Question 1 of 10

    Anorexia Nervosa (Anorexia Mentalis)

    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 emerges due to the following process: mental.

    Presentation

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

    Physical signs and symptoms of anorexia are [7]:

    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. 

    Skin
    Lanugo
    • Purging by vomiting or taking laxatives or diuretics • Cooking for others but not eating the food • Feeling sad, anxious or irritable • Feeling cold all the time • Tremendous weight loss • Exhaustion • Dizziness • Fine, soft hair on the body called lanugo[ulifeline.org]
    • Growth of a downy layer of hair called lanugo all over the body, including the face.[pbs.org]
    • […] include: Extreme and possibly sudden weight loss Fatigue Insomnia Dizziness or fainting A bluish discoloration to the fingers Dry skin, brittle nails, thinning hair, hair loss, or dry brittle hair that breaks easily Edema Swelling of hands and feet Lanugo[mccallumplace.com]
    • […] anorexia often the result of starvation or malnourishment: Absence of menstrual cycle Skin may be dry or have a yellow tint Breasts become smaller Adolescents often look physically younger than their age They can often be hyperactive The body grows lanugo[cincinnatichildrens.org]
    • Lanugo A soft, downy body hair that develops on the chest and arms of anorexic women.[medical-dictionary.thefreedictionary.com]
    Alopecia
    • Patients may also suffer from bone loss, dry mouth, low blood pressure and alopecia.[bulimia.com]
    • […] loss of muscle mass listlessness, fatigue , exhaustion hypotension , or blood pressure lightheadedness or dizziness hypothermia , or low body temperature, and cold hands and feet bloated or upset stomach and constipation dry skin swollen hands and feet alopecia[medicalnewstoday.com]
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  • urogenital
    Amenorrhea
    • A psychophysiological disorder usually occurring in teenage women, characterized by fear of becoming obese, a distorted self-image, a persistent aversion to food, and severe weight loss and often marked by hyperactivity, self-induced vomiting, amenorrhea[dictionary.reference.com]
    • Amenorrhea: The illness also causes a woman's menstrual cycle to stop, a condition called amenorrhea.[pamf.org]
    • Key Terms Amenorrhea Absence of the menses in a female who has begun to have menstrual periods.[medical-dictionary.thefreedictionary.com]
    • Amenorrhea is defined as the absence of the menstrual cycle in a woman of childbearing age.[eatingdisorderhope.com]
    Secondary Amenorrhea
    • Disturbances in the menstrual cycle are frequent, and secondary amenorrhea (absence of menstrual periods) affects about 90% of adolescent girls with anorexia.[medicinenet.com]
    • Endocrine symptoms in anorexia nervosa include hypothermia (feeling cold), delayed onset of menses or secondary amenorrhea, and osteopenia progressing to osteoporosis. 11 , 12 More than one-half of patients with eating disorders meet criteria for a current[aafp.org]
    • The continuous downward spiraling of weight loss then causes secondary amenorrhea and loss of secondary sexual characteristics, further worsening weight loss.[emedicine.medscape.com]
    • amenorrhea), mid-parental heights, assessments of skeletal frame, and benchmarks from Centers for Disease Control and Prevention (CDC) growth charts [I] .[mentalhealth.com]
    Irregular Menstruation
    • Dizziness or fainting A bluish discoloration to the fingers Dry skin, brittle nails, thinning hair, hair loss, or dry brittle hair that breaks easily Edema Swelling of hands and feet Lanugo, or a soft downy hair covering the body Loss of menstruation or irregular[mccallumplace.com]
    • […] even when thin Cooking for others, but not eating themselves Restricting food choices to only diet foods Guilt or shame about eating Depression, irritability, mood swings Evidence of vomiting, laxative abuse, diet pills or diuretics to control weight Irregular[mirror-mirror.org]
    • menstruation Excessive facial/body hair Binge eating alternating with fasting Vomiting or taking laxatives after over-eating Compulsive or excessive exercise Self-worth determined by weight or shape Persons with anorexia nervosa may also be socially[urmc.rochester.edu]
    • Irregular menstruation or amenorrhea may be present. 120 Classification (Bulimia nervosa)[statcan.gc.ca]
    Sexual Dysfunction
    • The individual may eventually become socially withdrawn and may experience somatic/sexual dysfunction, particularly in severely underweight individuals.[statcan.gc.ca]
