Anorexia Nervosa

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Anorexia Nervosa
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Overview

Anorexia nervosa is an eating disorder characterized by low body weight, fear of gaining weight, and an abnormally strong desire to be thin. There appear to be some genetic components, influence of cultural factors and environmental factors, such as a major life-change or stress-inducing event. Complications may include osteoporosis, infertility, metabolic problems and cardiac damage, among others.

Causes:

Known to be a highly heritable disease, first degree relatives of the patients have roughly 12 times the risk of developing anorexia nervosa. 128 different polymorphisms have been related to 43 genes including genes involved in regulation of eating behavior. Consistent associations have been identified with agouti-related peptide, catechol-o-methyl transferase, brain derived neurotrophic factor, SK3 and opioid receptor delta-1.

Environmental influences have a great role in pathogenesis of anorexia nervosa. Prenatal and perinatal complications may factor into the development of anorexia nervosa, such as preeclampsia, placental infarction, maternal anemia, diabetes mellitus, and neonatal cardiac abnormalities. Neuroendocrine dysregulation may contribute to the pathogenesis of anorexia nervosa by disrupting regulation of hunger and satiety. People with celiac disease, irritable bowel syndrome or inflammatory bowel disease are prone to develop anorexia nervosa.

Psychological causes of anorexia nervosa include low self-esteem, depression, anxiety, and loneliness. There is higher incidence and prevalence of anorexia nervosa in sports with an emphasis on aesthetics, dancers, models and persons engaged in media and show business.

Signs and symptoms:

Symptoms and signs are diverse and may include low body mass index for one's age and height, amenorrhea, brittle hair, unhealthy and yellow skin, fear of even the slightest weight gain, rapid and continuous weight loss, soft, fine hair growing over the face and body, obsession with counting calories, preoccupation with food, recipes, or cooking, food restrictions despite being underweight, and food rituals (cutting food into tiny pieces, refusing to eat around others).

Additional signs and symptoms may also include excessive exercise, perception of self as overweight, intolerance to cold, body temperature may lower (hypothermia), orthostatic hypotension, bradycardia or tachycardia, depression, anxiety and insomnia, abdominal distension, halitosis, dryness of hair and skin, as well as hair thinning, chronic fatigue, rapid mood swings, feet discoloration (orange appearance), muscle aches and pains, habits of self harming or self-loathing, and admiration of thinner people.

Diagnosis:

Diagnostic assessment includes the person's medical history, current circumstances, family history, current symptoms, and clinical findings. The assessment also includes a mental state examination along with views on weight and patterns of eating.

There are two subtypes of anorexia nervosa: Binge eating (purging type) & Restricting type.

Binge-eating: Patient resorts to binge eating or displays purging behavior as a means for cieving loss of body weight.

Restricting type: Patient uses restricting food intake, prolonged periods of fasting, diet pills, or exercise as a means for losing weight.

Medical tests required to check for signs of physical deterioration in anorexia nervosa include CBC, Urinalysis, glucose tolerance test, liver function test, BUN, CPK, BUN to creatinine ration, ECG, EEG, LH response to GNRH, serum cholinesterase test and serum electrolytes.

Management:

There is no particular treatment for anorexia. Treatment tries to address restoring the person to a healthy weight, treating the psychological disorders associated with the illness, and reducing behaviours or thoughts that led to the disordered eating behavior. Psychotherapy and family-based treatment (FBT) have been shown to be successful with good, sustained outcomes. Cognitive behavioral therapy, acceptance and commitment therapy, and Cognitive remediation therapy are used in treating anorexia. Drugs have no role in the treatment of anorexia and diet is the most essential factor that works in people with anorexia by tailoring their needs.

Other names of the condition:

Anorexia