Anorexia nervosa

For other uses, see Anorexia nervosa (disambiguation).

Anorexia Nervosa Classification and external resources
File:Anorexia billboard.jpg
An anti-anorexia nervosa billboard featuring recovering anorexic actress Isabelle Caro
ICD-10	F50.0-F50.1
ICD-9	307.1
OMIM	606788
DiseasesDB	749
eMedicine	emerg/34  med/144

Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components. It is an eating disorder characterized by an obsessive fear of gaining weight and distorted self image that results in a dangerously low body weight. Individuals with anorexia nervosa may use voluntary starvation, excessive exercise, or other measures such as diet pills or diuretic drugs to combat their fear. While primarily affecting adolescent females, approximately 10% of people with the diagnosis are male.

Diagnosis and cause

The most commonly used criteria for diagnosing anorexia nervosa are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD).

Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on observation of the behavior, reported beliefs and experiences, and physical characteristics of the patient.

To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:

1. Refusal to maintain body weight at or above a minimally normal weight for age and height (eg, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
2. Intense fear of gaining weight or becoming obese.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. The absence of at least three consecutive menstrual cycles (amenorrhea), in women who have had their first menstrual period but have not yet gone through menopause (postmenarcheal, premenopausal females).
5. Or other eating related disorders.

Furthermore, the DSM-IV-TR specifies two subtypes:

• Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
• Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

The ICD-10 criteria are similar, but in addition, specifically mention

1. The ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics).
2. Certain physiological features, including "widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion".
3. If onset is before puberty, that development is delayed or arrested.

It is clear that there is no single cause for anorexia and that it stems from a mixture of social, psychological and biological factors. Genetics may contribute considerably to one's predisposition towards anorexia nervosa, whereas certain family situations or social forces may be of considerable influence as well.

Prognosis

Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 6% of those who are diagnosed with the disorder eventually dying due to related causes. The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition.

Treatment

The first line of treatment for anorexia is usually focused on immediate weight gain, especially with those who have particularly serious conditions that require hospitalization. In particularly serious cases, this may be done as an involuntary hospital treatment under mental health law, where such legislation exists. In the majority of cases, however, people with anorexia are treated as outpatients, with input from physicians, psychiatrists, clinical psychologists and other mental health professionals.

A recent clinical review has suggested that psychotherapy is an effective form of treatment and can lead to restoration of weight, return of menses among female patients, and improved psychological and social functioning when compared to simple support or education programmes. However, this review also noted that there are only a small number of randomised controlled trials on which to base this recommendation, and no specific type of psychotherapy seems to show any overall advantage when compared to other types. Family therapy has also been found to be an effective treatment for adolescents with anorexia and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.

Psychiatrists commonly prescribe medications such as serotonin-reuptake inhibitors (SSRI) or other antidepressants medication with the intent of trying to treat the associated anxiety and depression. Efficacy of their use in initial treatment of anorexia nervosa is under debate.

Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was begun. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the amygdala, after adequate zinc intake begins resulting in increased appetite.

There are various non-profit and community groups that offer support and advice to people who suffer from anorexia or who care for someone who does. Several are listed in the links below and may provide useful information for those wanting more information or help on treatment and medical care.

References

ISBN links support NWE through referral fees

• "Anorexia Nervosa; Study challenges efficacy of SSRI treatment for adolescent anorexia nervosa"

Pain & Central Nervous System Week. Atlanta: May 16, 2005. pg. 40

• Le Grange, D."The Maudsley family-based treatment for adolescent anorexia nervosa." World Psychiatry: 2005. pg. 142-6

• Herzog, David B; Dara N Greenwood & David J Dorer et al. "Mortality in eating disorders: A descriptive study." International Journal of Eating Disorders. 2000, 28 (1): 20-26

• "DSM-IV Sourcebook, Volume 3." American Psychiatric Association. 1997</ref>

External links

Support organizations and information

• beat: beating eating disorders UK national charity. Retrieved May 3, 2008.
• Understanding eating distress from mental health charity Mind. Retrieved May 3, 2008.
• MayoClinic eating disorders information. Retrieved May 3, 2008.
• BBC Mental Health on eating disorders. Retrieved May 3, 2008.
• Anorexia nervosa NHS Direct. Retrieved May 3, 2008.
• Anorexia Nervosa: Signs, Symptoms, Causes, Effects, and Treatments Useful information about anorexia. Retrieved May 3, 2008.

Media stories and reports

• Anorexia goes high-tech - Time magazine on pro-ana websites. Retrieved May 3, 2008.
• Fighting Anorexia: No One to Blame - Newsweek on the increasing prevalence of anorexia in young people. Retrieved May 3, 2008.
• More 4 News report on how eating disorders are increasingly affecting men as well as women.Retrieved May 3, 2008.
• "This is the story of Karen Carpenter's Anorexia from her success in the Carpenters to her eventual death in 1983. Retrieved May 3, 2008.
• Resources on Anorexia Nervosa and other Eating Disorders including an hour long program on the subject. Retrieved May 3, 2008.

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