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  • psychiatrical
    Low Self-Esteem
    • The most common element surrounding ALL Eating Disorders, including Anorexia, is the inherent presence of a low self esteem Anorexia Nervosa Those who are suffering with this illness have a low self-esteem and often a tremendous need to control their[something-fishy.org]
    • Feelings of inadequacy, low self-esteem, anxiety , anger, or loneliness also might contribute to the development of the disorder.[webmd.com]
    • As with other eating disorders, anorexia can be associated with depression, low self-esteem, alcohol misuse and self-harm.[b-eat.co.uk]
    • self-esteem (guilt, self-criticism, worthlessness) Rigid thinking (‘black and white’, ‘good and bad’ foods) Feeling out of control Mood swings Anxiety or depression Heightened anxiety around meal times Heightened sensitivity to comments or criticism[eatingdisorders.org.au]
    • Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness also might contribute to the development of the disorder.[my.clevelandclinic.org]
    Denial
    • Treatments People affected with AN are often in denial, in that they don't see themselves as thin or in need of professional help.[minddisorders.com]
    • Severe food restriction Relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight Intense fear of gaining weight Distorted body image and self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial[ncbi.nlm.nih.gov]
    • Mental Symptoms of Anorexia The main mental and emotional symptoms of anorexia generally include a negative self-image, an intense fear of gaining weight, and a denial of hunger.[mccallumplace.com]
    • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.[medicalnewstoday.com]
    Preoccupation with Food
    • People with this disorder have a severe preoccupation with food and body image.[emedicinehealth.com]
    • Warning Signs of Anorexia Nervosa Preoccupation with body shape, weight and/or appearance Intense fear of gaining weight Preoccupation with food or food related activities Negative or distorted body image; perceiving self to be fat when at a healthy weight[eatingdisorders.org.au]
    • Most early signs of anorexia center on preoccupation with food or dieting.[timberlineknolls.com]
    • […] in secrecy or seclusion Refusal to eat in public or in front of others Withdrawal from normal social activities Wearing baggy or layered clothing to hide small size Loss of menstruation Excessive exercising in an attempt to lose more weight Obsessive preoccupation[mccallumplace.com]
    Compulsive Behavior
    • The restrictive eating behaviors associated with anorexia may therefore result from an imbalance between inhibitory and reward systems, which leads to a shift to compulsive behaviors.[brainblogger.com]
    • Timberline Knolls Residential Treatment Center places more emphasis up front on understanding a woman’s entire history of addictive and/or compulsive behavior, given the critical impact these co-occurring conditions will have on treatment and recovery[timberlineknolls.com]
    • behavior irritability over-exercising Food and eating become associated with guilt.[medicalnewstoday.com]
    • Although anorexia seldom appears before puberty, when it does, associated mental conditions, such as depression and obsessive-compulsive behavior are usually more severe.[umm.edu]
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  • cardiovascular
    Hypotension
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Common cardiac complications that may occur include the following: Arrhythmias (a fast, slow, or irregular heartbeat) Hypotension (low blood pressure) Electrolytes (salts and minerals in the blood).[stanfordchildrens.org]
    • Bradycardia, orthostatic hypotension, and palpitations may progress to potentially fatal arrhythmias.[aafp.org]
    • Accompanying physical signs in addition to profound weight loss include hypotension, bradycardia, edema, lanugo, metabolic changes, and endocrine disturbances.[medical-dictionary.thefreedictionary.com]
    • Signs and symptoms Vital sign changes found in patients with anorexia nervosa include hypotension, bradycardia, and hypothermia.[emedicine.medscape.com]
    Orthostatic Hypotension
    • Bradycardia, orthostatic hypotension, and palpitations may progress to potentially fatal arrhythmias.[aafp.org]
    • Cardiovascular effects of anorexia nervosa include the following [71, 21 , 72] : Cardiomyopathy Mitral valve prolapse Supraventricular and ventricular dysrhythmias Long QT syndrome Bradycardia Orthostatic hypotension Shock due to congestive heart failure[emedicine.medscape.com]
    Tachycardia
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  • musculoskeletal
