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Anorexia nervosa
From WikEM
Contents
Background
- Associated with body image disturbance
- Adolescent girls
- Life long risk
- Body image is predominate measure of self worth
- Mortality 6-20%
Clinical Features
Diagnostic Criteria
- A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. [1]
- B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Symptoms
- Constipation
- Abdominal pain
- Fatigue
- Weakness
- Amenorrhea
- Depression
- Hair loss
Signs
- Fine facial and body hair (lanugo)
- Brittle hair and nails
- Dry, scaly skin
- Loss of subcutaneous fat
- Breast and vaginal atrophy
Differential Diagnosis
- Gastrointestinal disease
- Hyperthyroidism
- Occult malignancies
- AIDS
- Major depressive disorder
- Schizophrenia
- Substance use disorders
- Social anxiety disorder
- Obsessive-compulsive disorder
- Body dysmorphic disorder
- Bulimia nervosa
- Avoidant/restrictive food intake disorder
Evaluation
- Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease[2]
- CBC
- Chem 10
- ECG
Management
- inpatient management
- Extremely low weight (<75% of expected body weight) or rapid weight loss
- Severe electrolyte imbalances
- Cardiac disturbances
- Acute medical disorders
- Severe or intractable purging
- Psychosis or a high risk of suicide
Disposition
Also See
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- ↑ John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452
Authors
Matin Shah, Aaron Snyder, Ross Donaldson, Daniel Ostermayer, Neil Young
