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Mental Health

Anorexia nervosa

Eating disorder defined as an abnormally low body weight associated with intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness

Introduction

Eating disorder defined as an abnormally low body weight associated with intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness

  • Anorexia nervosa the highest mortality of any psychiatric disorder
The behaviours and possible underpinning psychobiological features of anorexia nervosa across the various stages of the disorder. | Treasure, J., Zipfel, S., Micali, N. et al. Anorexia nervosa. Nat Rev Dis Primers 1, 15074 (2015). https://doi.org/10.1038/nrdp.2015.74

Aetiology

Risk factors for eating disorders:

Anorexia nervosa is more common in females than males. Onset is late adolescence and early adulthood.
  • Childhood obesity
  • Female sex
  • Mood disorders
  • Personality traits (impulsivity and perfectionism)
  • Sexual abuse
  • Weight-related concerns from family/peer environments

Associated conditions:

  • Depression (M/C, 65% cases)
  • Obsessive-compulsive disorder (OCD) (25% cases)
  • Social phobia (3-5% cases)
A neurobiological model for the development of anorexia nervosa | Treasure, J., Zipfel, S., Micali, N. et al. Anorexia nervosa. Nat Rev Dis Primers 1, 15074 (2015). https://doi.org/10.1038/nrdp.2015.74

Clinical features

  • Binge-eating/purging type: Individual utilizes binge eating or displays purging behavior as a means for losing weight
  • Restricting type: Individual uses restricting food intake, fasting, diet pills, or exercise as a means for losing weight or exercise excessively to keep off weight or prevent weight gain

Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5) criteria:

DSM-5 Diagnostic Criteria for Anorexia Nervosa | American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
  • SCOFF questionnaire is useful in diagnosis

Complications:

Somatic and psychosocial effects of anorexia nervosa affecting quality of life | Treasure, J., Zipfel, S., Micali, N. et al. Anorexia nervosa. Nat Rev Dis Primers 1, 15074 (2015). https://doi.org/10.1038/nrdp.2015.74

Management

Immediate management:

Severely undernourished cases:
  • Nutritional rehabilitation
  • Oral supervised feeding
    • If needed: Nasogastric/parenteral nutrition

Psychotherapy:

A nurturing emotional environment is essential
  • Individual and family therapy
  • Group therapy

Pharmacotherapy:

  • Antidepressant drugs
  • Antipsychotic drugs

Summary:

Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and associated problems of malnutrition. | Anorexia nervosa. Nat Rev Dis Primers 1, 15075 (2015). https://doi.org/10.1038/nrdp.2015.75

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