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. 

Jaw & Teeth
Entire body system
  • Anemia Consequences can include amenorrhea (absence of menstruation) in women, cognitive deficits, dental caries, hypothyroidism , constipation, gastrointestinal bleeding, anemia, infections, compromised immunity, bone fractures, and spinal compression, just [source] 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 [source] 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 Anemia [source]
  • Cold Intolerance Constipation, abdominal pain, lethargy, bradycardia, and cold intolerance are also experienced. [source] Malnourishment caused by (semi-) starvation may result in muscle wasting, dehydration, abdominal pain, amenorrhea, constipation, cold intolerance, cardiac arrhythmias, impaired renal function, and osteoporosis. [source] 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, [source]
  • Hypothermia Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp. 35o C oral) Electrolyte abnormalities (eg. hypokalaemia, hypernatraemia) Severe weight [source] 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 [source] 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 [source]
  • Malnutrition Hospitalization may be required for medical complications related to weight loss and malnutrition[source] Heart muscle damage that can occur as a result of malnutrition or repeated vomiting may be life threatening. [source] Anorexia nervosa, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. [source]
  • Weight Loss An indifference to excessive weight loss[source] Weight loss is achieved by a variety of obsessive behaviors. [source] Warning Signs: Dramatic weight loss with no known medical illness. [source]
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neurologic
  • Lethargy Constipation, abdominal pain, lethargy, bradycardia, and cold intolerance are also experienced. [source] Lethargy and fatigue are common, also due to lack of food/energy intake; self esteem levels are low; depression, anxiety, and irritability are experienced. [source] 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 [source]
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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 [source] Growth of a downy layer of hair called lanugo all over the body, including the face. [source] Articles Main Anorexia Page – All Recent Articles and Videos Anorexia Causes Anorexia Effects Anorexia Symptoms Anorexia Diagnosis Anorexia Treatment Anorexia Support Anorexia Recovery Anorexia Statistics Bulimia Nervosa Binge Eating Compulsive Overeating Lanugo [source]
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gastrointestinal
  • Abdominal Distension Abdominal distension[source] Delayed stomach emptying, or gastroparesis, often develops following food restriction and weight loss; the most common symptom is bloating with gas and abdominal distension, and often occurs after eating. [source]
  • Abdominal Pain pain Constipation Persons with anorexia may also have severe body distortions, restricted emotions, and show little insight to their disorder. [source] than their age They can often be hyperactive The body grows lanugo (fine soft hair that grows on the arms and legs) Fatigue (may be a sign of fluid or electrolyte imbalance, or dehydration) Intolerance to cold temperatures Dizziness or fainting spells Abdominal [source] Constipation, abdominal pain, lethargy, bradycardia, and cold intolerance are also experienced. [source]
  • Binge-Eating/Purging Type of Anorexia Nervosa Binge-Eating/Purging Type of Anorexia Nervosa is also frequently associated with other impulse control problems and mood disorders. [source] Unlike the binge-eating/purging type of anorexia nervosa, bulimia nervosa does not result in weight reduction below the minimal normal weight. [source]
  • Early Satiety Other symptoms of gastroparesis include early satiety, fullness, nausea, and vomiting. [source]
  • 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 [source] Although the word 'anorexia' literally means loss of appetite, this does not accurately describe what a person experiences. [source] The term anorexia literally means "loss of appetite." [source]
