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Anorexia nervosa (AN), usually seen in young girls, is characterised by severe emaciation induced by self-imposed starvation. Enlargement of the ventricular system and sulci has been reported, as has high signal on T2-weighted images. We present a case with atrophic changes and high signal on T2-weighted images, which resolved completely following weight gain.
Anorexia nervosa has been associated with various hematologic and immunologic abnormalities, including characteristic bone marrow changes, red cell acanthocytosis, leukopenia, complement deficiencies, and defective bactericidal activity of granulocytes. Dietary and psychogenic factors may play a role in these abnormalities, which are readily reversible after resolution of the underlying anorectic state. Although clinical data are conflicting, anorectic patients may have an increased susceptibility to infection.
Anorexia nervosa occurs predominantly in white, middle-class, adolescent females with perfectionistic tendencies. Their solution to the intense guilt induced by any sensory pleasure is to deny themselves the pleasure of eating. Amenorrhea is universal. Diagnostic criteria include a 25 percent weight loss. Therapies are long and involved different approaches. All recognize that food is the medicine for the body and that some form of supportive psychotherapy is the medicine for the mind.
Anorexia nervosa is a common disorder, that is becoming an increasing burden on health care institutions. It has complicated biological and psychological symptoms that reinforce each another. The treatment is of long duration and is often difficult. Patients are ambivalent about treatment and the treating doctor must actively motivate them to continue treatment. An important part of the treatment is the re-establishment of normal body weight. Uncomplicated cases should be treated by the general practitioner.
Anorexia nervosa typically occurs in a "model child" of a family that values achievement, appearance and nonconflictual interactions. Three diagnostic criteria are weight loss of at least 25 percent of ideal body weight, physiologic changes (including amenorrhea) and a distorted body image in which the patient, even when cachectic, insists she is fat. Therapy must involve the entire family, focusing not on pounds gained but on learning to handle conflict.
Anorexia nervosa and bulimia nervosa typically afflict individuals in adolescence. Given the intractability of these diseases in combination with the natural recalcitrance of adolescence, treatment with this population presents a daunting challenge. Traditional group therapy that focuses on verbal therapy is often not effective with this population, particularly in the acute stages of the diseases. A group therapy approach that integrates art therapy, psychodrama, and verbal therapy offers an innovative alternative to traditional group therapy.
Anorexia nervosa (AN) is a complex disorder of unclear etiology. We argue that the current DSM-IV criteria do not adequately describe the cardinal symptoms of this "eating disorder". Our reasoning is based on the lack of empirical evidence supporting the terminology of some of the criteria, which underlie the core of our current conceptualisation of AN. We propose alternative criteria which allow a better integration of biologically derived hypotheses addressing the nosology and the symptomatology of AN.
Anorexia nervosa is not a new disease but it has become increasingly recognized and occurs more frequently in adolescent girls and young women. Among older women, its incidence has remained constant. Scientific evidence suggests that dieting triggers a process of catastrophic weight loss in persons who are psychologically and physiologically vulnerable. Long-term studies are demonstrating diverse outcomes ranging from full recovery to chronicity and death. Treatment is often based on unproven theory and on short-term goals. Research studies comparing the effects of different treatment regimens are needed.
Anorexia nervosa is a multidimensional syndrome in which perfectionistic striving appears as a common component of the symptom cluster. Multiple studies have linked this character trait to attempts to achieve a "perfect" weight. In contrast, no empirical data are available that document perfectionistic striving outside of food and weight themes. The present study (N = 20) looked for evidence of perfectionistic striving in school behavior by comparing school achievement and IQ scores. School achievement was found to be significantly greater than would be predicted by IQ scores. This finding and directions for future research are discussed.
Anorexia nervosa (AN), one of the major eating disorders, is a primarily psychiatric illness affecting a number of adolescents and young adults. AN usually runs a chronic course and is associated with significant morbidity and mortality. Drug therapy has modest success in its treatment. Various pharmacotherapeutic agents are being tested, with variable success. Selective serotonin re-uptake inhibitors are the one class of drug that has been found to be effective in AN, especially in preventing relapse. This article provides an overview of the current literature on the role of selective serotonin re-uptake inhibitors in the treatment of AN.
Anorexia Nervosa (AN) usually follows a prolonged course accompanied by significant morbidity and high mortality. AN patients have been found to have elevated and attempted suicide rates, with suicide being the second most common cause of death in AN after the complications of the disorder itself. The suicide risk in AN is similar to that in major depression or conduct disorder and linked mainly to longer duration of illness, lower weight, bingeing and purging, impulsivity-related manifestations, comorbid substance abuse, and affective disorder. This paper reviews suicidal tendency and disturbed body image, death and eating disorders, and attachment and death with clinical implications related to AN.
