Anorexia Nervosa Overview

Anorexia Nervosa

• Characterized by self-starvation, extreme weight loss, and a distorted body image.
• Individuals remain convinced they need to lose more weight, even with significant weight loss.
• Amenorrhea (loss of menstrual periods) is often a consequence of extreme weight loss.
• Individuals often develop rituals around food and are chronically fatigued despite exercising.
• Subtypes include:
  • Restrictive type: Refusal to eat and/or excessive exercise to prevent weight gain.
  • Binge/purge type: Engage in episodes of binge eating and compensatory behaviors (e.g., vomiting, laxative abuse).

Level of Severity

• Severity is determined by Body Mass Index (BMI).
• Mild: BMI ≥ 17 kg/m2
• Moderate: BMI = 16-16.99 kg/m2
• Severe: BMI = 15-15.99 kg/m2
• Extreme: BMI < 15 kg/m2
• Severity is not solely based on BMI; clinical symptoms, functional disability, and supervision needs are also considered.

Prevalence

• 0.9% in adult women, 0.3% in adolescent girls.
• Lower rates in men (0.3%).
• Rates increased to 0.8% by 20, and 4% among women after the DSM-5 revision.

Comorbidity

• High mortality rate (5-9%).
• Cardiovascular complications (bradycardia, arrhythmia, heart failure).
• Stomach rupture.
• Bone weakening (in women with amenorrhea).
• Kidney damage.
• Impaired immune function.
• 31 times higher suicide rate compared to general population.

Bulimia Nervosa

• Episodes of binge eating followed by compensatory behaviors to prevent weight gain.
• Mild presentations involve 1-3 binges per week; more extreme presentations involve 14 or more.
• Binge amounts vary greatly (1,200-4,000 calories).
• Body image is a significant issue, with individuals often feeling dissatisfied with their body shape and weight.
• Distortions are less extreme than with AN.
• Often identified by others due to vomiting or dental problems (frequent vomiting can rot teeth).

Prevalence

• Lifetime prevalence is up to 2.6% among women.
• More prevalent in females and westernized cultures.
• Increased significantly in the second half of the 20th century.

Comorbidity

• Severe cases can lead to electrolyte imbalance (leading to heart failure).
• 7.5 times higher suicide rate than general population.

Binge-Eating Disorder

• Recurrent binges (large amounts of rapid eating when not physically hungry) with a lack of control over eating.
• Individuals feel disgusted after binges, they may eat in private, rapidly, feeling ashamed afterwards.
• Often overweight or obese, and might have co-occurring depression/anxiety/other addictive disorders.
• Binge eating episodes can be planned or happen continuously through the day.

Prevalence

• 2-3.5% in the USA.
• Rates are lower in other countries, but women are slightly more affected.

Comorbidity

• High rates of depression and anxiety.
• Higher incidence of alcohol abuse and personality disorders.

Other Specified Feeding or Eating Disorders

• Conditions that don't meet the full criteria of AN or BN.
• Atypical anorexia nervosa: Meets all AN criteria except for significant weight loss (weight is in a normal or above normal range).
• Bulimia nervosa of low frequency and/or limited duration: Meets all BN criteria but binges occur less frequently or for a shorter duration.
• Night Eating Disorder: Excessive eating occurring after dinner or at night, often in the absence of feeling hungry regularly.
• Individuals are highly distressed by their behavior and often accompanied with insomnia and are typically overweight/obese.

Treatment

• Psychotherapy - Cognitive-behavioral therapy (CBT), interpersonal therapy and others.
• Biological therapies - Medications like SSRIs (selective serotonin reuptake inhibitors) and others.
  • Family therapy is often crucial in AN treatments.