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  • gastrointestinal
    Vomiting
    • […] uses other methods of compensation, such as fasting or excessive exercise, but does not regularly engage in self-induced vomiting or the use of laxatives, diuretics, or enemas. 7 - Self-induced vomiting is the most common method to compensate for binge[statcan.gc.ca]
    • A psychophysiological disorder usually occurring in teenage women, characterized by fear of becoming obese, a distorted self-image, a persistent aversion to food, and severe weight loss and often marked by hyperactivity, self-induced vomiting, amenorrhea[dictionary.reference.com]
    • Frequent self-induced vomiting can contribute to parotitis, stained teeth or enamel erosions, and hand calluses.[aafp.org]
    • Deliberately vomiting Anorexia sufferers may try to get rid of food by vomiting immediately after meals.[nutritionist-resource.org.uk]
    • Some of the behavioral signs can be: obsessive exercise, calorie and fat gram counting, starvation and restriction of food, self-induced vomiting, the use of diet pills, laxatives or diuretics to attempt controlling weight, and a persistent concern with[something-fishy.org]
    Malnutrition
    • Trending Words Definition of anorexia nervosa : a serious disorder in eating behavior primarily of young women in their teens and early twenties that is characterized especially by a pathological fear of weight gain leading to faulty eating patterns, malnutrition[merriam-webster.com]
    • Hospitalization may be required for medical complications related to weight loss and malnutrition.[stanfordchildrens.org]
    • Blood tests , to check for signs of malnutrition.[cigna.com]
    • Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Brittle hair and nails Malnutrition Edema Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Hyperkeratosis Malnutrition[aafp.org]
    Constipation
    • They include: Anaemia (iron deficiency) Compromised immune system (e.g. getting sick more often) Intestinal problems (e.g. abdominal pain, constipation, diarrhoea) Loss or disturbance of menstruation in girls and women Increased risk of infertility in[nedc.com.au]
    • Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints and a new growth of thin hair over the body.[my.clevelandclinic.org]
    • Constipation and slow emptying of the stomach .[webmd.com]
    • Stopping them suddenly can cause problems, such as nausea and constipation.[hse.ie]
    Abdominal Pain
    • pain Constipation Persons with anorexia may also have severe body distortions, restricted emotions, and show little insight to their disorder.[cincinnatichildrens.org]
    • You may have indigestion and/or tummy (abdominal) pains.[patient.info]
    • Constipation, abdominal pain, lethargy, bradycardia, and cold intolerance are also experienced.[statcan.gc.ca]
    • They include: Anaemia (iron deficiency) Compromised immune system (e.g. getting sick more often) Intestinal problems (e.g. abdominal pain, constipation, diarrhoea) Loss or disturbance of menstruation in girls and women Increased risk of infertility in[nedc.com.au]
    • The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping.[nami.org]
    Loss of Appetite
    • English [ edit ] Etymology [ edit ] From the scientific term anorexia nervosa (1957), from the symptom anorexia ( “ loss of appetite ” ) , from Ancient Greek ἀν- ( an- , “ without ” ) ὄρεξις ( órexis , “ appetite, desire ” ) , and Latin nervōsa ( “ nervous[en.wiktionary.org]
    • The term anorexia literally means "loss of appetite."[my.clevelandclinic.org]
    • Loss of Appetite Symptoms and Causes Loss of appetite, medically referred to as anorexia Loss of appetite can be caused by a variety of conditions and diseases.[medicinenet.com]
    • When Gull reported about his work to the Clinical Society of London, he used the term anorexia nervosa , which literally means “nervous loss of appetite ,” to describe the condition.[britannica.com]
    Nausea
    • Stopping them suddenly can cause problems, such as nausea and constipation.[hse.ie]
    • […] refeeding plan. [ 20 ] Assessment of linolenic acid, retinol, vitamin A, vitamin D, and pantothenic acid levels can also be helpful, because early in anorexia, levels of vitamin A can be elevated, causing symptoms such as dizziness, cerebral edema, and nausea[emedicine.medscape.com]
    Binge-Eating/Purging Type of Anorexia Nervosa
    • Unlike the binge-eating/purging type of anorexia nervosa, bulimia nervosa does not result in weight reduction below the minimal normal weight.[medicinenet.com]
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  • neurologic
