PCL 11- WHAT IS ANOREXIA NERVOSA

Background

Anorexia nervosa (AN) is a psychiatric disorder with severe physiologic consequences, characterized by the inability or refusal to maintain a minimally normal weight. Patients have a profoundly disturbed body image as well as an intense fear of weight gain despite being moderately to severely underweight.

Diagnostic criteria for anorexia nervosa in the Diagnostic and Statistical Manual of Mental Disorders IV include the following:

* A refusal to maintain body weight at or above a minimally normal weight for age and height (usually less than 85% of ideal body weight)
* Intense fear of gaining weight or becoming fat
* Disturbance in the way one's body weight or shape is experienced, with denial of current low body weight
* Amenorrhea in postmenarchal females of at least 3 menstrual cycles

Anorexia nervosa may be further divided into 2 subtypes: (1) restricting, in which severe limitation of food intake is the primary means to weight loss, and (2) binge-eating/purging type, in which there are periods of food intake that are compensated by self-induced vomiting, laxative or diuretic abuse, and/or excessive exercise. Formal recommendations have been made to remove the amenorrhea criteria and the subtype distinctions from the criteria for AN in the upcoming DSM-V. In addition, numerous studies have demonstrated subthreshold eating disorders either alone or coexistent with other psychiatric diagnoses, suggesting the diagnostic criteria may need to be expanded, and there may be a higher prevalence of AN than previously thought.

Patients may or may not carry a diagnosis of AN when presenting to an emergency department for acute care, and other physiologic causes of malnutrition, weight loss, and amenorrhea must be ruled out before making the diagnosis.

Patients with anorexia nervosa often display other personality traits such as a desire for perfection, academic success, lack of age-appropriate sexual activity, and a denial of hunger in the face of starvation. Psychiatric characteristics include excessive dependency needs, developmental immaturity, social isolation, obsessive-compulsive behavior, and constriction of affect. Many patients also have comorbid mood disorders, with depression and dysthymic disorder being most prevalent.