Anorexia
Characteristics
Definition
BMI <17.5
overvalued
weight
body image
no organic cause
Causes
Genetic
55% concordance monozygotic
no adoption studies
5% concordance dizygotic
Risk factors
Female
10x compared to male
Western society
Caucasians
HIgher social classes
Adolescence / early adulthood
family Hx
Eating disorders
Depression
adverse parenting
high expectations
low level of contact
sexual abuse
family dieting
critical comments
weight
shape
Personality
perfectionism
anxious
low self esteem
occupation
models
Incidence
19 females / 100,000/year
2 males / 100,000/year
Prevalence
0.7% in female teens
Pathogenesis
Sensitised in early age
weight
shape
Controlling personality
fear loss of control
control over food intake and body weight
Complications
death
10x risk of population
chronic disability
S&S
loss of secondary sexual characteristics
loss of hair
lanugo
Endocrinological disturbances
amenorrhoea
hypothyroidism
osteoporosis
not reversible
loss of libido
infertility
low LH,FSH, and oestradiol
GI symptoms
bloatedness
constipation
Cardiological
bradycardia
arrhythmias
Neurological
Enlarged ventricles
pseudoatrophy
Management
Investigations
none needed for diagnosis
Treatment
Treat the cause
Feed
Acute
Family therapy
for adolescents
Chronic
Antidepressants
SSRIs
relapse prevention
CBT
CAT
cognitive analytical therapy
psychodynamic psychotherapy
compulsory feeding
last resort
Admit to hospital
suicidal
rapid or severe weight loss
medical complications
Prognosis
worse if
long history
late onset
vomiting/bingeing
10-20% unremittent
change of diagnosis
to other eating disorders
Differential
non-psychological causes
hunger strike
ascetism
psychosis
|
| |