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Anorexia Nervosa is an illness that mainly affects adolescent girls although in recent years there has been a rise in the number of boys being diagnosed with the disorder. The most common features are loss of weight and a change in behavior in which the weight loss may become severe and life threatening. Personality changes will be those of increasing seriousness and introversion and an increasing tendency to become obsessional. She/He will usually begin to lose contact with her friends, regress and appear to lose confidence. She/He may become less assertive, less argumentative and more dependant The disorder, which usually begins in young people around the time of puberty, involves extreme weight loss; at least 15 percent below the individual's normal body weight.
Typical symptoms are:
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. 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.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
Specify type:
Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Potential Medical Complications:
Dry skin, Hypothermia, Bradycardia, Hypertension, Dependent Edema, Anemia, Lanugo, Infertility, Osteoporosis, Cardiac Failure, and Death (most commonly results from starvation, suicide, or electrolyte imbalances).
Associated Features:
Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent Personality
Differential Diagnosis:
Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.
General Medical Conditions
Superior Mesenteric Artery Syndrome
Major Depressive Disorder
Schizophrenia
Social Phobia
Obsessive-Compulsive Disorder
Body Dysmorphic Disorder
Bulimia Nervosa
Cause:
The self esteem of individuals with eating disorders is directly related to their body shape, weight, and management of food. Eating disorders often lead to diminished concentration and attention leaving one less able to focus on academic course work. Preoccupation with food and body image result in feelings of anxiety which may also interfere with daily functioning. In severe cases medical problems may arise such as hypertension, dental enamel erosion, malnutrition, impaired renal functioning, electrolyte imbalance, and cardiovascular problems which require immediate medical attention and possible hospitalization.
Treatment:
Counseling and Psychotherapy:
Psychotherapeutic interventions may include individual or group therapy modalities. The focus of psychotherapy is often on improving self-esteem, but may be supplemented with nutrition education, discussions of eating habits, exploration of the role that food and eating play in one's life and underlying family and interpersonal dynamics.
There are a number of treatment options available according to the symptoms shown:
Inpatient:
Indications for hospitalization may include any of the following:
Patient's weight less than or equal to 70% of ideal body weight.
Persistent suicidal ideation.
Need for withdrawal from laxatives, diet pills, or diuretics.
Failure of outpatient treatment.
Outpatient:
The combination of medical, psychological, and educational treatments can be effective on an outpatient basis. Occasionally, a person with anorexia nervosa whose weight is dangerously low, or a person with bulimia who is out of control may require temporary hospitalization. It is important to seek professional treatment as quickly as possible. Treat the medical complications of starvation.
Nutritional counseling to establish a balanced diet, an expected rate of weight gain (up to 2 lbs. per week), and a final goal weight.
Use behavioral techniques to reward weight gain.
Individual and group cognitive therapy to alter anorexic attitudes, enhance autonomy, and improve self-esteem.
Family therapy may also be useful.
Treat any associated mood disorder.
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