Anorexia Nervosa F50.0 - ICD10 Description, World Health Organization
Anorexia Nervosa - Diagnostic Criteria, American Psychiatric AssociationIndividuals with anorexia nervosa and bulimia nervosa share many similar features. In both disorders, individuals have an obsession with weight loss, a phobia of weight gain, and marked dissatisfaction with their body size and shape. Both disorders can have self-imposed caloric restriction, food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse). Some individuals cycle back and forth between anorexia and bulimia. Anorexic individuals restrict their caloric intake far more than bulimic individuals do; thus anorexics are pathologically thin, whereas many bulimics have a normal weight. Bulimic individuals binge more than anorexic individuals. The risk of onset of anorexia nervosa is highest in late adolescence, with 40% of new cases found between ages 15 and 19 years, and drops significantly after 21 years of age.
Historically, eating disorders were a medical rarity prior to World War I. Then, after fashion magazines were introduced, the incidence of anorexia nervosa shot up. Thus the current epidemic of eating disorders started after World War I in America, spread to Europe, and only after World War II spread to Asia. In Canada's far north, eating disorders were historically unknown in previous generations of aboriginals. The current older aboriginal generation was largely protected from Western influences by a language barrier, but younger aboriginals now speak English. Historically, for the first time, eating disorders are starting to appear in young aboriginals. Thus exposure to Western culture appears to be causal in the development of eating disorders.
It appears that eating disorders start psychologically as an obsession with thinness. The individual diets, then develops a true phobia of getting fat. A point is reached in dieting when genetic and physiological factors kick in, and the disorder becomes physically compulsive and very difficult to stop.
Effective TherapiesThere is evidence that individual psychotherapy and family therapy are helpful. Research thus far hasn't shown that any specific form of psychotherapy (e.g., CBT) is superior to nonspecific psychotherapy. Although anorexia nervosa has a 6% mortality rate; usually this disorder spontaneously recovers after a few years. Severe cases need hospitalization to prevent death. The average duration of anorexia nervosa is 1.7 years. Even in severe cases, despite a 30% relapse rate after hospitalization, and an average duration of 4.7 to 6.6 years, the full recovery rate is still 76%.
Ineffective TherapiesResearch has shown that nutritional counselling, antidepressant and antipsychotic medication have little benefit.
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