Last modified: 1 day

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

• 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

• 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

• 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)

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

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

• Filter internet from Pro-ana web sites (i.e. promote eating disorders, and include Thinspiration)

• Osteoporosis
• Infertility
• Heart damage

• Can Die of starvation

• 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

• Eating disorder
• Cachexia (unintended weight loss)
• Bulimia (binge/purge cycle, at normal or above normal weight)