Definition of "Anorexia nervosa"

Last modified: 7 days



Anorexia nervosa is an eating disorder involving food restriction (very small quantiites of food), inappropriate eating habits/rituals, fear of weight gain, a strong desire to be thin, usually resulting in excessive weight loss. Various cognitive biasis present affect how the Pt evaluates/thinks about their:

  • Body, with an obsession with having a thin figure, and a distorted body self perception (e.g. viewing as overweight/big even when underweight)
  • Food/eating, with an irrational fear of weight gain

The majority of Pt's nonetheless continue to feel hunger. Anorexia (generally) is the lack/loss of appetite for food

Pathophysiology
  • Self restriction causes extremely high levels of ghrelin (i.e. hunger hormone signalling need for food) in blood, indicating hunger call is being suppressed/ignored/overridden
Causes
  • Cause is unknown
  • Predisposed, by:
    • Individual
    • Familial
    • Cultural, with socities that value thinness having higher rates of disease
    • Genetic
  • Precipitated, often by a major life change or stress inducing event, including by:
    • Developmental
    • Societal
    • Social, occurring more commonly in patients involved in activities that value thinness such as high level athletics, modelling, and dancing
    • Hormonal
  • Perpetuated, by:
    • Dietary/malnutrition
    • Identity
    • Gain
Sx
  • Systemic Sx:
    • Dizziness
    • Headaches
    • Drowsiness
    • Fever
    • Lack of energy
  • Counteract these Sx with harmful behaviors, including:
    • Smoking
    • Excessive caffeine consumption
    • Excessive use of diet pills
    • Increased exercise regime
  • Overriding hunger feelings with self-harm behaviors
  • Many patients see themselves as overweight even though they are underweight. When asked, patients usually deny any problems with low weight
  • They often weigh themselves frequently
  • Eating only small amounts
  • Only eating certain foods
  • Exercise excessively
  • Forcing themselves to vomit
  • Use laxatives to produce weight loss
  • Women will often have amenorrhea (i.e. stop having menstrual periods)
Dx

DSM-5 Dx criteria:

  • 1) Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
  • 2) Intense fear of gaining weight or becoming fat, even though underweight
  • 3) 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

Source: Alliance for Eating disorders

Classification

Severity of anorexia is determined by BMI:

  • >17: Mild
  • <17: Moderate
  • <16: Severe
  • <15: Extreme

In kids, a BMI for age percentile of less than the 5th percentile is often used

Tx
  • Filter internet from Pro-ana web sites (i.e. promote eating disorders, and include Thinspiration)
Complications
  • Osteoporosis
  • Infertility
  • Heart damage
Prognosis
  • Can Die of starvation
Epidemiology
  • It is 9x more common in women than men
  • Onset is usually in adolescence
  • Characteristics of Pt's:
    • Slightly younger than Bulimia nervosa Pt's
    • More obsessional, Shy introverted
    • Turns away from food to cope with stress
    • Denies illness
    • More self control of hunger, anger and behavior
  • 10-40% of Pt's with Anorexia also have Bulimia
See also

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Definition of Anorexia nervosa | Autoprac


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