CE: Anorexia Nervosa

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Anorexia

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: 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.

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