Anorexia nervosa

Background

• Associated with body image disturbance
• Adolescent girls
  • Life long risk
• Body image is predominate measure of self worth
• Mortality 6-20%

Clinical Features

Diagnostic Criteria

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

Symptoms

• Constipation
• Abdominal pain
• Fatigue
• Weakness
• Amenorrhea
• Depression
• Hair loss

Signs

• Fine facial and body hair (lanugo)
• Brittle hair and nails
• Dry, scaly skin
• Loss of subcutaneous fat
• Breast and vaginal atrophy

Differential Diagnosis

• Gastrointestinal disease
• Hyperthyroidism
• Occult malignancies
• AIDS
• Major depressive disorder
• Schizophrenia
• Substance use disorders
• Social anxiety disorder
• Obsessive-compulsive disorder
• Body dysmorphic disorder
• Bulimia nervosa
• Avoidant/restrictive food intake disorder

Evaluation

• Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease
• CBC
• Chem 10
• ECG

Management

• inpatient management
  • Extremely low weight (<75% of expected body weight) or rapid weight loss
  • Severe electrolyte imbalances
  • Cardiac disturbances
  • Acute medical disorders
  • Severe or intractable purging
  • Psychosis or a high risk of suicide

Also See

• Bulimia nervosa
• General psychiatric workup