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:
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).
Dry skin, Hypothermia,
Bradycardia, Hypertension, Dependent Edema, Anemia, Lanugo, Infertility,
Osteoporosis, Cardiac Failure, and Death (most commonly results from
starvation, suicide, or electrolyte imbalances).
or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent
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.
Superior Mesenteric Artery Syndrome
Major Depressive Disorder
Body Dysmorphic Disorder
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.
and Psychotherapy [ See
Therapy Section ]:
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
Indications for hospitalization may include any of the following:
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.
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.
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.
group cognitive therapy to alter anorexic attitudes, enhance autonomy,
and improve self-esteem.
may also be useful.
Treat any associated
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
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.