  • Nausea Stopping them suddenly can cause problems, such as nausea and constipation. [source] 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 [source] Other symptoms of gastroparesis include early satiety, fullness, nausea, and vomiting. [source]
  • Vomiting Self-induced vomiting B. [source] Anorexics will deny hunger, make excuses to avoid eating, will often hide food they claim to have eaten, or attempt to purge the food away with self-induced vomiting, or by taking laxatives. [source] Those with the Binge-Eating/Purging Type usually restrict their food intake but also regularly engage in binge eating and/or purging behaviors (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas). [source]
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musculoskeletal
cardiovascular
  • Orthostatic Hypotension Hypotension or orthostatic hypotension[source] Orthostatic hypotension, a marked decrease in blood pressure when standing from a supine position, may also occur. [source] 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 [source]
  • Tachycardia Physical signs and symptoms of anorexia are: 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 [source] 200-300 kcal every 3-5 days until a sustained weight gain of 1-2 pounds (0.45-0.9 kg) per week is achieved (rapid refeeding can lead to excessive bloating, edema, and, rarely, congestive heart failure) Monitor the patient carefully for development of tachycardia [source] Bradycardia or tachycardia[source]
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urogenital
  • Amenorrhea Amenorrhea is the absence of menstruation for three consecutive months in post-pubescent females and occurs when body weight becomes so low that it negatively impacts normal endocrine and hormonal function. [source] Anorexia Nervosa in males Even though amenorrhea is currently a criterion for the diagnosis of Anorexia Nervosa, the calorie restricting behaviors present in this eating disorder are not exclusive to females. [source] Males can also experience eating disorders that present like Anorexia Nervosa, though males will never experience amenorrhea and thus can never achieve a diagnosis of Anorexia Nervosa under the current diagnostic criteria. [source]
  • 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 [source] menstruation Constipation Irregular heart rhythms Dehydration and electrolyte imbalances Frequent feeling of cold Receiving Anorexia Treatment: What to Do After Recognizing Anorexia Symptoms Eating disorders, especially anorexia, often develop a strong [source] 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 [source]
  • Secondary Amenorrhea The continuous downward spiraling of weight loss then causes secondary amenorrhea and loss of secondary sexual characteristics, further worsening weight loss. [source] 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 [source] Disturbances in the menstrual cycle are frequent, and secondary amenorrhea (absence of menstrual periods) affects about 90% of adolescent girls with anorexia. [source]
  • Sexual Dysfunction The individual may eventually become socially withdrawn and may experience somatic/sexual dysfunction, particularly in severely underweight individuals. [source]
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psychiatrical
  • 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[source] 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 [source] behavior irritability over-exercising Food and eating become associated with guilt. [source]
  • Denial Denial of hunger. [source] Denial of the condition can be extreme. [source] 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. 4. [source]
  • 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 [source] With a low self-esteem and need for acceptance they will turn to obsessive dieting and starvation as a way to control not only their weight, but their feelings and actions regarding the emotions attached. [source] For men, sports like bodybuilding and wrestling increase their risk of getting anorexia. - Having low self-esteem[source]
  • Preoccupation with Food 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 [source] 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 [source] Most early signs of anorexia center on preoccupation with food or dieting. [source]
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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