    Lethargy
    • Constipation, abdominal pain, lethargy, bradycardia, and cold intolerance are also experienced.[statcan.gc.ca]
    • […] and women and decreased libido in men Fainting or dizziness Feeling cold most of the time, even in warm weather (caused by poor circulation) Feeling bloated, constipated, or the development of intolerances to food Feeling tired and not sleeping well Lethargy[nedc.com.au]
    • […] increased risk of heart failure and death Reduction of bone density (osteopenia and osteoporosis) which results in dry, brittle bones Muscle loss and weakness Severe dehydration, which can result in kidney failure Edema (swelling) Fainting, fatigue, lethargy[eatingdisorder.org]
    • Symptoms may include: Dry skin that when pinched and released, stays pinched Dehydration Abdominal pain Constipation Lethargy Dizziness Fatigue Intolerance to cold temperatures Emaciation Development of lanugo (fine, downy body hair) Yellowing of the[stanfordchildrens.org]
    • Physically, people with AN can exhibit cold hands and feet, dry skin, hair loss, headaches, fainting, dizziness, and lethargy (loss of energy).[minddisorders.com]
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  • Entire body system
    Weight Loss
    • An indifference to excessive weight loss.[pbs.org]
    • Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems and even death.[webmd.com]
    • Overall, there is an indication that weight loss is of primary importance and it begins to take precedence over other important life roles and responsibilities.[eatingdisorder.org]
    • Wearing loose clothing to hide weight loss.[my.clevelandclinic.org]
    Malnutrition
    • Trending Words Definition of anorexia nervosa : a serious disorder in eating behavior primarily of young women in their teens and early twenties that is characterized especially by a pathological fear of weight gain leading to faulty eating patterns, malnutrition[merriam-webster.com]
    • Hospitalization may be required for medical complications related to weight loss and malnutrition.[stanfordchildrens.org]
    • Blood tests , to check for signs of malnutrition.[cigna.com]
    • Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Brittle hair and nails Malnutrition Edema Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Hyperkeratosis Malnutrition[aafp.org]
    Anemia
    • Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints and a new growth of thin hair over the body.[my.clevelandclinic.org]
    • Consequences include impaired immunity, anemia, and diminished digestive function.[britannica.com]
    • […] illness Wearing loose clothing to hide weight loss Compulsive exercising Feeling worthless or hopeless Social withdrawal Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin , anemia[webmd.com]
    • […] breath Irregular heartbeats Cold hands and feet Bloating Constipation Hair loss Stomach pains Decreased metabolic rate Edema (water retention) Lanugo (fine downy hair) Loss of bone mass Kidney and liver damage Electrolyte imbalances Osteoporosis Insomnia Anemias[mirror-mirror.org]
    Hypothermia
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Thermoregulatory dysfunction, hypoglycemia, reduced fat tissue Lanugo (fine, white hairs on the body) Response to fat loss and hypothermia Marked weight loss Self starvation, low caloric intake Osteoporosis at a young age Malnutrition Bulimia nervosa[aafp.org]
    • People affected with AN may also suffer from lowered body temperature (hypothermia), and lowered blood pressure, heart rate, glucose and white blood cells (cells that help fight against infection).[minddisorders.com]
    • Other physical signs and symptoms resulting from a lack of nutrients include: severe loss of muscle mass listlessness, fatigue , exhaustion hypotension , or blood pressure lightheadedness or dizziness hypothermia , or low body temperature, and cold hands[medicalnewstoday.com]
    • Signs and symptoms Vital sign changes found in patients with anorexia nervosa include hypotension, bradycardia, and hypothermia.[emedicine.medscape.com]
    Cold Intolerance
    • Constipation, abdominal pain, lethargy, bradycardia, and cold intolerance are also experienced.[statcan.gc.ca]
    • intolerance, hypothermia, constipation, hypotension, bradycardia Clinical Anemia, leukopenia, electrolyte abnormalities, BUN and creatinine, cholesterol, LH, FSH DiffDx Panhypopituitarism, Addison's disease, hyperthyroidism, DM, Crohn's disease, CA,[medical-dictionary.thefreedictionary.com]
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  • Jaw & Teeth
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  • 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

