Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology

Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology


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of pharmacology and clinical reasoning topics. Try it free today. Anorexia nervosa, which is often just called
anorexia, is a disorder that is characterized by very low weight (typically less than 85%
of normal body weight), a constant fear of gaining even the slightest amount of weight,
and having a distorted view of their own body weight or shape, often believing that they
are overweight, while actually being underweight. Now there are two main types of anorexia. One form of the disorder is the restricting
type, where people reduce the amount of food they eat in order to lose weight. Another form of the disorder is the binge-eating
and then purging type, where individuals eat large amounts of food in one sitting and then
purge that food through vomiting or by taking laxatives. This can be confused with another eating disorder—bulimia
nervosa, but the main distinction between these two disorders has to do with an individual’s
weight. Individuals with bulimia are usually normal
weight or overweight, whereas individuals with anorexia are underweight. Because of this, people can potentially start
out with bulimia, and then develop anorexia over time. Anorexia can be further split by levels of
severity. A body mass index, or BMI, between 18.5 and
24.9 is considered healthy, someone with anorexia though that has a BMI between 17 and 18.5
is considered mild, a BMI of 16-17 is considered moderate, a BMI of 15-16 is severe, and having
a BMI of less than 15 is considered extreme. People who meet all the criteria for anorexia
except that they are within or above the normal weight range after significant weight loss
can be diagnosed with atypical anorexia nervosa. Now in addition to having a low BMI, individuals
with anorexia are typically fearful of weight gain, and often have a psychological obsession
with the caloric and fat content of food, often leading to food restrictive behaviors,
purging, exercise, and frequent weight checks. They might perform specific food rituals,
like cutting food into small pieces, or eating foods in a specific order. They might refuse to ever eat in front of
people, or cook elaborate meals for others, but then not eat themselves. Like a dinner party host who’s unwilling
to eat his/her own food. Anorexia literally starves the entire body
and can cause a number physical changes affecting every body system, which can end up being
clues to the diagnosis. There is often a loss of muscle tissue throughout
the body, reflected by a low creatinine level and symptoms of fatigue from weak muscles
throughout the body, including a weak diaphragm which can cause difficulty breathing. Even the heart can lose muscle, and this loss
of cardiac muscle tissue can lead to bradycardia—less than 60 heart beats per minute, and hypotension—a
blood pressure below 90/50, as well as orthostatic hypotension when blood pressure falls when
a person goes from a lying down position to a standing position. A weak heart can lead to congestive heart
failure and combined with low protein levels in their blood can cause significant edema
or swelling, especially in the feet. There may also be serious electrolyte abnormalities
like low potassium, magnesium, and phosphate level, as well as key vitamin deficiencies
such as thiamine also known as Vitamin B1. Women can have amenorrhea, where either the
normal menstrual cycle stops or menstruation doesn’t start by age 15. Prolonged food restriction can also make the
gastrointestinal tract unable to handle normal meals which causes terrible bloating and nausea
as well as constipation. Also, the bone marrow can start shutting down—so
you get fewer white blood cells which leads to a dampened immune response, fewer red blood
cells which leads to lower energy levels, and fewer platelets which leads to easy bleeding
and bruising. Anorexia can also cause osteoporosis where
the bones become weak and susceptible to fractures. The skin can change, with symptoms like dry
scaly skin, and also the hair on their head can become brittle and fall out easily, and
soft hairs called lanugo covering their body. Some people might also have halitosis or really
bad breath from repeated vomiting. Finally, it can affect the brain, which causes
atrophy and encephalopathy, which can cause symptoms like ataxia, confusion, and even
death. In addition to these complications, there’s
also something known as refeeding syndrome where refeeding stimulates secretion of insulin,
which causes cells to take in already low levels of potassium, magnesium, and phosphate,
which causes levels in the serum to be dangerously low, and these deficits in electrolytes can
lead to severe heart arrhythmias and even cardiac death. This is why patients with anorexia typically
get an exhaustive medical workup and are carefully monitored with ECGs as they are slowly refed
and brought back up to a healthy weight. Pinpointing the exact cause of anorexia is
tough right? Because it’s likely a complex interaction
of various factors like genetic and hormonal factors, for example abnormalities in the
signals that convey information about hunger and fullness, as well as social/environmental
factors like peer groups and popular culture. In addition, anorexia is associated with low
self-esteem, loneliness, sensitivity to peer pressure, and feeling a need for approval. Individuals with anorexia might also chronically
over-react to stressful situations, and they might exhibit perfectionist behavior, and
might feel the need to have control of specific parts of their life—like their weight. There are also higher rates of anorexia in
countries where thinness is valued, which could reflect an internalization of societal
standards of beauty. Anorexia typically starts in the teen years
or in young adulthood—a time when individuals usually start to pay attention to the media,
and rates of anorexia are higher for individuals who have higher exposure to media. Also, although anorexia is more common in
women, it’s worth mentioning that men suffer from anorexia as well, and in both genders
it can often be seen among athletes and professionals who are keenly focused on their body weight
and percent body fat, such as in some types of dancing, modeling, and wrestling. Finally, anorexia is also commonly associated
with other conditions like obsessive-compulsive disorder, depression, and anxiety, all of
which have overlapping symptoms and risk factors. As far as treatments go, medical treatment
with careful weight gain is important, there is an important role for psychotherapy and
cognitive behavioral therapy for both the individual and sometimes the family as well. These therapies focus on improving self-esteem
and teaching strategies to better cope with stress and social pressures, as well as identify
the patterns of thought that may be influencing their illness. So we’ve seen that anorexia can affect nearly
every body system in profound ways, but careful management and treatment and ultimately a
healthy pattern of eating can reverse a lot of these complications and issues associated
with anorexia.

One thought on “Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology”

  1. I struggle with anorexia nervosa and I’m not underweight. People can be over weight the perfect weight or underweight and be anorexic. The most that really matters is the thought and fears of food and the affect it has on ur body not how you look or how much you weigh.

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