Anorexia nervosa
The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when the patient is obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as “fat,” and commonly expresses dissatisfaction with a particular aspect of her physical appearance.
Although the term anorexia suggests that the patient’s weight loss is associated with a loss of appetite, this is rare. Anorexia nervosa and bulimia nervosa can occur simultaneously. With anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics.
Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising.
Although the prognosis varies, it improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15%—the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.
Causes
No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life.
Signs and symptoms
The patient’s history usually reveals a 25% or greater weight loss for no organic reason, coupled with a morbid dread of being fat and a compulsion to be thin. Such a patient tends to be angry and ritualistic. She may report amenorrhea, infertility, loss of libido, fatigue, sleep alterations, intolerance to cold, and constipation.
Hypotension and bradycardia may be present. Inspection may reveal an emaciated appearance, with skeletal muscle atrophy, loss of fatty tissue, atrophy of breast tissue, blotchy or sallow skin, lanugo on the face and body, and dryness or loss of scalp hair. Calluses on the knuckles and abrasions and scars on the dorsum of the hand may result from tooth injury during self-induced vomiting. Other signs of vomiting include dental caries and oral or pharyngeal abrasions.
Palpation may disclose painless salivary gland enlargement and bowel distention. Slowed reflexes may occur on percussion. Oddly, the patient usually demonstrates hyperactivity and vigor
(despite malnourishment) and may exercise avidly without apparent fatigue.
(despite malnourishment) and may exercise avidly without apparent fatigue.
Diagnosing anorexia nervosa
A diagnosis of anorexia nervosa is made when the patient meets the following criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision:
refusal to maintain body weight over a minimal normal weight for age and height (for instance, weight loss leading to maintenance of body weight 15% below that expected); or failure to achieve expected weight gain during a growth period, leading to a body weight 15% below that expected
intense fear of gaining weight or becoming fat, despite underweight status
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
