-IBIS-1.5.0-
tx
mental/emotional
anorexia nervosa
diagnoses
definition and etiology
definition:
An eating disorder characterized by a perverted sense of body image; an obsessive fixation on thinness and dread of weight gain; significant weight loss; and amenorrhea in women.
etiology:
The disorder primarily affects females, with only 5% of patients being male. Onset is usually during adolescence or young adulthood (rarely after the middle twenties), and chiefly in middle-to-upper class white women. It is rarely seen in lower socioeconomic levels or in Blacks or Asians. The incidence of eating disorders is increasing in America, with estimates of up to 18-25% of college women having either anorexia or bulimia (binge and purge: see "bulimia"). Anorexia is a disorder where the sufferer radically restricts caloric intake, based on an obsession to be thin: the end result is emaciation. Although pure forms of both anorexia and bulimia exist, it is not infrequent for a sufferer to overlap the two diseases.
The cause for anorexia nervosa is unknown, although possible factors include a hypothalamic disorder; psychiatric disorder (such as depression); peer pressure; and reactions to cultural or familiar attitudes towards the body.
Consider: pancreatic or liver hypoglycemia with sympathetic nervous system compensation affecting the bile duct, pyloric and ileocecal valves as well as enzyme availability (Easley).
signs and symptoms
Classically, the teenage female begins to become obsessed with weight and thinness, even if she is lean. She then starts to drastically reduce her caloric intake.
Denial of the disease is very common: the patient may deny her leanness (and other symptoms such as fatigue or hunger), and insist she is fat and has to lose more weight, even when she becomes seriously emaciated.
She is often very involved with strenuous activity, and may do zealous exercising after any food intake.
The patient develops amenorrhea (which may precede marked weight loss).
Constipation.
Bradycardia, low BP.
Hypothermia and intolerance to cold.
Edema (which may mask the emaciation).
Lanugo hair growth or hirsutism.
In advanced cases, all body fat will have disappeared and the bones will clearly protrude through the skin.
Hypoglycemia: wake up with nausea at 3-4 a.m.; restless, can't get back to sleep easily; daytime nausea, fatigue, nervous anxiety with no appetite (Easley).
lab findings:
Anemia and leukopenia, hypokalemia, hypoalbuminuria.
Increased blood urea nitrogen levels.
Abnormal glucose intolerance.
Decreased LH and FSH levels with severe weight loss.
Various other hormonal indicators may be abnormal (TSH, T4, T3).
diagnostic criteria:
Onset prior to age 25.
Anorexia with at least 25% of original weight lost.
Perverted ideas toward food, eating, and her ideal weight that are stronger than hunger pangs, threats, or reassurances.
Rule out of other medical diseases that could be responsible for such weight loss.
Rule out any other psychiatric disorder.
At least two of the following signs:
» Amenorrhea.
» Lanugo hair/hirsutism.
» Bradycardia.
» Vomiting (including self-induced.)
» Episodes of intense exercising.
» Episodes of bulimia.
course and prognosis
There is no specific treatment for anorexia nervosa, and due to the patient's tendency to deny the illness, and the extent of the seriousness of the situation, therapy can often be very difficult. Patient counseling is definitely needed, and, if the patient has lost more than 35% of her ideal weight (esp. if it occurred rapidly), hospitalization may be required as a life-saving measure.
differential diagnosis
Any systemic illness, such as an undiagnosed malignancy, that causes anorexia and wasting.
Drug addiction: including over-the-counter anti-sleep medication, amphetamines, coffee.
Psychiatric disorder such as schizophrenia.
Postpartum hypopituitarism (Sheehan's syndrome)
footnotes