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Bradycardia is a physical symptom of anorexia nervosa.
False
One of the haematological abnormalities in anorexia nervosa is normocytic normochromic anaemia.
True
Hypothermia is a common gastrointestinal symptom of anorexia nervosa.
False
Low T3 syndrome involves low luteinizing hormone and follicle-stimulating hormone levels in anorexia nervosa.
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Emaciation is a physical sign of anorexia nervosa.
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Heightened sensitivity to cold is a cognitive symptom of anorexia nervosa.
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Delayed gastric emptying is a gastrointestinal abnormality associated with anorexia nervosa.
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Hypercholesterolaemia is a metabolic abnormality in anorexia nervosa.
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Anorexia nervosa was first named in 1868 by William Gull, who emphasized the physiological causes of the condition.
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A defining feature of anorexia nervosa is maintaining a body weight that is 15% below the standard weight.
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ICD-10 and DSM-5 both include amenorrhoea as a criterion in women with anorexia nervosa.
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Anorexia nervosa most often begins in childhood and rarely starts in adolescence.
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Patients with anorexia nervosa often set themselves very low daily calorie limits, often between 600 and 1000 kcal.
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Patients with anorexia nervosa are typically preoccupied with thoughts of becoming overweight and often enjoy cooking elaborate meals for themselves.
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Repeated episodes of binge eating become more frequent with chronicity and increasing age in anorexia nervosa patients.
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After binging, anorexia nervosa patients typically feel remorse and sometimes induce vomiting.
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The NICE guidelines for the treatment of anorexia nervosa were published in 2004.
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Deep brain stimulation is a well-established treatment for severe anorexia nervosa.
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Family therapy is more effective than individual psychotherapy for treating children and adolescents with anorexia nervosa.
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Psychodynamic concepts are the mainstay of treatment for anorexia nervosa.
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There has been a lack of good evidence about treatment and management of anorexia nervosa.
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Restricting fluids is a common symptom assessed in patients with eating disorders.
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Feeling fat and disliking her body are assessment criteria for psychological issues in anorexia nervosa.
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Use of appetite suppressants without any effects is a sign of eating disorders.
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Family factors are not considered important in the origins of anorexia nervosa.
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The patient’s experience of hunger or any urge to eat is part of the assessment of eating disorders.
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A body mass index (BMI) less than 14 kg/m² requires urgent follow-up or intervention in anorexia nervosa.
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Bradycardia is considered a heart rate of less than 60 beats per minute in the context of anorexia nervosa.
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Postural hypotension greater than 20 mmHg is an abnormality requiring urgent follow-up in anorexia nervosa.
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A QTc interval greater than 50 msec is considered normal in patients with anorexia nervosa.
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Hypokalaemia, when potassium levels are below 3.5 mmol/l, requires urgent intervention in anorexia nervosa.
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Malabsorption syndromes, such as coeliac disease, are part of the differential diagnosis for anorexia nervosa.
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Diabetes mellitus is not considered in the differential diagnosis of anorexia nervosa.
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Neutropenia is a condition that necessitates urgent follow-up in patients with anorexia nervosa.
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Hyperthyroidism can be confused with anorexia nervosa due to similar symptoms.
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Achieving an adequate weight is not essential in treating anorexia nervosa.
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Anorexia nervosa is an eating disorder recognized for its distorted body image and intense fear of gaining weight.
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Amenorrhea, or the absence of menstruation, is a common symptom in later stages of anorexia nervosa.
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The incidence of anorexia nervosa in primary care surveys is about 5 per 100,000 people.
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Genetic studies have definitively identified specific genes associated with anorexia nervosa.
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Anorexia nervosa is more common in higher social classes and is rare in non-Western countries.
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A large proportion of people with anorexia nervosa experience social withdrawal.
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The lifetime prevalence rate of anorexia nervosa in men is usually higher than 10:1 compared to women.
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Persistent psychopathology and physical health problems are common challenges faced by patients recovering from anorexia nervosa.
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Lack of sexual interest is an uncommon symptom in patients with anorexia nervosa.
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The highest incidence of anorexia nervosa is found in females between the ages of 15 and 19.
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Most people with anorexia nervosa should be managed on an inpatient basis with psychological treatment and monitoring of their physical condition.
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Outpatient psychological treatment for anorexia nervosa should normally be of at least 6 months duration.
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Dietary counselling should be provided as the sole treatment for anorexia nervosa.
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For inpatients with anorexia nervosa, rigid behaviour modification programmes should be used in the management.
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Compulsory treatment for anorexia nervosa is controversial both legally and ethically.
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In cases of extreme physical health risks, admission to a medical ward may be indicated for patients with anorexia nervosa.
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A reasonable aim for weight increase in anorexia nervosa treatment is 1.0 kg a week.
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Re-feeding is accepted as a treatment for eating disorders under the Mental Health Act.
