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ANOREXIA NERVOSA
 


Prediction: Variable (Few Months To Many Years)

      Occupational-Economic:
  • When severe, causes academic/vocational impairment
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion:
  • Pathologically thin, yet obsessed with weight loss, phobic of weight gain, and markedly dissatisfied with own body size and shape
  • Primarily caloric restriction, but also food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse)
  • May cycle between having anorexia nervosa (caloric restriction), and having bulimia nervosa (food binging)
  • Some develop obsessive-compulsive disorder (not related to food)
  • Many have obsessive-compulsive personality traits: strong need to control one's environment, inflexible thinking, limited social spontaneity, perfectionism, overly restrained initiative and emotional expression
  • When severe, develop major depressive disorder, anger, decreased interest in sex, suicide attempts
      Helping Others vs Detachment:
  • When severe becomes socially withdrawn
      Self-Control vs Disinhibition: N/A
      Justice vs Antagonism: N/A
      Medical:
  • Denial of illness; starvation can be life-threatening, 12% mortality rate; hospitalization may be required to prevent death from starvation, suicide, or electrolyte imbalance; medical symptoms are those caused by starvation (e.g., emaciation; cessation of menstruation; abnorally low blood pressure, body temperature, and heart rate; peripheral edema); serious medical conditions can result (e.g., anemia, impaired renal function, cardiovascular problems, dental enamel erosion from self-induced vomiting, and osteoporosis)


SYNOPSIS

Anorexia Nervosa F50.0 - ICD10 Description, World Health Organization

A disorder characterized by deliberate weight loss, induced and sustained by the patient. It occurs most commonly in adolescent girls and young women, but adolescent boys and young men may also be affected, as may children approaching puberty and older women up to the menopause. The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and the patients impose a low weight threshold on themselves. There is usually undernutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics.
Anorexia Nervosa - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with anorexia nervosa needs to meet all of the following criteria:

  • Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

  • Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

  • 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 persistent lack of recognition of the seriousness of the current low body weight.

  • Specify whether:

  • Restricting type: During the past 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

  • Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Individuals 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 Therapies

There 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 Therapies

Research has shown that nutritional counselling, antidepressant and antipsychotic medication have little benefit.

Which Behavioral Dimensions Are Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Anrexia Nervosa: Negative Emotion
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion:
      • Pathologically thin, yet obsessed with weight loss, phobic of weight gain, and markedly dissatisfied with own body size and shape
      • Primarily caloric restriction, but also food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse)
      • When severe, develop depression and anxiety
            Helping Others vs Detachment:
      • When severe becomes socially withdrawn
            Self-Control vs Disinhibition: N/A
            Justice vs Antagonism: N/A

Description

Stories

Free Diagnosis Of This Disorder

Rating Scales

Treatment

Research

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