Anorexia Nervosa Calvina

8/12/2019 Anorexia Nervosa Calvina

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ANOREXIA NERVOSA


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What is eating disorders?

Eating disorders are disorders of eating

behavior overvalued desire of weight

loss functional medical,

psychological, and social impairment.


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Pathways to Eating Disorders


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Types of eating disorders

Anorexia Nervosa

Bulimia Nervosa

Binge-eating disorder

MAJOR TYPES


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ANOREXIA NERVOSA?

The term anorexia nervosa is derived from

the Greekterm means loss o f appet i te.

Anorexia nervosa is a psychiatric illness

that describes an eating disorder

characterized by extremely low body

weight and body image distortion with an

obsessive fear of gaining weight.


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Epidemiology

Lifetime prevalence of anorexia nervosa is

less than 1% and is 10 times more

frequent in women than in men.

Peaks occur at early and late teen years.


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Three essential criteria!!

1. Behaviorself-induced starvation to a

significant degree.

2. Psychopathologystrong drive for

thinness and/or a morbid fear of fatness.

3. Physiological symptomatology the

presence of medical signs and

symptoms resulting from starvation.


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Types of anorexia nervosa

Restricting typeloses weight by severely

limiting the amount of food consumed.

Binge-eating-purgingtypeengages in

binges (large amount of food consumed)

following by purging (vomiting or use of

laxatives).


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Etiology

1. Physiological factors:

Genetic factors

Neurobiological factors

Nutritional factors

2. Psychological factors

3. Social and environmental factors


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CLINICAL FEATURES

Ph i l f t


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Physical features : Extreme weight loss

Body mass index less than 17.5 in adults, or 85% of expected weight inchildren

Stunted growth

Endocrine disorder, leading to cessation of periods in girls (amenorrhoea) Decreased libido; impotence in males

Starvation symptoms, such as reduced metabolism, slow heart rate(bradycardia), hypotension, hypothermia and anemia

Abnormalities of mineral and electrolyte levels in the body

Thinning of the hair Constantly feeling cold

Zinc deficiency

Constipation

Dry skin

In cases of extreme weight loss, there can be nerve deterioration, leading todifficulty in moving the feet

Fragile appearance; frail body image

Slowing of the rate of growth of breasts

Drastic changes in blood pressure upon standing

Dizzyness and fainting

Etc.


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Psychological features: Distorted body image

Poor insight

Self-evaluation largely, or even exclusively, in terms oftheir shape and weight

Pre-occupation or obsessive thoughts about food andweight

Perfectionism

Obsessive compulsive disorder (OCD) Belief that control over food/body is synonymous with

being in control of one's life

Refusal to accept that one's weight is dangerously loweven when it could be deadly

Refusal to accept that one's weight is normal, or healthy loss in memory

hallucinations


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Emotional features :

Low self-esteem and self-efficacy

Phobia of becoming overweight

Clinical depression

Mood swings

Feelings of loneliness


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Behavioral features:

Excessive exercise, food restrictions

Secretive about eating or exercise behavior Self-harm, substance abuse

Very sensitive to references about body weight

Aggressive when forced to eat Social withdraw or being anti-social

Checking body in the mirror constantly

Checking body weight on scale constantly Thoughts of suicide


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Table 1. DSM-IV-TR Diagnostic Criteria for Anorexia Nervosa

A.Refusal to maintain body weight at or above a minimally normal weight for age

and height (e.g., weight loss leading to maintenance of body weight less than 85%of

that expected, or failure to make expected weight gain during period of growth, leadingto body weight less than 85% of that expected).

B.Intense fear of gaining weightor becoming fat, even though underweight.

C.Disturbancein the way in which onesbody weight or shape is experienced, undue

influence of body weight or shape on self-evaluation, or denialof the seriousness of the

current low body weight.D.In postmenarcheal women, amenorrhea, i.e., the absence of at least three

consecutive menstrual cycles. (A woman is considered to have amenorrhea if her

periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

Restricting type: during the current episode of anorexia nervosa, the person has not

regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the

misuse of laxatives, diuretics, or enemas)

Binge-eating or purging type: during the current episode of anorexia nervosa, the

person has regularly engaged in binge-eating or purging behavior (i.e., self-induced

vomiting or the misuse of laxatives, diuretics, or enemas)

T bl 2 ICD 10 Di i C i i f A i N


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Table 2. ICD-10 Diagnostic Criteria for Anorexia Nervosa

Anorexia nervosa :

A.There is weight lossor, in children, a lack of weight gain, leading to a body weight at least

15% below the normalor expected weight for age and height.

B.The weight loss is self-inducedby avoidance of fatteningfoods.

C.There is self-perception of being too fat, with an intrusive dread of fatness, which leads to a

self-imposed low weight threshold.

D.A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is

manifest in women as amenorrheaand in men as a loss of sexual interest and potency. (An

apparent exception is the persistence of vaginal bleeds in anorexic women who are on

replacement hormonal therapy, most commonly taken as a contraceptive pill.)

E.The disorder does not meet Criteria A and B for bulimia nervosa.

Comments :

The following features support the diagnosis but are not essential elements: self-induced

vomiting, self-induced purging, excessive exercise, and use of appetite suppressants or diuretics.

If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth

ceasesin girls, the breasts do not develop and there is a primary amenorrhea; in boys, thegenitals remain juvenile). With recovery, puberty is often completed normally, but the menarche

is late.

Atypical anorexia nervosa :

Researchers studying atypical forms of anorexia nervosa are recommended to make their own

decisions about the number and type of criteria to be fulfilled.


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COMPLICATIONS

Cardiovascular

Muscular Skeletal

GIT

Endocrine System

Death


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TREATMENT

Medical care

Psychotherapy

Nutritional therapy

Medications

Hospitalization


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THANK YOU

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Anorexia Nervosa Calvina