La Anorexia

Anorexia nervosa is an eating disorder characterized by immoderate food restriction, inappropriate eating habits or rituals, obsession with having a thin figure, and an irrational fear of weight gain, as well as a distorted body self-perception. It typically involves excessive weight loss and is diagnosed approximately nine times more often in females than in males.[1] Due to their fear of gaining weight, individuals with this disorder restrict the amount of food they consume. Outside of medical literature, the terms anorexia nervosa and anorexia are often used interchangeably; however, anorexia is simply a medical term for lack of appetite, and the majority of individuals afflicted with anorexia nervosa do not, in fact, lose their appetites.[2] Patients with anorexia nervosa often experience dizziness, headaches, drowsiness, fever, and a lack of energy. To counteract these side effects, particularly the latter, individuals with anorexia may engage in other harmful behaviors, such as smoking, excessive caffeine consumption, and attempting to take diet pills, along with an increased exercise regimen. (Of course, side effects such as fever or headaches may be treated with other, non-diet medication, such as acetaminophen and ibuprofen.)

Anorexia nervosa is often coupled with a distorted self image[3][4] which may be maintained by various cognitive biases[5] that alter how the affected individual evaluates and thinks about their body, food, and eating.[6] People with anorexia nervosa often view themselves as overweight or "big" even when they are already underweight.[7]

Anorexia nervosa most often has its onset in adolescence and is more prevalent among adolescent females than adolescent males.[8]

While the majority of people with anorexia nervosa continue to feel hunger, they deny themselves all but very small quantities of food.[6] The average caloric intake of individuals with anorexia nervosa varies drastically depending both on whether the individual engages in binging and/or purging behavior, and if the individual has engaged in that behavior in the day in question.[9] Extreme cases of complete self-starvation are known. It is a serious health condition with a high incidence of comorbidity and similarly high mortality rate to serious psychiatric disorders.[7] People with anorexia have extremely high levels of ghrelin (the hunger hormone that signals a physiological need for food) in their blood. The high levels of ghrelin suggests that their bodies are desperately trying to make them hungry; however, that hunger call is being suppressed, ignored, or overridden. Sufferers may commonly engage in self-harm behaviors in order to override their feelings of hunger.

Contents [hide]

1 Signs and symptoms

1.1 Complications

2 Causes

2.1 Biological

2.2 Sociological

2.2.1 Media effects

2.3 Relationship to autism

3 Diagnosis

3.1 Medical

3.2 Psychological

3.2.1 DSM-V Criteria

3.2.2 ICD-10 Criteria

3.3 Differential diagnoses

4 Treatment

4.1 Dietary

4.2 Medication

4.3 Therapy

5 Prognosis

5.1 Relapse

6 Epidemiology

7 History

8 See also

9 References

10 External links

Signs and symptoms[edit]

Anorexia nervosa is an eating disorder that is characterized by attempts to lose weight, to the point of self-starvation. A person with anorexia nervosa may exhibit a number of signs and symptoms, the type and severity of which may vary in each case and may be present but not readily apparent. Anorexia nervosa, and the associated malnutrition that results from self-imposed starvation, can cause severe complications in every major organ system in the body.[10][11][12]

Hypokalaemia, a drop in the level of potassium in the blood, is a sign of anorexia nervosa. A significant drop in potassium can cause abnormal heart rhythms, constipation, fatigue, muscle damage and paralysis.

Between 50% and 75% of individuals with an eating disorder experience depression. In addition, one in every four individuals who are diagnosed with anorexia nervosa also exhibit obsessive-compulsive disorder.[13]

Symptoms of a person with anorexia nervosa may include:

Refusal to maintain a normal body mass index for their age[14]

Amenorrhea, a symptom that occurs after prolonged weight loss; causes menses to stop, hair becomes brittle, and skin becomes yellow and unhealthy[14]

Fearful of even the slightest weight gain and takes all precautionary measures to avoid weight gain and becoming overweight[14]

Obvious, rapid, dramatic weight loss

Lanugo: soft, fine hair growing on the face and body[15] One theory is that this is related to hypothyroidism, as there are several reports of a similar hypertrichosis occurring in hypothyroidism.[16][17]

Obsession with calories and fat content of food

Preoccupation with food, recipes, or cooking; may cook elaborate dinners for others, but not eat the food themselves[18]

Food restriction despite being underweight

Food rituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food

Purging: May use laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomiting; may run to the bathroom after eating in order to vomit and quickly get rid of ingested calories[19][20] (see also bulimia nervosa).

May engage in frequent, strenuous, or compulsive exercise[21]

Perception of self as overweight despite being told by others they are too thin

Intolerance to cold and frequent complaints of being cold. Body temperature may lower (hypothermia) in an effort to conserve energy[22]

Hypotension and/or orthostatic hypotension

Bradycardia or tachycardia

Depression: may frequently be in a sad, lethargic state[23]

Solitude: may avoid friends and family; becomes withdrawn and secretive

Cheeks may become swollen because of enlargement of the salivary glands caused by excessive vomiting[24]

Swollen joints[25]

Abdominal distension

Halitosis (from vomiting or starvation-induced ketosis)

Hair loss or thinning[26]

Fatigue[27]

Rapid mood swings

Absence of menses

Dermatological signs of anorexia nervosa[28]

xerosis cutis telogen effluvium carotenoderma acne vulgaris hyperpigmentation

seborrhoeic dermatitis acrocyanosis chilblains petechiae livedo reticularis

interdigital intertrigo paronychia generalized pruritus acquired striae distensae angular stomatitis

prurigo pigmentosa edema linear erythema craquele acrodermatitis enteropathica pellagra

Possible medical complications of anorexia nervosa

constipation[29] diarrhea[30] electrolyte imbalance[31] cavities[32] tooth loss[33]

cardiac arrest[34] amenorrhoea[35] edema[36] osteoporosis[37] osteopenia[38]

hyponatremia[39] hypokalemia[40] optic neuropathy[41] brain atrophy[42][43] leukopenia[44][45]

The prevalent symptoms for anorexia nervosa (as discussed above) such as decreased body temperature, obsessive-compulsivity, and changes in psychological state, can actually be attributed to symptoms of starvation. This theory can be supported by a study by Routtenberg in 1968 involving rats who were deprived of food; these rats showed dramatic increases in their activity on the wheel in their cage at times when not being fed.[46] These findings could explain why those with anorexia nervosa are often seen excessively exercising; their overactivity is the result of fasting, and by increasing their activity they could raise their body temperature, increase their chances of stumbling upon food, or become distracted from their desire for nourishment (because they do not, in fact, lose their appetite). While it is commonly believed that those with AN do not have a normal appetite, this is not the case. Those with AN are typically obsessive about food, cooking often for others, but not eating the food themselves. Despite the fact that the physiological cause behind each case of anorexia nervosa is different, the most common theme seen across the board is the element of self-control. The underlying cause behind the disorder is rarely about the food itself; it is about the individual attempting to gain complete control over an aspect of their lives, in order to prove themselves, and distract them from another aspect of their lives they wish they could control. For example, a child with a destructive family life who restricts food intake in order to compensate for the chaos occurring at home.[46]

Complications[edit]

Anorexia nervosa can have serious implications if its duration and severity are significant and if onset occurs before the completion of growth, pubertal maturation, or the attainment of peak bone mass.[47] Complications specific to adolescents and children with anorexia nervosa can include the following:

Growth retardation – height gain may slow and can stop completely with severe weight loss or chronic malnutrition. In such cases, provided that growth potential is preserved,

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