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Questions and Answers
Bradycardia is a physical symptom of anorexia nervosa.
Bradycardia is a physical symptom of anorexia nervosa.
False
One of the haematological abnormalities in anorexia nervosa is normocytic normochromic anaemia.
One of the haematological abnormalities in anorexia nervosa is normocytic normochromic anaemia.
True
Hypothermia is a common gastrointestinal symptom of anorexia nervosa.
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.
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.
Emaciation is a physical sign of anorexia nervosa.
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Heightened sensitivity to cold is a cognitive symptom of anorexia nervosa.
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.
Delayed gastric emptying is a gastrointestinal abnormality associated with anorexia nervosa.
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Hypercholesterolaemia is a metabolic abnormality in anorexia nervosa.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
