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Anorexia Nervosa

Overview

Anorexia Nervosa is a psychiatric eating disorder. The patients suffering from Anorexia Nervosa carry a distorted image of their body within their minds and cannot comprehend the ramifications. Anorexia leads to a reduced dietary intake in comparison to the requirement of the body.

Anorexia Nervosa is a psychiatric eating disorder. The patients suffering from Anorexia Nervosa carry a distorted image of their body within their minds and cannot comprehend the ramifications. Anorexia leads to a reduced dietary intake in comparison to the requirement of the body.

Causes

Anorexia has not been associated with a single cause. Genetic predisposition seems to play a role in the development of this disease. It seems that families with a perfectionist outlook, competitive traits, and autistic spectrum traits tend to produce anorexic individuals. A common precipitant for Anorexia is puberty and adolescence; however, research has found it in well-functioning families. 

Individuals who suffer from Anorexia tend to have an altered brain function with a deficit in neurotransmitters that regulate eating habits. These individuals have a low level of dopamine that holds eating behavior and the feeling of reward. Serotonin, another hormone that regulates mood and happiness, is also common in these individuals.

Anorexia has not been associated with a single cause. Genetic predisposition seems to play a role in the development of this disease. It seems that families with a perfectionist outlook, competitive traits, and autistic spectrum traits tend to produce anorexic individuals. A common precipitant for Anorexia is puberty and adolescence; however, research has found it in well-functioning families. 

Individuals who suffer from Anorexia tend to have an altered brain function with a deficit in neurotransmitters that regulate eating habits. These individuals have a low level of dopamine that holds eating behavior and the feeling of reward. Serotonin, another hormone that regulates mood and happiness, is also common in these individuals.

Risk factor and Epidemiology

Anorexia is more commonly found in females than males. The onset is around adolescence and early adulthood. The lifetime prevalence of this disease is 0.3% to 1% regardless of culture, class, and race. 

The risk factors associated with eating disorders like Anorexia Nervosa range in social, psychological, and biological facets. Studies have found that the presence of a first-degree relative like mother or sister may predispose an individual to develop Anorexia. Furthermore, issues like anxiety, depression, and addiction run in families. This leads to an elevated risk of developing Anorexia. Another vital risk factor is perfectionism, more commonly self-oriented perfectionism that leads to unrealistic expectations. The impact of media has integrated a body image in young minds. This internalization of an ideal body leads to dissatisfaction with body image leading to eating disorders. Weight stigma, where a person is stereotyped based on their appearance, tends to have a negative impact and leads to body dysmorphia in the mind of these individuals. Such individuals are at an elevated risk of being driven towards eating disorders. Individuals from racial and ethnic minorities, especially those who undergo westernization, may develop eating disorders due to an intense interaction between stress and acculturation.

Anorexia is more commonly found in females than males. The onset is around adolescence and early adulthood. The lifetime prevalence of this disease is 0.3% to 1% regardless of culture, class, and race. 

The risk factors associated with eating disorders like Anorexia Nervosa range in social, psychological, and biological facets. Studies have found that the presence of a first-degree relative like mother or sister may predispose an individual to develop Anorexia. Furthermore, issues like anxiety, depression, and addiction run in families. This leads to an elevated risk of developing Anorexia. Another vital risk factor is perfectionism, more commonly self-oriented perfectionism that leads to unrealistic expectations. The impact of media has integrated a body image in young minds. This internalization of an ideal body leads to dissatisfaction with body image leading to eating disorders. Weight stigma, where a person is stereotyped based on their appearance, tends to have a negative impact and leads to body dysmorphia in the mind of these individuals. Such individuals are at an elevated risk of being driven towards eating disorders. Individuals from racial and ethnic minorities, especially those who undergo westernization, may develop eating disorders due to an intense interaction between stress and acculturation.