    Laboratory

    Urine
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  • Serum
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  • Imaging

    X-ray
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  • ECG

    QT, RR, ST Intervals
    Prolonged QT Interval
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  • 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.

    Complications

    Alopecia
    • Patients may also suffer from bone loss, dry mouth, low blood pressure and alopecia.[bulimia.com]
    • […] loss of muscle mass listlessness, fatigue , exhaustion hypotension , or blood pressure lightheadedness or dizziness hypothermia , or low body temperature, and cold hands and feet bloated or upset stomach and constipation dry skin swollen hands and feet alopecia[medicalnewstoday.com]
    Constipation
    • They include: Anaemia (iron deficiency) Compromised immune system (e.g. getting sick more often) Intestinal problems (e.g. abdominal pain, constipation, diarrhoea) Loss or disturbance of menstruation in girls and women Increased risk of infertility in[nedc.com.au]
    • Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints and a new growth of thin hair over the body.[my.clevelandclinic.org]
    • Constipation and slow emptying of the stomach .[webmd.com]
    • Stopping them suddenly can cause problems, such as nausea and constipation.[hse.ie]
    Sudden Death
    • Sudden death in eating disorders.[womenshealth.gov]
    • death (common in anorexia nervosa) Brittle hair and nails Malnutrition Edema Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Hyperkeratosis Malnutrition, vitamin and mineral deficiencies Hypotension Malnutrition[aafp.org]
    • Anorexia may cause serious long-term health complications, including congestive heart failure, sudden death, growth retardation, dental problems, constipation, stomach rupture, swelling of the salivary glands, anemia and other abnormalities of the blood[medical-dictionary.thefreedictionary.com]
    • All the aforementioned changes are clinically insignificant; however, the frequency of rhythm disturbances is most concerning, especially QT-interval prolongation that may be an indication for those at risk of cardiac arrhythmias and sudden death.[emedicine.medscape.com]
    Cardiac Arrhythmia
    • Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.[nami.org]
    • Malnourishment caused by (semi-) starvation may result in muscle wasting, dehydration, abdominal pain, amenorrhea, constipation, cold intolerance, cardiac arrhythmias, impaired renal function, and osteoporosis.[statcan.gc.ca]
    • Temperature 96 F 75% ideal body weight or ongoing weight loss despite intensive management Body fat 10% Refusal to eat Failure to respond to outpatient treatment Bulimia nervosa Syncope Serum potassium 3.2 mmol/L Serum chloride 88 mmol/L Esophageal tears Cardiac[aafp.org]
    • All the aforementioned changes are clinically insignificant; however, the frequency of rhythm disturbances is most concerning, especially QT-interval prolongation that may be an indication for those at risk of cardiac arrhythmias and sudden death.[emedicine.medscape.com]
    Malnutrition
    • Trending Words Definition of anorexia nervosa : a serious disorder in eating behavior primarily of young women in their teens and early twenties that is characterized especially by a pathological fear of weight gain leading to faulty eating patterns, malnutrition[merriam-webster.com]
    • Hospitalization may be required for medical complications related to weight loss and malnutrition.[stanfordchildrens.org]
    • Blood tests , to check for signs of malnutrition.[cigna.com]
    • Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Brittle hair and nails Malnutrition Edema Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Hyperkeratosis Malnutrition[aafp.org]
    Hypoglycemia
    • Severe hypoglycemia may lead to seizures.[aafp.org]
    • Endocrine and metabolic disturbances, for example, result in the following [ 70 ] : Delayed puberty Amenorrhea Anovulation Low estrogen states Increased growth hormone Decreased antidiuretic hormone Hypercarotenemia Hypothermia Hypokalemia Hyponatremia Hypoglycemia[emedicine.medscape.com]
    Dehydration
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.[nami.org]
    • Limited fluid intake can cause dehydration and highly concentrated urine.[stanfordchildrens.org]
    • , anxious or irritable • Feeling cold all the time • Tremendous weight loss • Exhaustion • Dizziness • Fine, soft hair on the body called lanugo • Thinning hair or hair loss • Amenorrhea (when a woman’s menstrual cycle stops) • Irregular heartbeat • Dehydration[ulifeline.org]
    • Severe dehydration, which can result in kidney failure.[pbs.org]
    Hypokalemia
    • Endocrine and metabolic disturbances, for example, result in the following [ 70 ] : Delayed puberty Amenorrhea Anovulation Low estrogen states Increased growth hormone Decreased antidiuretic hormone Hypercarotenemia Hypothermia Hypokalemia Hyponatremia[emedicine.medscape.com]
