Anorexia nervosa is an eating disorder characterized by the inability to maintain a minimally normal weight, a devastating fear of weight gain, relentless dietary habits that prevent weight gain, and a disturbance in the way in which body weight and shape are perceived. This condition has potentially life-threatening physiologic effects and causes enduring psychological disturbance. Patients resort to methods like extreme caloric deprivation, induction of vomiting, use of laxatives and diuretics
Causes Of Anorexia Nervosa
- Anorexia nervosa results from biologic, psychological, and social factors.
- It tends to affect women more than men, and adolescents more than older women.
- Prepubescent patients who subsequently develop anorexia nervosa have a high incidence of premorbid anxiety disorders.
- The onset of anorexia nervosa during puberty has led to the theory that teenagers compensate for lack of self worth by exerting control over food intake and weight.
- Preoccupation with slenderness and beauty in the Western world may contribute to the mindset of thinness as a valued quality in adolescents.
Predisposing factors
Predisposing factors in eating disorders include the following:
- Female sex
- Family history of eating disorders
- Perfectionistic personality
- Difficulty communicating negative emotions
- Difficulty resolving conflict
- Low self-esteem
- Maternal psychopathology (negative expressed emotion, maternal encouragement of weight loss) can also be a risk factor for anorexia nervosa, especially for childhood-onset of this disorder.
- Reported cases of anorexia nervosa in twins and triplets suggest the possibility of an increased genetic predisposition.
Signs and Symptoms:
The history given commonly is:
- Physical health and mental health concerns (including depression )
- Amenorrhea
- Concentration difficulties
- Headaches
- Irritability
- Cold hands or feet
- Constipation
- Dry skin or hair loss
- Social withdrawal
- Fainting or dizziness
- Obsessiveness (food)
- Lethargy
The SCOFF questionnaire is used to diagnose Anorexia Nervosa and other eating disorders.
The signs commonly seen on examination are:Â Vital sign changes include low BP, slow heart rate, and hypothermia (low body temperature).
Other changes include the following :
- Dry skin
- Hypercarotenemia (yellowish pigmentation of skin and sclera)
- Lanugo body hair (thin silky body hair like infants)
- Acrocyanosis
- Atrophy of the breasts
- Swelling of the parotid and submandibular glands
- Peripheral edema
- Thinning hair
Diagnosis:
The diagnosis is quite clear from history and physical examination.
- Laboratory studies show
- Hyponatremia: low serum sodium
- Hypokalemia: low potassium from diuretic or laxative use.
- Hypoglycemia: low blood glucose
- Elevated blood urea nitrogen (BUN): Renal function is generally normal except in patients with dehydration, in whom the BUN level may be elevated
- Hypokalemic hypochloremic metabolic alkalosis: Observed with vomiting
- Acidosis: Observed in cases of laxative abuse
- Serum vitamin D and calcium levels may be helpful, especially if osteoporosis is suspected.
Management:
Treatment is a mixture of pharmacological therapy, psycho social therapy, counselling, family therapy and refeeding strategies.
Admission to hospital may be necessary in very severe cases.
