woodbury, DR Demaso, SJ Goldman - Journal of the American , 1992 - Elsevier
  • Anorexia nervosa: An affective disorder? - DP Cantwell, S Sturzenberger, J Burroughs - Archives of General , 1977 - Am Med Assoc
  • A double-blind controlled trial of lithium carbonate primary anorexia nervosa. - HA Gross, MH Ebert, VB Faden, SC Goldberg - Journal of clinical , 1981 - ukpmc.ac.uk
  • Ampulla cardiomyopathy after hypoglycemia in three young female patients with anorexia nervosa - R OHWADA, M HOTTA, H KIMURA, S TAKAGI - Internal medicine, 2005 - J-STAGE
  • 5-HT< sub> 2A receptor gene polymorphisms in anorexia nervosa and bulimia nervosa - B Nacmias, V Ricca, A Tedde, B Mezzani, CM Rotella - Neuroscience , 1999 - Elsevier
  • Current results of surgery for achalasia of the cardia. - R Emblem, MD Stringer, CM Hall, L Spitz - Archives of disease in , 1993 - adc.bmj.com
  • Diaphragmatic function in severely malnourished patients with anorexia nervosa. Effects of renutrition. - D Murciano, D Rigaud, S Pingleton - American journal of , 1994 - Am Thoracic Soc
  • 5-HT2A promoter polymorphism-1438G/A, anorexia nervosa, and obsessive-compulsive disorder. - MA Enoch, WH Kaye, A Rotondo, BD Greenberg - Lancet, 1998 - ukpmc.ac.uk
  • Brain glucose metabolism in anorexia nervosa and affective disorders: influence of weight loss or depressive symptomatology - V Delvenne, S Goldman, V De Maertelaer - Psychiatry Research: , 1997 - Elsevier
  • Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa - PW Gold, W Kaye, GL Robertson - New England Journal of , 1983 - Mass Medical Soc
  • Complications of laxative abuse - EH Baker, MD, GI Sandle, MD - Annual review of medicine, 1996 - annualreviews.org
  • Anorexia nervosa: An affective disorder? - DP Cantwell, S Sturzenberger, J Burroughs - Archives of General , 1977 - Am Med Assoc
  • An evaluation of family therapy in anorexia nervosa and bulimia nervosa - GFM Russell, GI Szmukler, C Dare - Archives of general , 1987 - Am Med Assoc
  • . Cachectin/tumor necrosis factor-secreting tumor in skeletal muscle induces chronic cachexia, while implantation in brain induces predominantly acute anorexia. - KJ Tracey, S Morgello, B Koplin - Journal of Clinical , 1990 - ncbi.nlm.nih.gov
  • Association of body cathexis and morphological variables on college-aged females in an exercise setting - E TOM, CM BARRY - Perceptual and Motor Skills, 1987 - amsciepub.com
  • Anorexia nervosa - RM Boyar, J Katz, JW Finkelstein - England Journal of , 1974 - Mass Medical Soc
  • Anorexia nervosa: Let me be - AH Crisp - 1995 - books.google.com
  • A cognitive behavioural theory of anorexia nervosa - CG Fairburn, R Shafran, Z Cooper - Behaviour Research and Therapy, 1999 - Elsevier
  • Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis - PT Akins, S Glenn, PM Nemeth, CP Derdeyn - Stroke, 1996 - Am Heart Assoc
  • ANOREXIA NERVOSA IN THE MALE CHILD* - EI FALSTEIN, SC FEINSTEIN - American Journal of , 1956 - Wiley Online Library
  • Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa - S Grinspoon, L Thomas, K Miller, D Herzog - Journal of Clinical , 2002 - Endocrine Soc
  • 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study - AR Lucas, CM Beard, WM O'Fallon - Am J , 1991 - Am Psychiatric Assoc
  • Acquired zinc deficiency in association with anorexia nervosa: case report and review of the literature - AS Voorhees, M Riba - Pediatric dermatology, 1992 - Wiley Online Library
  • , and the comparison of this procedure with other tests of pituitary and adrenal function. II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. - J Landon, FC Greenwood, TC Stamp - journal of Clinical , 1966 - ncbi.nlm.nih.gov
  • Anorexia nervosa: Demographic and clinical features in 94 cases - KA Halmi - Psychosomatic Medicine, 1974 - Am Psychosomatic Soc
  • Abdominal bloating - F Azpiroz, JR Malagelada - Gastroenterology, 2005 - Elsevier
  • A qualitative study of the experience of caring for a person with bulimia nervosa. Part 2: Carers' needs and experiences of services and other support - S Winn, S Perkins, J Murray, R Murphy - Journal of Eating , 2004 - Wiley Online Library
  • Asynchronous breathing during sleep - J Kohyama, T Shiiki, M Shimohira - Archives of disease in , 2001 - adc.bmj.com
  • Anorexia nervosa and schizophrenia in an adolescent female - ME Lyon, TJ Silber - Journal of adolescent health care, 1989 - Elsevier
  • Anorexia nervosa and bulimia - KA Halmi - Annual review of medicine, 1987 - annualreviews.org
  • , and the comparison of this procedure with other tests of pituitary and adrenal function. II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. - J Landon, FC Greenwood, TC Stamp - journal of Clinical , 1966 - ncbi.nlm.nih.gov
  • 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study - AR Lucas, CM Beard, WM O'Fallon - Am J , 1991 - Am Psychiatric Assoc
  • Acute hypophosphataemia and hypokalaemia in a patient starting antiretroviral therapy in Zambia—a new context for refeeding syndrome? - C Nyirenda, I Zulu, EK Kabagambe, S Bagchi - BMJ case , 2009 - casereports.bmj.com
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