Dr. Huntley's
Diagnosis
Checklist
Have a symptom?
See what questions
a doctor would ask.
See what questions
a doctor would ask.
The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when the patient is obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as “fat,” and commonly expresses dissatisfaction with a particular aspect of her physical appearance.
Although the term anorexia suggests that the patient’s weight loss is associated with a loss of appetite, this is rare. Anorexia nervosa and bulimia nervosa can occur simultaneously. With anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics.
Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising.
Although the prognosis varies, it improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15% — the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.
No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life.
The patient’s history usually reveals a 25% or greater weight loss for no organic reason, coupled with a morbid dread of being fat and a compulsion to be thin. Such a patient tends to be angry and ritualistic. She may report amenorrhea, infertility, loss of libido, fatigue, sleep alterations, intolerance to cold, and constipation.
Hypotension and bradycardia may be present. Inspection may reveal an emaciated appearance, with skeletal muscle atrophy, loss of fatty tissue, atrophy of breast tissue, blotchy or sallow skin, lanugo on the face and body, and dryness or loss of scalp hair. Calluses on the knuckles and abrasions and scars on the dorsum of the hand may result from tooth injury during self-induced vomiting. Other signs of vomiting include dental caries and oral or pharyngeal abrasions.
Palpation may disclose painless salivary gland enlargement and bowel distention. Slowed reflexes may occur on percussion. Oddly, the patient usually demonstrates hyperactivity and vigor (despite malnourishment) and may exercise avidly without apparent fatigue.
During psychosocial assessment, the anorexic patient may express a morbid fear of gaining weight and an obsession with her physical appearance. Paradoxically, she also may be obsessed with food, preparing elaborate meals for others. Social regression, including poor sexual adjustment and fear of failure, is common. Like bulimia nervosa, anorexia nervosa is commonly associated with depression. The patient may report feelings of despair, hopelessness, and worthlessness as well as suicidal thoughts.
For characteristic findings in patients with this condition, see Diagnosing anorexia nervosa.
In addition, laboratory tests help to identify various disorders and deficiencies and help to rule out endocrine, metabolic, and central nervous system abnormalities; cancer; malabsorption syndrome; and other disorders that cause physical wasting.
Abnormal findings that may accompany a weight loss of more than 30% of normal body weight include:
Appropriate treatment aims to promote weight gain or control the patient’s compulsive binge eating and purging and to correct malnutrition and the underlying psychological dysfunction. Hospitalization in a medical or psychiatric unit may be required to improve the patient’s precarious physical condition. The facility stay may be as brief as 2 weeks or may stretch from a few months to 2 years or longer.
The most effective treatment for anorexia combines aggressive medical management, nutritional counseling, and individual, group, or family psychotherapy or behavior modification therapy. Treatment results may be discouraging. Many clinical centers are now developing inpatient and outpatient programs specifically aimed at managing eating disorders.
Treatment may include behavior modification (privileges depend on weight gain); curtailed activity for physical reasons (such as arrhythmias); vitamin and mineral supplements; a reasonable diet with or without liquid supplements; subclavian, peripheral, or enteral hyperalimentation (enteral and peripheral routes carry less risk of infection); and individual, group, or family psychotherapy.
All forms of psychotherapy, from psychoanalysis to hypnotherapy, have been used in treating anorexia nervosa, with varying success. To be successful, psychotherapy should address the underlying problems of low self-esteem, guilt, anxiety, feelings of hopelessness and helplessness, and depression.
CLINICAL TIP: Remember that the anorexic patient uses exercise, preoccupation with food, ritualism, manipulation, and lying as mechanisms to preserve the only control she thinks that she has in her life.
Read excerpts from these other book chapters related to Poor feeding:
Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.
|
More About This Book:
Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Next articles:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2010 Health Grades Inc. All rights reserved. Last Update: 9 February, 2010 (1:00)