Sign and Symptoms

The physical signs and symptoms of Anorexia include:

  • Weight loss 
  • Extremely frail appearance 
  • Thin hair 
  • Dry and yellowish skin
  • Bluish discoloration of fingers 
  • Intolerance towards cold
  • Insomnia 
  • Fatigue 
  • Low blood pressure
  • Irregular heart rhythm 

Emotional and behavioral symptoms include 

  • Excessive exercise in routine 
  • Extreme restriction in food intake 
  • Lying about food intake 
  • The morbid fear of gaining weight as a result of which the individual may take repeated measurements of their weight

The physical signs and symptoms of Anorexia include:

  • Weight loss 
  • Extremely frail appearance 
  • Thin hair 
  • Dry and yellowish skin
  • Bluish discoloration of fingers 
  • Intolerance towards cold
  • Insomnia 
  • Fatigue 
  • Low blood pressure
  • Irregular heart rhythm 

Emotional and behavioral symptoms include 

  • Excessive exercise in routine 
  • Extreme restriction in food intake 
  • Lying about food intake 
  • The morbid fear of gaining weight as a result of which the individual may take repeated measurements of their weight

Diagnosis

The diagnosis of Anorexia is suspected by family members and friends. At the primary level, it may be suspected by the school before a doctor gets involved. If weight loss is expertly concealed, symptoms of depression, infertility, amenorrhea, and obsessive behavior may be diagnosed. Furthermore, basic tests like echocardiography, blood tests (CBC, electrolytes, metabolic panel, urinalysis), and weight measurements may open a discussion between doctor and patient. This interaction may lead to a psychological issue getting un-covered.

The diagnosis of Anorexia is suspected by family members and friends. At the primary level, it may be suspected by the school before a doctor gets involved. If weight loss is expertly concealed, symptoms of depression, infertility, amenorrhea, and obsessive behavior may be diagnosed. Furthermore, basic tests like echocardiography, blood tests (CBC, electrolytes, metabolic panel, urinalysis), and weight measurements may open a discussion between doctor and patient. This interaction may lead to a psychological issue getting un-covered.

Differential Diagnosis

The differential diagnosis of Anorexia can prove complicated because these diseases may also be comorbid with Anorexia. These include achalasia (a disorder of the esophagus), where Anorexia may be sub-clinically present in lupus disease, Lyme disease, brain tumor, depression, and borderline personality disorders. The distinction between anorexia nervosa, bulimia nervosa, and other eating disorders can prove difficult because of the overlap in patients' symptoms in all these diseases. A minor change in the patient's attitude or belief may lead him from Anorexia to bulimia.

The differential diagnosis of Anorexia can prove complicated because these diseases may also be comorbid with Anorexia. These include achalasia (a disorder of the esophagus), where Anorexia may be sub-clinically present in lupus disease, Lyme disease, brain tumor, depression, and borderline personality disorders. The distinction between anorexia nervosa, bulimia nervosa, and other eating disorders can prove difficult because of the overlap in patients' symptoms in all these diseases. A minor change in the patient's attitude or belief may lead him from Anorexia to bulimia.

Treatment

The outpatient treatment of patients suffering from Anorexia includes intensive therapy that includes 2-3 hours per week of psychotherapy. Extreme cases may also require partial hospitalization with 6 hours per day.

The outpatient treatment of patients suffering from Anorexia includes intensive therapy that includes 2-3 hours per week of psychotherapy. Extreme cases may also require partial hospitalization with 6 hours per day.

Medication

Pharmacological drugs are not being ensued initially. When an initial line of treatment does not work in acutely ill patients, Olanzapine is used as the first line of medication. Bupropion is contraindicated in patients with eating disorders because of the chance of seizures. Tri-cyclin anti-depressants are less preferred because they may lead to cardiotoxicity.

Pharmacological drugs are not being ensued initially. When an initial line of treatment does not work in acutely ill patients, Olanzapine is used as the first line of medication. Bupropion is contraindicated in patients with eating disorders because of the chance of seizures. Tri-cyclin anti-depressants are less preferred because they may lead to cardiotoxicity.

Lifestyle modification

The lifestyle modifications that anorexic patients need to acquire include a change in mindset. If they can combat their negative thoughts about body image, they can walk towards a healthy and better life. A regular exercise regime of 30 minutes, 3-5 days per week, can boost their confidence along with healthy dietary control.

The lifestyle modifications that anorexic patients need to acquire include a change in mindset. If they can combat their negative thoughts about body image, they can walk towards a healthy and better life. A regular exercise regime of 30 minutes, 3-5 days per week, can boost their confidence along with healthy dietary control.