Anorexia nervosa in childhood and adolescence, associated with impaired growth can be considered as a form of chronic malnutrition. Twelve patients aged 11 to 17 years were investigated. In spite of increased GH secretion, plasma somatomedin activities were diminished in 8 cases. Plasma T4, T3 and arginine stimulated insulin secretion were also decreased. In six patients who gained weight a significant negative correlation was found between weight deficit and plasma somatomedin activity. Prolonged administration of growth hormone in one case did not stimulate the generation of somatomedin activity. Nutrition and increased insulin secretion could plan a role in changes observed during recovery.
Anorexia nervosa (AN) is associated with a paradoxical reduction in hunger ratings following 2-deoxy-D-glucose (2DG) induced glucose insufficiency. Because of the relationship between exercise and AN, there is interest in the weight-loss phenomenon produced by exercise in food restricted rats. This investigation determined if the weight-loss phenomenon is associated with a paradoxical suppression of food intake following 2DG and if the effect is related to reductions in prevailing glucose and insulin levels. Weight-matched, normal-weight exercised and normal-weight unexercised rats served as controls. As predicted, 2DG reduced food intake in animals subjected to the phenomenon (1.5 h/day food access and 22.5 h/day running wheel access). This effect was related to reductions in plasma glucose and insulin under the conditions that prevailed at the time of injection. Since these changes also occurred in weight-matched controls, they were attributed to the general effects of weight loss. A situational specificity for the "anorexia" of the weight-loss syndrome was also demonstrated. Finally, the strengths and weaknesses of the phenomenon as a model of AN were considered.
Anorexia nervosa is a serious psychiatric illness with a high morbidity and a significant lifetime mortality. Recurring themes in such patients centre on issues of self-worth and control. Treatment is difficult and prolonged, and may require hospitalisation. Therapy focuses on altering the misperceptions that patients have of themselves, both psychologically and physically. A multi-disciplinary team based in a specialised unit provides the treatment of choice, but if this is not available, a consistent, supportive relationship with an individual therapist familiar with the condition will be beneficial. Successful outcome should be based not simply on body weight but also on the resolution of anorexic thinking.
Anorexia nervosa (AN) is an eating disorder (ED) identified using DSM-IV criteria. Eating disorders are occurring increasingly earlier in childhood and can lead to a series of oral manifestations. The aim of this study was to evaluate the correlation between stomatognathic lesions and eating disorders in 80 young patients (76 females and 4 males aged 9-18 years) with restricting or binge-eating/purging AN. The results confirm the close correlation between ED and oral lesions, the most common of which were dental erosion, dentinal hypersensitivity, the extrusion of amalgam restorations and xerostomia. The authors conclude by emphasising the importance of involving dentists in the diagnosis and treatment of ED.
Anorexia nervosa is an eating disorder observed with increasing frequency, especially among adolescent females. No consensus exists concerning the causes of the disorder. Social, psychosexual, family system, biological theories, and the regression hypothesis have been advanced to explain the phenomenon. The major characteristics are 25% loss of body weight, use of various means to lose weight, weight phobia, preoccupation with food, body image disturbances, as well as numerous associated medical conditions: bradycardia, hypotension, dehydration, hypothermia, electrolyte abnormalities, amenorrhea, metabolic changes, and abdominal distress. Anorexic adolescents resist treatment and may die if not cured. The following therapeutic modalities have been effective: hospitalization, and cognitive, behavioral, and family therapy. Some of the typical family patterns, early characteristics, social adjustment problems, and society's contribution to the disorder are presented.
Anorexia nervosa (AN) is classified as a high-risk factor for osteoporotic fractures. Dual X-ray absorptiometry (DXA) is the most popular method for measuring bone loss, but it is less sensitive than quantitative computed tomography (QCT). We compared DXA and QCT in measuring the lumbar spine of 17 female patients with AN and 27 healthy subjects. We found discordance between DXA and QCT using World Health Organization (WHO) criteria with the T-score. With QCT as a reference method because of its sensitivity, we found one false-negative, one false-positive, and two misdiagnosed cases. We suggest some correction factors to improve DXA evaluation and screening of bone loss in AN.
Anorexia nervosa (AN) is commonly attributed to psychological conflicts, attempts to be fashionably slender, neuroendocrine dysfunction, or some combination of these factors. Considerable research reveals these theories to be incomplete. Psychological and societal factors account for the decision to diet but not for the phenomenology of the disorder; theories of biological defects fail to explain neuroendocrine findings that suggest coordinated physiological mechanisms. This article presents evidence that AN's distinctive symptoms of restricting food, denial of starvation, and hyperactivity are likely to be evolved adaptive mechanisms that facilitated ancestral nomadic foragers leaving depleted environments; genetically susceptible individuals who lose too much weight may trigger these archaic adaptations. This hypothesis accounts for the occurrence of AN-like syndromes in both humans and animals and is consistent with changes observed in the physiology, cognitions, and behavior of patients with AN.