1-Eating Disorders 2-Anorexia Nervosa -Definition -Subtypes -Etiology -Ebdimyology -Physical findings and complications -DSM-5 Diagnostic Criteria -Course and Prognosis -Treatment

2. Eating Disorders
• Eating disorders are characterized by a persistent disturbance of
eating that impairs health or psychosocial functioning.
• The disorders include anorexia nervosa, binge eating disorder, bulimia
nervosa, pica, and rumination disorder.
• and affect both females and males.

3. • Eating disorders can develop during any stage in life but typically
appear during the teen years or young adulthood.
• Although these conditions are treatable, the symptoms and
consequences can be detrimental and deadly if not addressed. Eating
disorders commonly coexist with other conditions, such as anxiety
disorders, substance abuse, or depression.
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5. Definition:
• Anorexia nervosa (AN) is an 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.
• It is often associated with obsessive-compulsive personality traits.
• Anorexia nervosa has the highest mortality of any psychiatric disorder.

6. There are two main sub types:
• Restricting type: Has not regularly engaged in binge-eating or purging
behavior; weight loss is achieved through diet, fasting, and/or
excessive exercise.
• Binge-eating/purging type: Eating binges followed by self-induced
vomiting, and/or using laxatives, enemas, or diuretics. Some
individuals purge after eating small amounts of food without binging.

7. Multifactorial.
• Genetics:
• Higher concordance in monozygotic (55%) than dizygotic twin studies (5%).
• Psychodynamic theories:
• Difficulty with separation and autonomy (e.g., parental enmeshment), and
struggle to gain control.
• Social theories:
• Exaggeration of social values (achievement, control, and perfectionism).
• Idealization of thin body.
• ↑ prevalence of dieting at earlier ages.
Etiology

8. Epidemiologiy
• 10 : 1 female to male ratio
• Average age is 17 years.
• More common in industrialized countries where food is abundant and a thin body ideal is
held.
• Common in sports that involve thinness, revealing attire, subjective judging, and weight
classes (e.g., running, ballet, wrestling, diving, cheerleading, figure skating).

9. PHYSICAL FINDINGS AND MEDICAL COMPLICATINS
• With pure food restriction, once weight loss below approximately 15–20 percent
of ideal body weight occurs, there is often the development of gastroparesis.
• Bradycardia (pulse <60) and hypotension are among the most common physical
findings in patients with anorexia nervosa, with bradycardia seen in up to 95% of
patients.
• As weight loss worsens due to the nutritional deprivation, it is common for the
patient with anorexia nervosa to have dry skin which can fissure and bleed
especially in the fingers and toes.

10. PHYSICAL FINDINGS AND MEDICAL COMPLICATINS
• The bone marrow is adversely affected by anorexia nervosa. All three cell lines,
namely red blood cells, white blood cells and platelets, may be affected by
anorexia nervosa. Specifically, anemia and leukopenia occur in approximately
one-third of the patients and thrombocytopenia occurs in ten percent.
• Severe cases of anorexia nervosa may appear, on magnetic resonance imaging
(MRI), to be indistinguishable from the brain of a person with Alzheimer’s
disease; ventricles are enlarged and cortical substance is decreased.

11. PHYSICAL
FINDINGS
AND
MEDICAL
COMPLICATINS

12. DSM-5 Diagnostic Criteria
• Restriction of energy intake relative to requirements --> leading to
significant low body weight.
• Defined as less than minimally normal or expected.
• Intense fear of gaining weight or becoming fat, or persistent behaviors
that prevent weight gain
• Disturbed body image, undue influence of weight or shape on self-
evaluation, or denial of the seriousness of the current low body
weight.

13. COURSE AND PROGNOSIS
• Chronic and relapsing illness. Variable course
• May completely recover,
• Have fluctuating symptoms with relapses,
• Or progressively deteriorate.
• Most remit within 5 years.
• Mortality rate is cumulative and approximately 5% per decade due to
starvation, suicide, or cardiac failure.
• Rates of suicide are approximately 12 per 100,000 per year.

14. TREATMENT
• Food is the best medicine!
• Patients may be treated as outpatients unless they are dangerously
below ideal body weight (>20–25% below) or if there are serious
medical or psychiatric complications, in which case they should be
hospitalized for supervised refeeding.
• Treatment involves: cognitive-behavioral therapy, family therapy (e.g.,
Maudsley approach), and supervised weight-gain programs.
• Selective serotonin reuptake inhibitors (SSRIs) have not been effective in the
treatment of anorexia nervosa but may be used for comorbid anxiety or
depression.

15. Family-Based Treatment for AN
• Developed in London at the Maudsley Hospital (1980s)
• First line treatment for medically stable children and adolescents with
AN
• Outpatient treatment to restore weight and return adolescent to
developmental track
• Team approach, i.e., parents, therapist, paediatrician and psychiatrist

17. MCQs
1) Which of the following is not a common feature of Anorexia Nervosa?
A. Binge eating
B. Amenorrhoea
C. Self perception of being ‘fat`
D. Under weight
2) Which of the following is a diagnostic criterion for anorexia nervosa in
DSM-IV-TR?
A. A refusal to maintain a minimal body weight
B. A pathological fear of gaining weight
C. A distorted body image in which, even when clearly emaciated, sufferers continue
to insist they are overweight
D. All of the above

18. MCQs
3) In Restricted Type anorexia nervosa, self-starvation is NOT
associated with which of the following?
A. Concurrent purging
B. Socialising
C. Body dysmorphic issues
D. Eating only certain food types
4) What are common anorexia symptoms?
A. Anxiety and depression
B. Weakness and shortness of breath
C. Unhealthy complexion and brittle skin
D. Any of the above

19. References:
1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
2) https://www.eatingdisorderhope.com/information/eating-disorder
3) Ganti, Latha. (2005). First aid for the psychiatry clerkship : a student-to-student guide. New York
:McGraw-Hill, Medical Pub. Div.,
4) Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders.
Curr Opin Psychiatry 2006;19:389-94.
5) Marwick, K. (2013). Crash Course Psychiatry (4th edition). Elsevier Ltd.
6) Kaplan Test Prep: USMLE Step 2 CK Lecture Notes 2017 - Psychiatry, Epidemiology, Ethics,
Patient Safety Vol. by Kaplan Medical Staff.
7) Mehler, P. S., & Brown, C. (2015). Anorexia nervosa - medical complications. Journal of eating
disorders, 3, 11. doi:10.1186/s40337-015-0040-8.
8) https://www.eatingdisorders.org.au/eating-disorders/anorexia-nervosa