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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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Regional body composition in anorexia nervosa - Eating Disorders and Obesity - Author Abstract
From Nutrition Research Newsletter, 7/1/03

Anorexia nervosa (AN) is the third-most common chronic disorder diagnosed in adolescent girls in the United States. Although improved nutrition intake and weight recovery remain the goal for all patients with AN, the effect on body composition, especially regional fat distribution, may make psychological and physical recovery more difficult in a population so focused on body image.

Studies of regional fat distribution in adults with AN have shown decreased extremity fat at baseline and increased trunk fat with weight recovery, resulting in truncal adiposity. There have been several studies on this topic in adults but very few have focused on adolescents. Therefore, a recent study in the American Journal of Clinical Nutrition sought to determine body composition and regional fat distribution in adolescents with AN and measured changes in these parameters during weight recovery.

Twenty-one adolescent girls with AN and 21 control subjects matched for age and pubertal stage were included in this study. All AN subjects were enrolled in integrated treatment programs for the duration of the study. Height, weight and body composition were measured at baseline through dual-energy X-ray absorptiometry (DXA), six month and 12 month visits. Four-day food records were analyzed to assess intakes of macronutrients and micronutrients at each visit. Weight recovery was defined as a >10% increase in body mass index (BMI).

At baseline, the girls with AN had a lower percentage of trunk fat than did the control subjects, whereas the percentage of extremity fat was not significantly different between the groups. There was no significant difference between the groups for total calories, protein or carbohydrates. However, girls with AN consumed significantly less fat and saturated fat than did the controls. BMI increased by a mean of 3.5 in the 13 anorexic subjects who met the criteria for weight recovery. At 12 months, in weight-recovered AN subjects, 55.6% of the weight gain was attributable to an increase in fat mass and 44.4% was attributable to an increase in lean body mass (LBM).

In contrast to studies on adults with AN, percentage extremity and trunk fat was not significantly different in adolescent AN subjects compared with controls. Thus, weight recovery resulted in a tendency toward normalization of body composition rather than the development of central adiposity. This concept is further supported by the finding that girls with the least trunk fat at baseline gained the most trunk fat over time. Regional fat distribution at baseline and changes with weight recovery are thus very different in adolescent than in adults with AN and may be related to the duration or severity of hypercortisolemia in adolescents compared with adults. These results are important in that they will allow healthcare providers to convey to adolescents with AN that weight recovery is not likely to lead to central adiposity.

Madhusmita Misra, Leslie A. Soyka, Karen K. Miller, et al., Regional body composition in adolescents with anorexia nervosa and changes with weight recovery, Am J Clin Nutr 77: 1361-1367 (June 2003) [Reprints not available. Address correspondence to A Klibanski, Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, BUL 457B, 55 Fruit Street, Boston, MA 02114. E-mail: aklibanski@partners.org]

COPYRIGHT 2003 Frost & Sullivan
COPYRIGHT 2003 Gale Group

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