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Anorexia Nervosa

Onset is usually in adolescence and affects females 10:1 over males. Prevalence in young women is up to 1%. Some will also have episodes of binge eating or purging. Anorexia is a life-threatening disorder, with mortality over 10%.

Diagnostic Criteria

Early signs may include withdrawal from family and friends, increased sensitivity to criticism, sudden increased interest in physical activity, anxiety or depressive symptoms.

  1. 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).
  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.
  4. 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 if:

  • 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)

Evaluation

Laboratory tests No single lab test helps with the diagnosis; however, a battery of tests should be performed to rule out medical complications of starvation. CBC, general screen (to include electrolytes, glucose, calcium, phosphate, BUN, and Cr), Mg, liver and thyroid function tests, amylase, carotene, UA, ECG. Other useful tests include CK with isoenzymes if an ipecac abuser; or bone densitometry if amenorrheic for >6 months.

Potential medical complications

Dry skin, hypothermia, bradycardia, hypotension, dependent edema, anemia, lanugo, infertility, osteoporosis, cardiac failure, and death (most commonly results from starvation, suicide, or electrolyte imbalances).

Treatment Options

  1. Inpatient:Indications for hospitalization may include any of the following:
    1. Patient's weight less than or equal to 70% of ideal body weight.
    2. Persistent suicidal ideation.
    3. Need for withdrawal from laxatives, diet pills, or diuretics.
    4. Failure of outpatient treatment.
  2. Outpatient:
    1. Treat the medical complications of starvation.
    2. Nutritional counseling to establish a balanced diet, an expected rate of weight gain (up to 2 lbs. per week), and a final goal weight.
    3. Use behavioral techniques to reward weight gain.
    4. Individual and group cognitive therapy to alter anorexic attitudes, enhance autonomy, and improve self-esteem.
    5. Family therapy may also be useful.
    6. Treat any associated mood disorder.

Associated Feature

  • 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.