Anorexia nervosa

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Anorexia nervosa ICD-10 F500-F501 ICD-9 307.1 OMIM {{{OMIM}}} DiseasesDB {{{DiseasesDB}}} MedlinePlus {{{MedlinePlus}}} eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}} MeSH {{{MeshNumber}}}

Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion. Individuals with anorexia often control body weight by voluntary starvation, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects young adolescent girls in the Western world and has one of the highest mortality rates of any psychiatric condition, with approximately 10% of people diagnosed with the condition eventually dying due to related factors. Anorexia nervosa is thought to be a complex condition, involving psychological, neurobiological, physiological and sociological components.

A person who is suffering from anorexia is referred to as 'anorexic' or (less commonly) 'anorectic'. "Anorectic" is the noun form, whereas "anorexic" is the adjectival form. These two are often used incorrectly when applied. Although technically incorrect, the term is frequently shortened to anorexia in both the popular media and scientific literature. This can also refer to the medical symptom of reduced appetite. In this article, for the purpose of brevity, anorexia will be used in the place of anorexia nervosa.

Description

The most commonly used criteria for diagnosing anorexia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD).

Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on a combination of behaviour, reported beliefs and experiences, and physical characteristics of the patient. Anorexia is typically diagnosed by a clinical psychologist, psychiatrist or other suitably qualified clinician.

Notably, diagnostic criteria are intended to assist clinicians, and are not intended to be representative of what an individual sufferer feels or experiences in living with the illness.

The full ICD-10 diagnostic critera for anorexia nervosa can be found here, and the DSM-IV-TR criteria can be found here.

To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:

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.
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, premenopausal females (women who have had their first menstural period but have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).

Furthermore, the DSM-IV-TR specifies two subtypes:

• 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, over-exercise or the misuse of laxatives, diuretics, or enemas)
• Binge-Eating Type 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, over-exercise or the misuse of laxatives, diuretics, or enemas).

The ICD-10 criteria are similar, but in addition, specifically mention: i) ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite supressants or diuretics); ii) physiological features, including "widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion"; and iii) if the onset if before puberty, development is delayed or arrested.

Presentation

There are a number of features, that although not necessarilly diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.

Psychological

• 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

Emotional

• Low self-esteem and self-efficacy
• Clinical depression or chronically low mood
• Intense fear about becoming fat

Interpersonal and social

• Poor or deteriorating school performance
• Withdrawal from previous friendships and other peer-relationships
• Deterioration in relationships with the family

Physiological

• Endocrine disorder, leading to cessation of periods in girls (amenorrhoea)
• Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia.
• Growth of lanugo hair over the body
• Abnornalities of mineral and electrolyte levels in the body
• Zinc deficiency
• Reducing immune system functioning
• Body mass index less than 17.5 in adults, or 85% of expected weight in children
• Possibly with palid complexion and sunken eyes

Behavioural

• Excessive exercise, food restriction and purging
• Fainting
• Secretive about eating or exercise behavior
• Possible self-harm, substance abuse or suicide attempts

Main article: Anorexia nervosa - History of the disorder.

Main article: Anorexia nervosa - Theoretical approaches.

Main article: Anorexia nervosa - Epidemiology.

Main article: Anorexia nervosa - Risk factors.

Main article: Anorexia nervosa - Etiology.

Main article: Anorexia nervosa - Assessment.

Main article: Anorexia nervosa - Diagnosis.

Main article: Anorexia nervosa - Comorbidity.

Main article: Anorexia nervosa - Treatment.

Main article: Anorexia nervosa - Prognosis.

Main article: Anorexia nervosa - Service user page.

Main article: Anorexia nervosa - Carer page.

See also

• Anorexia (symptom)
• Body dysmorphic disorder
• Body image disturbances
• Bulimia nervosa
• Cachexia
• Eating disorder
• Eating disorder not otherwise specified
• Muscle dysmorphia ('reverse' anorexia nervosa)
• Nutritional deficiencies
• Orthorexia nervosa
• Pro-ana
• Somatoform disorders
• Underweight

External links

Support organisations and information

• F.E.A.S.T.'s Eating Disorders Glossary, a comprehensive online eating disorders dictionary with more than 400 terms and concepts used in diagnosis and treatment of anorexia nervosa and other eating disorders, disturbances and associated conditions.
• Understanding eating distress from mental health charity Mind.
• MayoClinic eating disorders information
• BBC Mental Health on eating disorders
• The National Eating Disorders Association
• Eating Disorders Association
• Somerset & Wessex Eating Disorders Association Eating Disorders support and information in Somerset, UK.
• Something Fishy Eating Disorders website
• Web4health Anorexia nervosa section
• pdf of American Psychiatric Association eating disorders leaflet
• Mental Health Matters: Anorexia
• Psych Forums: Anorexia Forum
• Anorexia and Bulimia Care
• The ABC's of Eating Disorders educational documentary

Further reading

• Wasted (ISBN 0060187395) by Marya Hornbacher. An autobiographical look at her lifetime of Bulimia nervosa and Anorexia nervosa.
• Breaking Free from Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers (ISBN 0863777600) by Janet Treasure.
• Overcoming Anorexia Nervosa (ISBN 1854879693) by Christopher Freeman and Peter Cooper.
• Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence (ISBN 0863778046) by Bryan Lask and Rachel Bryant-Waugh.

References

• Agree, W.S., Barlow, T.H., Charm, H.N., Abel, G.G. & Leitenberg, H. (1974). Behaviour modification of anorexia nervosa, Archives of General Psychiatry 30, 343-52.

Instructions_for_archiving_academic_and_professional_materials Anorexia nervosa: Academic support materials

• Anorexia nervosa: Academic: Lecture slides
• Anorexia nervosa: Academic: Lecture notes
• Anorexia nervosa: Academic: Lecture handouts
• Anorexia nervosa: Academic: Multimedia materials
• Anorexia nervosa: Academic: Other academic support materials
• Anorexia nervosa: Academic: Anonymous fictional case studies for training