Anorexia Nervosa is characterized by marked distortion of body image, pathological desire for thinness & self induced weight loss.
Epidemiology:
*Male: female – 1:10
*0.5% of adolescents & young women.
*More common in high socioeconomic status.
Diagnostic criteria:
✯Low body weight:-
°15%+ below expected
°BMI <17.5
✯Self induced weight loss:-
°Excessive Exercise
°Self induced vomiting
°Using appetite suppressants.
✯Body image distortion:-
°Fear of fatness
°Imposed low weight threshold
✯Endocrine disorders
°Amenorrhoea
°Decreased libido
°Increased GH levels
°Altered thyroid functions tests
°Abnormal insulin secretion
✯Delayed/Arreste puberty
Aetiology
✦Genetics:-
Monozygotic Twins: Dizygotic twins:‐ 65% : 32%
✦Psychodynamic models:-
☞Family pathology
°Over protectiveness
°Lack of conflict resolution
°Weak generational boundaries.
☞Individual pathology
°Dietary problems in early life.
°Parents’ preoccupation with food.
°Lack of sense of identity.
☞Analytical model
°Regression to childhood.
°Fixation on oral stage.
°Escape from emotional problems of adolesense.
✦Biological:-
☞CT Brain
°Pseudoatrophy/ Sulcal widening & ventricular enlargements
(corrects with weight gain)
☞Functional imaging:
°U/l temporal lobe hypofunction.
Differential Diagnosis:
°Chronic debilitating physical disease.
°Brain tumor
°GI disorder (e.g. Crohn’s disorder, malabsorption syndromes)
Physical consequences:
⋆Oral: Dental caries
⋆CVS: °Bradycardia
°Hypotension
°Prolonged QT
°Arrhythmias
°Cardiomyopathy
👉Cardiac complications are most common cause of death.
⋆GT: °Delayed gastric emptying
°Gastric Atroply
°Increased intestinal Motility
°Constipation
⋆Endocrine & Metabolic:
°Hypo-kalemia
°Hypo-natraemia
°Hypo-glycemia
°Hypo-corticosolaemia
°Hypo-thermia
°Altrered thyroid function
°Amenorrhoea (can persist even after recovery)
°Delay in puberty
°Arrested growth
°Osteoporosis
⋆Kidney:
°Renal calculi
⋆Reproductive:
°Infertility
⋆Dermatological
°Dry scaly skin
°Hair loss
°Lanugo body hair.
⋆Neurological
°Peripheral neuropathy
°Ventricular enlargements, sulcal widening
°Cerebral atrophy (pseudo atrophy)
⋆Haematological
°Anaemia
°Leukopenia
°Thrombocytopenia
⋆Psychiatric symptoms
°Decreased concentration
°Depression
°Reduced energy
°Insomnia
°Social withdrawal
°Obsessions regarding food.
Treatment:
⋆Pharmacological:
Olanzapine is the most extensively studied antipsychotic in AN
⋆Psychological:
Cognitive Behaviour Therapy
Family Therapy
⋆Education:
°Nutritional education
⭐Hospital Admission:
If there are serious medical problems.
Reference:
- Oxford Handbook of Psychiatry (3rd edition) https://amzn.to/3rsJxse
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