Anorexia Nervosa

Anorexia Nervosa is an illness that mainly affects adolescent girls although in recent years there has been a rise in the number of boys being diagnosed with the disorder. The most common features are loss of weight and a change in behavior in which the weight loss may become severe and life threatening. Personality changes will be those of increasing seriousness and introversion and an increasing tendency to become obsessional. She/He will usually begin to lose contact with her friends, regress and appear to lose confidence. She/He may become less assertive, less argumentative and more dependant The disorder, which usually begins in young people around the time of puberty, involves extreme weight loss; at least 15 percent below the individual's normal body weight.  Typical symptoms are:

The patient will not maintain a minimum body weight (for example, 85% of expected weight for height and age).

Despite being underweight, the patient intensely fears becoming fat.

Self-perception of the body is abnormal, shown by at least 1 of:

Unduly emphasizes weight or shape in self-evaluation.
Denies seriousness of low weight.
Has a distorted perception of own body shape or weight.

Due to weight loss, a female patient has missed at least 3 consecutive periods (or periods occur only  when she is given hormones).

Potential Medical Complications: 

Dry skin, Hypothermia, Bradycardia, Hypertension, Dependent Edema, Anemia, Lanugo, Infertility, Osteoporosis, Cardiac Failure, and Death (most commonly results from starvation, suicide, or electrolyte imbalances).

Associated Features:

Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent Personality

Differential Diagnosis:

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.

General Medical Conditions
Superior Mesenteric Artery Syndrome
Major Depressive Disorder
Schizophrenia
Social Phobia
Obsessive-Compulsive Disorder
Body Dysmorphic Disorder
Bulimia Nervosa

Cause:

The self esteem of individuals with eating disorders is directly related to their body shape, weight, and management of food. Eating disorders often lead to diminished concentration and attention leaving one less able to focus on academic course work. Preoccupation with food and body image result in feelings of anxiety which may also interfere with daily functioning. In severe cases medical problems may arise such as hypertension, dental enamel erosion, malnutrition, impaired renal functioning, electrolyte imbalance, and cardiovascular problems which require immediate medical attention and possible hospitalization.

Treatment:

Counseling and Psychotherapy [ See Therapy Section ]:

Psychotherapeutic interventions may include individual or group therapy modalities. The focus of psychotherapy is often on improving self-esteem, but may be supplemented with nutrition education, discussions of eating habits, exploration of the role that food and eating play in one's life and underlying family and interpersonal dynamics.

There are a number of treatment options available according to the symptoms shown:

Inpatient:

Indications for hospitalization may include any of the following:

Patient's weight less than or equal to 70% of ideal body weight.
Persistent suicidal ideation.
Need for withdrawal from laxatives, diet pills, or diuretics.
Failure of outpatient treatment.

Outpatient:

The combination of medical, psychological, and educational treatments can be effective on an outpatient basis. Occasionally, a person with anorexia nervosa whose weight is dangerously low, or a person with bulimia who is out of control may require temporary hospitalization. It is important to seek professional treatment as quickly as possible. Treat the medical complications of starvation.

Nutritional counseling to establish a balanced diet, an expected rate of weight gain (up to 2 lbs. per week), and a final goal weight.

Use behavioral techniques to reward weight gain.

Individual and group cognitive therapy to alter anorexic attitudes, enhance autonomy, and improve self-esteem.

Family therapy may also be useful.

Treat any associated mood disorder.

Treatment options are best discussed with the general practitioner who will be able to advise if specialist help is needed. Another source of unbiased advice is the Eating Disorders Association. Some regions have good N.H.S. facilities but many do not or have long waiting lists. Some private clinics also have well developed eating disorder units, but quality varies and costs are often high making medical insurance necessary for many. Sometimes the N.H.S. will pay for private treatment where there are no suitable N.H.S. facilities and these options can be explored by the clinic with the assistance of the local doctor.