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Anorexia nervosa

Anorexia nervosa is an eating disorder characterized by voluntary starvation and exercise stress. Anorexia nervosa is a complex disease, involving psychological, sociological and physiological components. A person who is suffering from anorexia is referred to as 'anorexic' or (less commonly) 'anorectic'. "Anorectic" is the noun form, where "anorexic" is the adjectival form. These two are often used incorrectly when applied. Although technically incorrect, the term is frequently shortened to anorexia, which simply refers to the medical symptom of lost appetite. more...

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In this article, for the purpose of brevity, anorexia will be used in the place of anorexia nervosa.

Anorectic can also refer to appetite-suppressing drugs.

Sometimes the condition is called variously Cibophobia, Sitophobia, Sitophobia, translated as "aversion to food".

Characteristics

The causes of anorexia are a matter of debate in medical circles and society in general. General perspectives fit between the poles of it being physiological or psychological (with the potential for sociological and cultural influences being a cause to various degrees) in origin. Some now take the opinion that it is a mix of both, in that it is a psychological condition which is often (though not inherently) borne of certain conducive neurophysiologic conditions.

Clinical definition

The four DSM IV criteria

The following is the definition of anorexia nervosa from the Diagnostic and Statistical Manual of Mental Disorders, used to assist doctors in making a clinical diagnosis. This definition may not be representative of what an individual sufferer feels or experiences in living with the illness. Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e.g., subclinical anorexia nervosa or ED-NOS: eating disorder, not otherwise specified) even if one of the below signs is not present. In particular, a substantial number of patients diagnosed with ED-NOS meet all criteria for diagnosis of anorexia nervosa except the requirement of three consecutive missed menstrual cycles.

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., 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 fat, even though underweight.
  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. In postmenarcheal females (women who have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).

The two DSM IV Subtypes

  • Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting 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 (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

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Clinical findings in outpatient anorexia nervosa
From American Family Physician, 10/1/05 by Caroline Wellbery

Anorexia nervosa affects 0.2 to 4 percent of adolescent girls in the United States and is increasing in prevalence. In addition to the 5.6 percent mortality rate of adults with anorexia, changes in bone metabolism and other nutritional parameters are common. Few data exist to define the consequences of these complications. Misra and colleagues studied various hemodynamic and laboratory parameters that are found in community-dwelling adolescents with anorexia to promote vigilance as well as timely and effective intervention.

The study included 118 adolescent girls 12 to 19 years of age. Sixty girls diagnosed with anorexia nervosa were compared with 58 healthy girls. Participants in the anorexia nervosa group were receiving outpatient care but had not been hospitalized for at least three months. The authors evaluated clinical characteristics (e.g., body mass index [BMI], blood pressure, heart rate, blood count, bone age, chronologic age, and bone density) as well as biochemical data (e.g., follicle-stimulating hormone, luteinizing hormone, hematocrit, glucose, potassium, calcium, creatinine, estradiol [Estraderm], urinary free cortisol, and insulin-like growth factor 1 [IGF-1] levels). BMI and weight were lower in the anorexia nervosa group compared with the control group, as was the ratio of bone age and chronologic age. Premenarchal girls with anorexia nervosa were older than premenarchal girls in the control group. The anorexia nervosa group also had lower blood pressure and mean heart rates than girls in the control group. Participants with anorexia nervosa were more likely to have a higher mean corpuscular volume and lower red and white blood cell counts, despite insignificant differences in hematocrits. Calcium and phosphorus levels were not different between groups, but potassium and urinary free cortisol levels were slightly higher in the anorexia nervosa group. Urinary free cortisol levels standardized for creatinine and for surface area and creatinine were also higher in the anorexia nervosa group, compared to the control group. Estradiol and IGF-1 levels were significantly lower in the anorexia nervosa group. Participants in the anorexia nervosa group had significantly lower bone density, particularly at the lumbar spine. Bone density measurements at the hip and femoral neck were also significantly lower in the anorexia nervosa group. When controlling for other factors, lean body mass was the most significant predictor of bone mineral density at most sites.

The authors conclude that community-dwelling adolescent girls with anorexia nervosa had an increased risk for hematologic, metabolic, hemodynamic, and skeletal abnormalities, including bradycardia, low blood pressure, and pubertal delay, compared with healthy girls. They recommend that physicians monitor these parameters closely in anorexia nervosa patients.

CAROLINE WELLBERY, M.D.

Misra M, et al. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics December 2004;114:1574-83.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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