Prevalence of Anorexia Nervosa is around 0.6% of the US population and is more commonly seen in teenage females wherein consciousness on body image is at its peak. It involves the perception of being fat even when the person is very thin in reality that may eventually result to ill effects on the body. In fact, studies have shown that anorexic persons are 18 times more likely to die compared with normal people of similar age. Although there are no established causes yet, this condition can be attributed to several risk factors such as having a history of sexual or physical abuse, genetic factors that predisposes one to mood disorders and having abnormal neurotransmitters, particularly serotonin, which is similarly seen in depression. Societal pressure and cultural preferences on self-image may also cause a person to become anorexic.
Diagnosis of Anorexia Nervosa
Clinical diagnosis of Anorexia Nervosa is based on the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. It is important to differentiate it from Bulimia wherein the critical distinction is made by checking for the body weight. The criteria for Anorexia Nervosa is as follows:
- Refusal to maintain body weight at or beyond the minimum normal weight relative to both age and height
- Intense fear of weight gain or being fat
- Distortion of body image as manifested by the feeling of being fat despite a low body weight
- Amenorrhea or the absence of menstruation is also strictly included in the criteria
Signs and Symptoms of Anorexia Nervosa
Signs and symptoms of Anorexia Nervosa in a person can manifest both physically and behaviorally. A severely low body weight leads to the disruption of normal bodily functions that lead to the following physical abnormalities:
- Low to severely low weight which is the most obvious presenting symptom
- Hypotension, bradycardia or a slow heart beat and acrocyanosis or the blue coloration of the extremities brought about by the decrease in the basal metabolic rate and core temperature
- Edema due to the lack of protein from food
- Salivary gland enlargement that is caused by the anticipation eating
- Leukopenia which makes the person more prone to infection
- Osteopenia or the thinning out of the bones due to a decrease in bone mineral density
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Behavioral abnormalities occur when the person’s thoughts and behaviors disrupt his maintenance of normal social relationships. These include the following:
- Irrational fear of gaining weight as manifested by constantly checking their weight, starving themselves and exercising excessively
- Social withdrawal as they become too preoccupied with their weight
- Rarely complain of hunger
- Thoughts of food dominate mental life but still resist eating
Treatment for Anorexia Nervosa
Treatment for Anorexia Nervosa will depend mainly on the severity of the weight problem. If the person presents with a weight of less than 75% of the expected body weight for age and height, hospital admission is recommended. Other conditions that warrant hospitalization is when the person is medically unstable, such as when the person has a low heart rate or suffering from a severe electrolyte imbalance, or when the person has other psychiatric problems.
The primary goal of treatment is a weight restoration of at least 90% of the predicted weight. This is done through a holistic approach that includes both medical and psychological interventions. The following are the treatment for Anorexia Nervosa:
- Nutritional restoration of at least 1200 to 1800 kcal/day with prioritization of resolving fluid and electrolyte problems
- Multivitamin supplementation
- Emotional support during weight gain with emphasis on reassuring the self image of the person
- Shift basis of self esteem from body weight to interpersonal relationships, academic achievements or occupational achievements
- Medications such as Olanzapine may also be recommended
Anorexia nervosa, often simply called anorexia, is a type of eating disorder that is characterized by the voluntary restriction of food by the person relative to his daily caloric requirement leading to an inappropriately low body weight.