Eating Disorders: Anorexia Nervosa Overview

Eating Disorders

• Anorexia nervosa is a condition where individuals restrict their energy intake significantly, maintaining a body weight far below a healthy level for their age and sex (typically BMI below 18.5).
• This leads to an emaciated body type with physical symptoms arising from starvation.
• Anorexia can be categorized into two subtypes: restricting and binge eating/purging.
• Restricting type involves weight loss achieved through dieting and exercise.
• Binge eating/purging involves self-induced vomiting, laxative misuse, or diuretics to compensate for overeating.
• Binge eating/purging subtype may lead to parotid gland enlargement, dental caries, halitosis, and calluses on the hands (Russell's sign).
• Other potential complications include:
  • Severe weight loss
  • Stress fractures
  • Amenorrhea
  • Lanugo (fine, downy body hair)
  • Anemia
  • Electrolyte imbalances (hypokalemia, hypochloremia, metabolic alkalosis)
  • Vital sign derangements (hypotension, hypothermia, bradycardia)
  • Depression
• Psychotherapy and nutritional rehabilitation are the first-line therapies for anorexia.
• Hospitalization may be needed for patients with unstable vital signs, cardiac dysrhythmias, severe electrolyte imbalances, or extremely low body weight.
• Refeeding syndrome can be a life-threatening complication of anorexia, arising from the body resuming metabolism after a period of starvation. Carbohydrate intake can lead to rapid cellular uptake of phosphorus, potassium, and magnesium, needing careful management.
• Phosphorus and magnesium deficiencies can also potentiate cardiac arrhythmias, as malnutrition's effects include atrophic heart conditions.

Sleeping Disorders

• Narcolepsy is a neurological sleep disorder characterized by excessive daytime sleepiness.
• A primary characteristic of narcolepsy is the presence of a genetic component.
• It involves a disordered regulation of sleep-wake cycles, particularly due to the loss of hypocretin (orexin) production in the lateral hypothalamus.
• This results in an inability to regulate sleep-wake cycles, leading to excessive sleepiness throughout the day.
• Narcolepsy is further characterized by a tetrad of symptoms:
  • Sleep attacks and excessive daytime sleepiness
  • Cataplexy (sudden loss of muscle tone triggered by strong emotions)
  • Hypnagogic or hypnopompic hallucinations (dreams or dreamlike experiences right before or after sleep)
  • Sleep paralysis (inability to move or speak upon falling asleep or waking)

Insomnia

• Insomnia is a sleep disorder primarily characterized by difficulty initiating or maintaining sleep.
• It is frequently associated with anxiety, anticipatory anxiety, and other underlying psychiatric disorders (e.g., depression).
• Insomnia can have a significant impact on daily functioning, often accompanied by daytime symptoms such as yawning, tiredness, and fatigue.

Personality Disorders

• Personality disorders are characterized by enduring, maladaptive patterns of perceiving, relating to, and thinking about the environment and oneself.
• These patterns typically begin in early adulthood and cause significant distress and/or impaired functioning.
• Personality disorders are categorized into three clusters based on shared symptoms:
  • Cluster A (odd or eccentric): Paranoid, Schizoid, and Schizotypal.
  • Cluster B (dramatic, emotional, or erratic): Antisocial, Borderline, Histrionic, and Narcissistic.
  • Cluster C (anxious or fearful): Avoidant, Dependent, and Obsessive-compulsive