Related articles: Anorexia Nervosa
Definition
Anorexia nervosa (AN) is a disorder of eating behavior. It is characterized by an obsessive search for thinness, with the refusal of food by the subject and pathological fear of gaining weight, even in the presence of an obvious underweight. This problem arises mainly in girls and young women, especially during adolescence. Probably family and social factors are involved.
The adoption of dietary regimes and other measures to keep weight under control seems to indicate an increased risk. Anorexia nervosa can be mild and transient or severe and long lasting.
Most common symptoms and signs *
- Acne
- Aggression
- Amenorrhea
- Anorexia
- Arrhythmia
- bradycardia
- Cachexia
- calli
- Decline in sexual desire
- Brittle and dry hair
- Depression
- Difficulty concentrating
- dysphoria
- Erectile dysfunction
- dysgeusia
- Dehydration
- Abdominal pain
- dromomania
- Edema
- Bone fractures
- Reddened gums
- Abdominal swelling
- Starvation
- hypertrichosis
- Hypophosphatemia
- Hypoglycemia
- undernourishment
- Hypotension
- Hypothermia
- Hirsutism
- lanugo
- Thinness
- Headache
- marasma
- Mediastinitis
- Functional Meteorism
- Osteopenia
- Pallor
- Dry skin
- Weight loss
- Gastrointestinal perforation
- Cold sensation
- Drowsiness
- Constipation
- Inflated stomach
- Brittle nails
- Wear of teeth
Further indications
Anorexia nervosa can occur with restrictions or with compulsive feeding, associated with elimination behaviors. In the first case, the subject simply limits the intake of food (despite the appetite is preserved), without putting in place binges or elimination behaviors. In the second case, however, patients regularly binge, then self-induce vomiting or abuse of laxatives and diuretics.
Anorexic patients study maniacs and calories maniacally; sometimes they engage in excessive physical activity; they accumulate, hide and throw away food; they lie about taking meals and behaving in secret (such as self-induced vomiting).
The anorexic patient has an extreme thinness. Frequently encountered symptoms include bloating, abdominal pain and constipation. In those who vomit often erosions of the tooth enamel are found, painless hypertrophy of the salivary glands and inflammation of the esophagus; characteristic is also the sign of Russel, a callosity that forms on the back of the hands due to the repeated rubbing against the upper incisors, during the introduction of the fingers in the oral cavity, in an attempt to induce vomiting.
Anorexia nervosa influences psychological, neuroendocrine, hormonal and metabolic functions.
Endocrine changes that can be found include: reduced secretion of the luteinizing hormone, increased secretion of cortisol (or Cushing's syndrome), low levels of thyroxine (T4) and triiodothyronine (T3). In women, menstruation generally ceases (amenorrhea). Over time, malnutrition, decay, dehydration and metabolic alkalosis can develop; all this is aggravated by self-induced vomiting and the use of laxatives or diuretics.
Bone mineral density decreases. This can lead to osteopenia and even osteoporosis. The cardiac muscle mass also decreases, with a reduction in the size of the heart chambers and cardiac output. Possible consequence is mitral valve prolapse. Many individuals with anorexia nervosa have bradycardia.
Anorexic patients usually lose interest in sex and show psychological distress in the form of anxiety, depression or personality disorders.
Other manifestations that can be found in the case of anorexia nervosa are: marked hypotension, cold intolerance (or hypothermia), hypoglycemia, peripheral edema, headache, decreased concentration, lethargy or excess energy. On a dermatological level, there may be skin xerosis, acne, nail fragility, lanugo (fine and soft hair) or slight hirsutism.
The diagnosis is clinical. Criteria to confirm anorexia nervosa include: body weight ≤ 85% of expected weight; fear of obesity; amenorrhea in females; distortion of body image and denial of disease. The differential diagnosis is made with respect to schizophrenia and primary depression; both of these disorders can lead to similar results.
Treatment may require short-term hospitalization to regain body weight. Anorexia nervosa requires psychological therapy. Antipsychotics like olanzapine can help with weight gain and alleviate the pathological fear of obesity. Fluoxetine, on the other hand, can help prevent relapses after weight has been stabilized.