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It is good practice to monitor the patient’s physical state regularly and to prescribe vitamin supplements if indicated during anorexia treatment.
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The target weight for patients with anorexia nervosa should be above a BMI of 18.0.
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Study Notes
Physical Features of Anorexia Nervosa
-
Physical Symptoms:
- Heightened sensitivity to cold
- Gastrointestinal symptoms: constipation, fullness after eating, bloating
- Dizziness and syncope
- Amenorrhoea
- Lack of sexual interest
- Poor sleep, with early-morning wakening
-
Physical Signs:
- Emaciation
- Stunted growth and failure of breast development (if onset is prepubertal)
- Dry skin, with orange discoloration of the palms and soles
- Fine downy hair (lanugo) on the back, forearms, and sides of face
- Salivary gland swelling
- Erosion of the inner surface of the front teeth (perimylolysis) in those who vomit frequently
- Cold hands and feet; hypothermia
- Bradycardia; hypotension; cardiac arrhythmias (especially in those with electrolyte abnormalities)
- Peripheral oedema
- Weak proximal muscles (e.g.difficulty in rising from a squatting position)
-
Abnormalities on Physical Investigation:
-
Endocrine Abnormalities:
- Low luteinizing hormone, follicle-stimulating hormone, and oestradiol levels
-
Other Abnormalities:
- Low T3, with T4 in low normal range, and normal concentrations of thyroid-stimulating hormone (low T3 syndrome)
- Increase in cortisol and dexamethasone non-suppression
- Raised growth hormone concentration
- Hypoglycaemia
-
Cardiovascular Abnormalities:
- Conduction defects, especially prolongation of the QT interval
-
Gastrointestinal Abnormalities:
- Delayed gastric emptying
- Decreased colonic motility (if chronic laxative misuse)
- Acute gastric dilatation (rare, secondary to binge eating or excessive re-feeding)
-
Haematological Abnormalities:
- Normocytic normochromic anaemia
- Mild leucopenia with relative lymphocytosis
- Thrombocytopenia
-
Other Metabolic Abnormalities:
- Hypercholesterolaemia
- Raised serum carotene
- Hypophosphataemia (exaggerated during re-feeding)
- Dehydration
- Electrolyte disturbances, especially hypokalaemia (in those who vomit frequently or misuse laxatives or diuretics)
-
Other Abnormalities:
- Osteopenia and osteoporosis
-
Endocrine Abnormalities:
Assessment of Anorexia Nervosa
-
Assessment of eating:
- Typical day's eating
- Mealttime arrangements at home and at school/work
- Degree of restraint
- Pattern of eating
- Avoidance of particular foods
- Restriction of fluids
- Experience of hunger or urge to eat
- Binge eating
- Self-induced vomiting
- Laxative, diuretic, or emetic misuse
- Fasting
- Eating in front of others
- Exercise
-
Assessment of psychological issues:
- Body image and weight
- Motivation for restricting eating
- Fear of gaining weight
- Body image distortion
- Fear of loss of control
- Guilt or self-disgust
- Feelings before, during, and after bingeing
- Disclosure of eating disorder to others
Treatment of Anorexia Nervosa
-
Psychotherapy:
- Cognitive behavioural therapy (CBT)
- Family therapy
- Individual interventions
- Cognitive-interpersonal therapy
-
Medication:
- Antidepressants
- Antipsychotics
- Olanzapine
-
Management:
- Outpatient or day-patient treatment
- Inpatient treatment for severe cases
- Dietary counselling
- Psychological treatment
- Monitoring of physical and psychological risk
Definition and Epidemiology of Anorexia Nervosa
-
Definition:
- Distorted body image
- Intense fear of gaining weight
- Restriction of food intake
- Significant weight loss
-
Epidemiology:
- Incidence: 5 per 100,000 people
- Highest among young women (15-19 years old)
- Rare in children under 13 years old
- Sex ratio: 10:1 ( females:males)
- More common in higher social classes
- Rare in non-Western countries and amongst non-white populations in Western countries
Onset, Course, and Prognosis of Anorexia Nervosa
-
Onset:
- Often in adolescence
- Fluctuating course
- Periods of exacerbations and partial remissions
-
Course:
- Long-term prognosis: difficult to determine
- Weight and menstrual function recovery: 60%
- Eating behaviors normalization: 50%
- Persistent abnormalities: eating habits and attitudes towards weight and shape
-
Prognosis:
- Poor prognosis factors: onset before puberty or in adulthood, long history of AN, premorbid personality issues, substance misuse, and childhood obesity
- Managing AN: challenging due to severe and enduring symptoms, and patients may experience chronic psychopathology, physical health problems, and impaired social functioning and employment
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Description
Identify the physical symptoms and signs of anorexia nervosa, a serious eating disorder. Learn about the effects of anorexia on the body, including gastrointestinal symptoms, dizziness, and changes in skin and hair.