    • Hypokalemia should be treated with oral or intravenous potassium supplementation and rehydration [I] .[mentalhealth.com]
    Hypotension
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Common cardiac complications that may occur include the following: Arrhythmias (a fast, slow, or irregular heartbeat) Hypotension (low blood pressure) Electrolytes (salts and minerals in the blood).[stanfordchildrens.org]
    • Bradycardia, orthostatic hypotension, and palpitations may progress to potentially fatal arrhythmias.[aafp.org]
    • Accompanying physical signs in addition to profound weight loss include hypotension, bradycardia, edema, lanugo, metabolic changes, and endocrine disturbances.[medical-dictionary.thefreedictionary.com]
    • Signs and symptoms Vital sign changes found in patients with anorexia nervosa include hypotension, bradycardia, and hypothermia.[emedicine.medscape.com]
    Cachexia
    • As cachexia progresses, patients with anorexia nervosa lose strength and endurance, move more slowly, and demonstrate decreased performance in sports.[aafp.org]
    • Severe cachexia or extreme dietary deviance may require hospitalization and intravenous correction of acute nutritional and electrolyte deficiencies.[medical-dictionary.thefreedictionary.com]
    Panhypopituitarism
    • Average 25% below normal weight:height ratio, absence of 3 menstrual periods, cold intolerance, hypothermia, constipation, hypotension, bradycardia Clinical Anemia, leukopenia, electrolyte abnormalities, BUN and creatinine, cholesterol, LH, FSH DiffDx Panhypopituitarism[medical-dictionary.thefreedictionary.com]
    Anemia
    • Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints and a new growth of thin hair over the body.[my.clevelandclinic.org]
    • Consequences include impaired immunity, anemia, and diminished digestive function.[britannica.com]
    • […] illness Wearing loose clothing to hide weight loss Compulsive exercising Feeling worthless or hopeless Social withdrawal Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin , anemia[webmd.com]
    • […] breath Irregular heartbeats Cold hands and feet Bloating Constipation Hair loss Stomach pains Decreased metabolic rate Edema (water retention) Lanugo (fine downy hair) Loss of bone mass Kidney and liver damage Electrolyte imbalances Osteoporosis Insomnia Anemias[mirror-mirror.org]
    Crohn's Disease
    Alkalosis
    • […] dysrhythmias Long QT syndrome Bradycardia Orthostatic hypotension Shock due to congestive heart failure Renal disturbances include the following: Decreased glomerular filtration rate (GFR) Elevated BUN Edema Acidosis with dehydration Hypokalemia Hypochloremic alkalosis[emedicine.medscape.com]
    Addison's Disease
    • These include: diabetes Addison's disease chronic infections malabsorption immunodeficiency inflammatory bowel disease (IBS) cancer hyperthyroidism These may include blood tests, imaging scans, and an electrocardiogram (ECG).[medicalnewstoday.com]
    • disease, hyperthyroidism, DM, Crohn's disease, CA, TB, CNS tumors Management Psychotherapy, hospitalization.[medical-dictionary.thefreedictionary.com]
    Syncope
    • In the acute state of the disease it is common for patients to report dizziness, fatigue, or even syncope .[brainblogger.com]
    • […] changes in pulse ( 20 beats/min) or blood pressure ( 10 mm Hg) Arrhythmia Temperature 96 F 75% ideal body weight or ongoing weight loss despite intensive management Body fat 10% Refusal to eat Failure to respond to outpatient treatment Bulimia nervosa Syncope[aafp.org]
    Depression
    • Re-establishing a normal weight may relieve depression on its own, and anti-depressants are not effective at very low body weight.[urmc.rochester.edu]
    • The individual binge eats to reduce these feelings but self-criticism and depression tend to follow.[statcan.gc.ca]
    • Sufferers can feel depressed, irritable, hopeless and moody as a result.[mirror-mirror.org]
    • Psychopathology in Anorexia Nervosa and Depression .[womenshealth.gov]
    Osteopenia and Osteoporosis
    • […] and osteoporosis) which results in dry, brittle bones Muscle loss and weakness Severe dehydration, which can result in kidney failure Edema (swelling) Fainting, fatigue, lethargy and overall weakness Dry skin and hair, brittle hair and nails, hair loss[eatingdisorder.org]
    • […] or osteoporosis) Kidney stones or kidney failure Lack of periods, which can cause problems getting pregnant During pregnancy, a higher risk for miscarriage, cesarean delivery, or having a baby with low birth weight Anorexia is a serious illness that[womenshealth.gov]
    Vitamin Deficiency
    • Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss.[umm.edu]
    Pellagra
    Edema
    • […] signs of symptoms of anorexia nervosa include: Extreme and possibly sudden weight loss Fatigue Insomnia Dizziness or fainting A bluish discoloration to the fingers Dry skin, brittle nails, thinning hair, hair loss, or dry brittle hair that breaks easily Edema[mccallumplace.com]
