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. [1]
  • 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

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[2]
  • CBC
  • Chem 10
  • ECG

Management

  • Inpatient management
    • Extremely low weight (<75% of expected body weight) or rapid weight loss
    • Hypotension (< 80/50)
    • Hypothermia (< 96 degrees F)
    • Severe electrolyte imbalances
    • Cardiac disturbances
    • Bradycardia < 50
    • Acute medical disorders
    • Severe or intractable purging
    • Psychosis or a high risk of suicide

Disposition

Also See

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452