Serum
Urine

Imaging

X-ray

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

  • Abuse of Diuretics This may include exercising obsessively, or abusing laxatives, diuretics / water pills, or other diet drugs. [source] 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. [source] Both disorders can have self-imposed caloric restriction, food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse). [source]
  • 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). [source] disease, hyperthyroidism, DM, Crohn's disease, CA, TB, CNS tumors Management Psychotherapy, hospitalization. [source] 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, Addison's [source]
  • 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 [source]
  • Alopecia Patients may also suffer from bone loss, dry mouth, low blood pressure and alopecia[source] 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 [source]
  • Bradycardia Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp. 35o C oral) Electrolyte abnormalities (eg. hypokalaemia, hypernatraemia) Severe weight [source] Physical signs and symptoms of anorexia are: 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 [source] Signs and symptoms Vital sign changes found in patients with anorexia nervosa include hypotension, bradycardia, and hypothermia. [source]
  • Cachexia As cachexia progresses, patients with anorexia nervosa lose strength and endurance, move more slowly, and demonstrate decreased performance in sports. [source] chloride 88 mmol/L Esophageal tears Cardiac arrhythmias including prolonged QTc Hypothermia Suicide risk Intractable vomiting Hematemesis Failure to respond to outpatient treatment The focus of initial treatment for patients who have anorexia nervosa with cachexia [source] Severe cachexia or extreme dietary deviance may require hospitalization and intravenous correction of acute nutritional and electrolyte deficiencies. [source]
  • Cardiac Arrhythmia Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death. [source] Malnourishment caused by (semi-) starvation may result in muscle wasting, dehydration, abdominal pain, amenorrhea, constipation, cold intolerance, cardiac arrhythmias, impaired renal function, and osteoporosis. [source] 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. [source]
  • 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 [source] Signs Rapid weight loss or frequent weight changes Loss or disturbance of menstruation in girls 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 [source] Constipation and slow emptying of the stomach . [source]
  • Crohn's Disease disease, CA, TB, CNS tumors Management Psychotherapy, hospitalization. [source] menstrual periods, cold 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 [source] Liver Function Test: A series of tests used to assess liver function some of the tests are also used in the assessment of malnutrition, protein deficiency, kidney function, bleeding disorders, and Crohn's Disease[source]
  • Dehydration Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp. 35o C oral) Electrolyte abnormalities (eg. hypokalaemia, hypernatraemia) Severe weight [source] Poor nutrition and dehydration produce changes in brain chemistry. [source] The physical effects of starvation include: Dehydration - risk of kidney failure. [source]
  • Depression Re-establishing a normal weight may relieve depression on its own, and anti-depressants are not effective at very low body weight. [source] A personal or family history of anxiety, depression or obsessive-compulsive habits is common. [source] Medication may be helpful if depressed moods or worrisome thoughts interfere with daily life. [source]
  • Eating Disorder There's no guaranteed way to prevent anorexia nervosa or other forms of eating disorders[source] Anorexia nervosa is an eating disorder characterized by a pathological fear of weight gain and usually excessive weight loss. [source] 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 [source]
  • Edema 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). [source] Indications for hospital admission include the following: Low weight (85% or less of expected weight and/or less than the third percentile for BMI) [ 103 ] Lack of any weight gain Significant edema Physiologic decompensation including, but not limited [source] refeeding period Attempt to increase daily caloric intake slowly from 1000 to 1900 kcal/day by 200-300 kcal every 3-5 days until a sustained weight gain of 1-2 pounds (0.45-0.9 kg) per week is achieved (rapid refeeding can lead to excessive bloating, edema [source]
  • Hypoglycemia Severe hypoglycemia may lead to seizures. [source] Malnutrition Edema Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa) Hyperkeratosis Malnutrition, vitamin and mineral deficiencies Hypotension Malnutrition, dehydration Hypothermia Thermoregulatory dysfunction, hypoglycemia [source] 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 [source]
  • 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 [source] and ventricular 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 [source] Hypokalemia most commonly results in anorexic patients when restricting is accompanied by purging (induced vomiting or laxative use). [source]
  • Hypotension Physical ( for nasogastric resuscitation ) Bradycardia ( 50 bpm) Postural hypotension (fall in systolic BP lying to standing 20 mmHg) Dehydration Hypothermia (temp. 35o C oral) Electrolyte abnormalities (eg. hypokalaemia, hypernatraemia) Severe weight [source] signs and symptoms of anorexia are: 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 [source] Hypotension or orthostatic hypotension[source]
  • 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 [source] energy, resulting in serious acute and long-term medical consequences including: Abnormally slow heart rate and low blood pressure Damage to the structure and function of the heart; increased risk of heart failure and death Reduction of bone density (osteopenia [source] 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 [source]
  • 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 [source]
  • Pellagra sustained weight gain of 1-2 pounds (0.45-0.9 kg) per week is achieved (rapid refeeding can lead to excessive bloating, edema, and, rarely, congestive heart failure) Monitor the patient carefully for development of tachycardia [ 106 ] or edema Monitor for pellagra [source]
  • Schizophrenia Mortality and causes of death in schizophrenia in Stockholm County, Sweden. [source] Studies in other psychiatric disorders have found SMRs of 2.8 and 2.5 in males and females with schizophrenia, 54 1.9 and 2.1 in males and females with bipolar disorder, and 1.5 and 1.6 in males and females with unipolar disorder, respectively. 55 Our [source] 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. [source]
  • 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. [source] Low potassium-dependent QT prolongation increases the risk of ventricular arrhythmia. [ 18 ] The patient's vital signs reflect hypotension with systolic pressures as low as 70 mm Hg and sinus bradycardia with heart rates as low as 30-40 beats per minute [source]
  • Sudden Death Sudden death in eating disorders. [source] Over time, anorexia can affect your body in the following ways: 4 Heart problems, including low blood pressure, a slower heart rate, irregular heartbeat, heart attack, and sudden death from heart problems 5 Anemia (when your red blood cells do not carry [source] Sudden death in eating disorders. [source]
  • Syncope In the acute state of the disease it is common for patients to report dizziness, fatigue, or even syncope[source] 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 [source]
  • Vitamin Deficiency Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss. [source] Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss. [source]
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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.

Self-assessment

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.

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