Eating disorder: Anorexia nervosa (self-starvation; malnutrition; extreme weight loss)

• What is Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• Statistics on Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• Risk Factors for Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• Progression of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• Symptoms of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• Clinical Examination of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• How is Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) Diagnosed?
• Prognosis of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)
• How is Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) Treated?
• Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) References

What is Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)

Anorexia nervosa is a psychological disease.

This condition is hallmarked by an extreme reluctance to consume food as a result of a psychological disturbed body image. This may lead to extreme malnutrition and weight loss. Anorexia nervosa is potentially life-threatening.

Statistics on Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)

The incidence of anorexia nervosa is 1-10 per 100,000 females aged between 15 and 34 years. There is a prevalence rate of 1-2% among schoolgirls and university students. Anorexia nervosa is much less common among men with a 1:10 ratio of boys:girls.

The onset of anorexia nervosa disease usually occurs between the ages of 10 and 30 years, initiated by a stressful life event. Anorexia nervosa occurs mostly in those individuals striving for success in industries that demand a slim body image such as modelling and dancing. There is also a higher prevalence of anorexia nervosa in higher social classes.

Risk Factors for Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)

Several theories have been put forward to explain the origin of anorexia nervosa, but none have stood the test of time.

The following are important important associations of anorexia nervosa:

1. Stressful life events: The condition most commonly follows a stressful situation or event in the patient’s life.
2. Genetic: There is a higher rate of anorexia nervosa in those with a family history of this anorexia. An increased occurrence has beenshown to exist in full-blood sisters.
3. Turbulent family relationships: Overprotective parents, and a pattern of conflict avoidance is shown to increase the risk of developing anorexia in children. Children are thought to use anorexia nervosa as a kind of hunger strike. The child then gains power in the family dynamic for it is the child who recieves the attention and decides the outcome of a family dilemma.

Progression of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)

The age of onset of anorexia in women is usually between 10 and 30 years of age, seldom occurring after the age of 30 years.

The onset of anorexia nervosa usually goes unnoticed until a significant amount of weight has been lost. Weight loss is achieve with severe diet restriction and excessive amounts of exercise. Weight loss may be also occur with self-stimulation of vomiting and excessive use of laxatives. With further weight loss, a woman’s period may cease, and the patient may develop low blood pressure, slow heart rate, and become very sensitive to the cold. Throughout any stage of the disease, the patient may exhibit psychological symptoms of depression and anxiety, related to their distorted body image of being “fat.”

How is Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) Diagnosed?

Fecal occult blood may be indicative of esophagitis, gastritis, or repetitive colonic trauma from laxative abuse as well as a bleeding disorder or severe protein malnutrition.

Prognosis of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss)

Anorexia nervosa runs a fluctuating course, with exacerbations and partial remissions. Long-term follow up suggests that about two-thirds of patients maintain normal weight and that the remaining one-third are split between those who are moderately underweight and those who are seriously underweight.

Indicators of a poor anorexia nervosa outcome include:

• A long initial illness;
• Severe weight loss;
• Older age at onset;
• Bulimia, vomiting or purging;
• Personality difficulties; and
• Difficulties in relationships.

Suicide has been reported in 2-5% of patients with chronic anorexia nervosa. The mortality rate per year is 0.5% from all causes. More than one-third have recurrent affective illness, and various family, genetic and endocrine studies have found associations between eating disorders and depression.

50% of patients make a full recovery, 30% a partial recovery and 20% none.

How is Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) Treated?

Anorexia nervosa treatment can be conducted on an outpatient basis unless the weight loss is severe and accompanied by marked physical symptoms such as dizziness, weakness and/or electrolyte and vitamin disturbances. Hospital admission may then be unavoidable and may need to be on a medical ward initially. Rarely the patient’s weight loss may be so severe as to be life-threatening. If the patient cannot be persuaded to enter hospital, compulsary admission may have to be used.

Inpatient treatment goals include:

• Establishing a good relationship with the patient;
• Restoring the weight to a level between the ideal bodyweight and the patient’s ideal weight;
• The provision of a balanced diet, building up to 12.6MJ (3000 calories) in 3 to 4 meals per day;
• The elimination of purgaitve and/or laxative use and vomiting.

Outpatient treatment can be conducted on either or both of cognitive behavioural psychotherapeutic lines or dynamic psychotherapeutive lines. It is vital to set up a therapeutic alliance. Individual psychotherapy is better than family therapy if the patient has left home and vice versa.

Motivational enhancement techniques have been used with some success.

Drug treatment has met with limited success, except to symptomatically treat insomnia and depressive illness.

Article kindly reviewed by:

The DAA WA Oncology Interest Group
and
Food4Health (Helen Baker Dietitian-APD)

More information

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.

For more information on psychology and psychotherapy, including different types of therapy, see Psychology and Psychotherapy.

 

Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) References

1. Bochereau D, Clervoy P, Corcos M, Girardon N. Eating disorders: Anorexia nervosa in adolescents [in French]. Presse Med. 1999;28(2):89-99. Abstract
2. Deep AL, Nagy LM, Weltzin TE, et al. Premorbid onset of psychopathology in long-term recovered anorexia nervosa. Int J Eat Disord. 1995;17(3):291-7. Abstract
3. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. Book
4. Cushing TA, Waldrop RD. Anorexia nervosa [online]. Omaha, NE: eMedicine; 2003 [cited 8 July 2003]. Available from: URL link