    • Complications Fatigue and lack of energy Amenorrhea (loss of menstruation) Skin problems Dizziness and headaches Dehydration Shortness of breath Irregular heartbeats Cold hands and feet Bloating Constipation Hair loss Stomach pains Decreased metabolic rate Edema[mirror-mirror.org]
    • […] structure and function of the heart; increased risk of heart failure and death Reduction of bone density (osteopenia and osteoporosis) which results in dry, brittle bones Muscle loss and weakness Severe dehydration, which can result in kidney failure Edema[eatingdisorder.org]
    • […] fat stores, malnutrition Arrhythmia Electrolyte disorders, heart failure, prolonged corrected QT interval Bradycardia Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Brittle hair and nails Malnutrition Edema[aafp.org]
    • Although weight gain is a primary goal of treatment, the weight gain should not be excessive, because rapid refeeding can lead to refeeding syndrome: excessive bloating, edema, and, rarely, congestive heart failure (CHF).[emedicine.medscape.com]
    Schizophrenia
    • The doctor also will need to distinguish between anorexia and other psychiatric disorders, including depression, schizophrenia, social phobia, obsessive-compulsive disorder, and body dysmorphic disorder.[medical-dictionary.thefreedictionary.com]
    • […] medications have been identified that can definitively reduce the compulsion to starve oneself, olanzapine ( Zyprexa , Zydis ), risperidone ( Risperdal ), and quetiapine ( Seroquel ) are medications that are also used as mood stabilizers and to treat schizophrenia[medicinenet.com]
    • […] possibility of an increased genetic predisposition. [25, 26 ] Indeed, there is evidence from twin studies to suggest that the genetic contribution to the disease is as high as 50-80%, a heritability estimate similar to that for bipolar disorder and schizophrenia[emedicine.medscape.com]
    Sinus Bradycardia
    • If electrocardiography (ECG) is performed, evidence of sinus bradycardia, ST-segment elevation, T-wave flattening, low voltage, and rightward QRS axis is apparent.[emedicine.medscape.com]
    Hypothermia
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Thermoregulatory dysfunction, hypoglycemia, reduced fat tissue Lanugo (fine, white hairs on the body) Response to fat loss and hypothermia Marked weight loss Self starvation, low caloric intake Osteoporosis at a young age Malnutrition Bulimia nervosa[aafp.org]
    • People affected with AN may also suffer from lowered body temperature (hypothermia), and lowered blood pressure, heart rate, glucose and white blood cells (cells that help fight against infection).[minddisorders.com]
    • Other physical signs and symptoms resulting from a lack of nutrients include: severe loss of muscle mass listlessness, fatigue , exhaustion hypotension , or blood pressure lightheadedness or dizziness hypothermia , or low body temperature, and cold hands[medicalnewstoday.com]
    • Signs and symptoms Vital sign changes found in patients with anorexia nervosa include hypotension, bradycardia, and hypothermia.[emedicine.medscape.com]
    Bradycardia
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Bradycardia, orthostatic hypotension, and palpitations may progress to potentially fatal arrhythmias.[aafp.org]
    • Accompanying physical signs in addition to profound weight loss include hypotension, bradycardia, edema, lanugo, metabolic changes, and endocrine disturbances.[medical-dictionary.thefreedictionary.com]
    • Heart function is also compromised and a person affected with AN may develop congestive heart failure (a chronic weakening of the heart due to work overload), slow heart rate (bradycardia), and abnormal rates and rhythms (arrhythmias).[minddisorders.com]
    • Signs and symptoms Vital sign changes found in patients with anorexia nervosa include hypotension, bradycardia, and hypothermia.[emedicine.medscape.com]
    Abuse of Diuretics
    • This may include exercising obsessively, or abusing laxatives, diuretics / water pills, or other diet drugs.[timberlineknolls.com]
    • Purge-type anorectics eat and then get rid of the calories and weight by self-induced vomiting, excessive laxative use, and abuse of diuretics or enemas.[medical-dictionary.thefreedictionary.com]
    • Both disorders can have self-imposed caloric restriction, food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse).[mentalhealth.com]
    Prolonged QT Interval
    Eating Disorder
    • Binge Eating Disorder (BED).[nami.org]
    • Treatment of athletes with eating disorders Males with eating disorders The EDs that males get Statistics for males with eating disorders Risk factors for males Males and females with eating disorders: differences Treatment of males with eating disorders[anred.com]
    • Parents do not cause eating disorders, and patients do not choose eating disorders.[glossary.feast-ed.org]
    • Contact an eating disorder treatment facility, like McCallum Place, in order to speak with an eating disorder professional and learn how you can overcome your eating disorder.[mccallumplace.com]

