ANOREXIA NERVOSA

What is eating disorders?

Eating disorders are disorders of eating behavior overvalued desire of weight loss functional medical, psychological, and social impairment.

Pathways to Eating Disorders

Types of eating disorders

Anorexia Nervosa Bulimia Nervosa Binge-eating disorder
MAJOR TYPES

ANOREXIA NERVOSA?
The term anorexia nervosa is derived from the Greek term means loss of appetite. Anorexia nervosa is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight.

Epidemiology
Lifetime prevalence of anorexia nervosa is less than 1% and is 10 times more frequent in women than in men. Peaks occur at early and late teen years.

Three essential criteria!!

1. Behavior self-induced starvation to a significant degree. 2. Psychopathology strong drive for thinness and/or a morbid fear of fatness. 3. Physiological symptomatology the presence of medical signs and symptoms resulting from starvation.

Types of anorexia nervosa

Restricting type loses weight by severely limiting the amount of food consumed. Binge-eating-purging type engages in binges (large amount of food consumed) following by purging (vomiting or use of laxatives).

Etiology
1. 2. 3. Physiological factors : Genetic factors Neurobiological factors Nutritional factors Psychological factors Social and environmental factors

CLINICAL FEATURES

 Physical features :
Extreme weight loss Body mass index less than 17.5 in adults, or 85% of expected weight in children Stunted growth Endocrine disorder, leading to cessation of periods in girls (amenorrhoea) Decreased libido; impotence in males Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia Abnormalities of mineral and electrolyte levels in the body Thinning of the hair Constantly feeling cold Zinc deficiency Constipation Dry skin In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet Fragile appearance; frail body image Slowing of the rate of growth of breasts Drastic changes in blood pressure upon standing Dizzyness and fainting Etc.

 Psychological features :
Distorted body image Poor insight Self-evaluation largely, or even exclusively, in terms of their shape and weight Pre-occupation or obsessive thoughts about food and weight Perfectionism Obsessive compulsive disorder (OCD) Belief that control over food/body is synonymous with being in control of one's life Refusal to accept that one's weight is dangerously low even when it could be deadly Refusal to accept that one's weight is normal, or healthy loss in memory hallucinations

Emotional features : Low self-esteem and self-efficacy Phobia of becoming overweight Clinical depression Mood swings Feelings of loneliness

 Behavioral features :
Excessive exercise, food restrictions Secretive about eating or exercise behavior Self-harm, substance abuse Very sensitive to references about body weight Aggressive when forced to eat Social withdraw or being anti-social Checking body in the mirror constantly Checking body weight on scale constantly Thoughts of suicide

Table 1. DSM-IV-TR Diagnostic Criteria for Anorexia Nervosa 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 ones 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 women, 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 or 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)

Table 2. ICD-10 Diagnostic Criteria for Anorexia Nervosa Anorexia nervosa : A.There is weight loss or, in children, a lack of weight gain, leading to a body weight at least 15% below the normal or expected weight for age and height. B.The weight loss is self-induced by avoidance of fattening foods. C.There is self-perception of being too fat, with an intrusive dread of fatness, which leads to a self-imposed low weight threshold. D.A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are on replacement hormonal therapy, most commonly taken as a contraceptive pill.) E.The disorder does not meet Criteria A and B for bulimia nervosa. Comments : The following features support the diagnosis but are not essential elements: self-induced vomiting, self-induced purging, excessive exercise, and use of appetite suppressants or diuretics. If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth ceasesin girls, the breasts do not develop and there is a primary amenorrhea; in boys, the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late. Atypical anorexia nervosa : Researchers studying atypical forms of anorexia nervosa are recommended to make their own decisions about the number and type of criteria to be fulfilled.

COMPLICATIONS
Cardiovascular Muscular Skeletal GIT Endocrine System Death

TREATMENT
Medical care Psychotherapy Nutritional therapy Medications Hospitalization

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