Anorexia Nervosa

– An eating disorder characterized by drastically reduced food intake and intense exercise, leading to marked weight loss and eventual emaciation. Anorectic individuals have a disturbed sense of body image and attempt to achieve control, autonomy, and competence in their lives by manipulating their food intake and body weight.

Causes and Incidence

Etiology is unknown, but various psychological theories suggest societal factors, dysfunctional family systems, or disturbed mother/child relationships. Onset usually occurs in adolescence in young white women of middle or upper socioeconomic status. Men account for only 5% of cases, and the disorder is not seen in areas where food is in short supply. Estimates of the incidence of anorexia in the United States range from 1 in 800 to 1 in 100 among adolescent girls. Reports of anorexia in young black women with professionally educated and employed parents are increasing. The incidence among men and adults is also rising. The mortality rate averages about 15% of reported cases.

Disease Process

The pathologic processes are those seen in malnutrition and starvation. Eventually all body systems become involved as they are deprived of vital nutrients.

Symptoms

Early signs and symptoms include meticulousness; perfectionism; preoccupation with weight; increase in physical activity; restriction of intake; preoccupation with food, recipes, and meal planning; hoarding and hiding food; and meal preparation for others. This is followed by marked weight loss, amenorrhea, social isolation, increasingly secretive behavior, and denial of any problem.

Potential Complications

As malnourishment continues, all body systems are affected, cachexia ensues, and endocrine disorders, electrolyte imbalances, metabolic acidosis, and cardiac dysfunction appear. Sudden death from ventricular dysrhythmia is possible, as is eventual death from total system failure.

Diagnostic Tests

Diagnosis is made through a constellation of symptoms and patterns described above, in concert with loss of at least 15% of body weight, particularly in individuals in high-risk groups.

Treatments

Surgery – None.

Drugs
Doxepin to reduce anxiety and depression.

General
Short term: hospitalization to stabilize fluid and electrolytes and stop weight loss; long term: psychotherapy, family therapy, dietary supplements to induce weight gain.

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