    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.

    Causes

    Constipation
    • They include: Anaemia (iron deficiency) Compromised immune system (e.g. getting sick more often) Intestinal problems (e.g. abdominal pain, constipation, diarrhoea) Loss or disturbance of menstruation in girls and women Increased risk of infertility in[nedc.com.au]
    • Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints and a new growth of thin hair over the body.[my.clevelandclinic.org]
    • Constipation and slow emptying of the stomach .[webmd.com]
    • Stopping them suddenly can cause problems, such as nausea and constipation.[hse.ie]
    Dehydration
    • Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp.[rch.org.au]
    • Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.[nami.org]
    • Limited fluid intake can cause dehydration and highly concentrated urine.[stanfordchildrens.org]
    • , anxious or irritable • Feeling cold all the time • Tremendous weight loss • Exhaustion • Dizziness • Fine, soft hair on the body called lanugo • Thinning hair or hair loss • Amenorrhea (when a woman’s menstrual cycle stops) • Irregular heartbeat • Dehydration[ulifeline.org]
    • Severe dehydration, which can result in kidney failure.[pbs.org]
    Hypokalemia
    • Endocrine and metabolic disturbances, for example, result in the following [ 70 ] : Delayed puberty Amenorrhea Anovulation Low estrogen states Increased growth hormone Decreased antidiuretic hormone Hypercarotenemia Hypothermia Hypokalemia Hyponatremia[emedicine.medscape.com]
    • Hypokalemia should be treated with oral or intravenous potassium supplementation and rehydration [I] .[mentalhealth.com]
    Alkalosis
    • […] dysrhythmias Long QT syndrome Bradycardia Orthostatic hypotension Shock due to congestive heart failure Renal disturbances include the following: Decreased glomerular filtration rate (GFR) Elevated BUN Edema Acidosis with dehydration Hypokalemia Hypochloremic alkalosis[emedicine.medscape.com]

    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.

    Other symptoms


    Self-assessment

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    References

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    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.

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