Anorexia Nervosa (AN)

Signs and symptoms

• Obvious, rapid, dramatic weight loss.
• Scarring on the knuckles from placing fingers down the throat to induce vomiting (Russell's sign).
• Soft, fine hair grows on face and body (lanugo).
• Obsession with calories and fat content.
• Preoccupation with food, recipes, or cooking. May cook elaborate dinners for others but not eat themselves.
• Dieting despite being thin or dangerously underweight.
• Fear of gaining weight or becoming overweight.
• Cuts food into tiny pieces, refuses to eat around others, hides or discards food.
• Uses laxatives, diet pills, ipecac syrup, or water pills. May engage in self-induced vomiting. May run to the bathroom after eating in order to vomit and quickly get rid of the calories (purging).
• May engage in frequent, strenuous exercise.
• Perceives self to be overweight despite being told by others they are too thin.
• Becomes intolerant to cold. Frequently complains of being cold due to loss of insulating body fat. Body temperature lowers (hypothermia) in effort to conserve calories.
• May frequently be in a sad, lethargic state (depression).
• May avoid friends and family, becomes withdrawn and secretive.
• May wear baggy, loose-fitting clothes to cover weight loss.
• Cheeks may become swollen due to enlargement of the salivary glands caused by excessive vomiting.

Dermatologic signs

Xerosis, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticilaris, interdigital intertrigo, paronychia, generalized pruritus, acquired striae distensae, angular stomatitis, prurigo pigmentosa, edema, linear erythema craquele, acrodermatitis enteropathica, pellagra.

Possible medical complications

Constipation, diarrhea, electrolyte imbalance, cavities, tooth loss, cardiac arrest, amenorrhoea, edema, osteoporosis, osteopenia, hyponatremia, hypokalemia, optic neuropathy, brain atrophy, leukopenia.

What is anorexia nervosa (AN)?

Anorexia is probably one of the most common eating disorders out there. It's characterized by refusal to maintain a healthy body weight, and an obsessive fear of gaining weight due to a distorted self image. It is a serious mental illness with as high morbidity and mortality rates as any other psychiatric illnesses.

The term anorexia nervosa was established in 1873 by Sir William Gull. The word originate from from Greek and means lack of desire to eat. In the published medical papers of Sir Gull one can read about Miss A and her treatment in 1866-1870. She was one of the earliest AN case studies.

The history of anorexia nervosa began earlier than that though. There were early descriptions dating from the 16th and 17th century and the first recognition and description of AN as a disease was in the late 19th century.

The causes

There's a lot of theories to what causes AN, and other eating disorders, but there is so far no actual proof. Studies have hypothesized that the continuance of disordered eating patterns may be epiphenomena of starvation. The results of the Minnesota Starvation Experiment showed that normal controls exhibit many of the behavioral patterns of anorexia nervosa when subjected to starvation. This may be due to the numerous changes in the neuroendocrine system, which results in a self perpetuating cycle. Studies have suggested that the initial weight loss such as dieting may be the triggering factor in developing AN in some cases, possibly due to an already inherent predisposition toward AN. One study reports cases of AN resulting from unintended weight loss that resulted from varied causes such as a parasitic infection, medication side effects, and surgery. The weight loss itself was the triggering factor.

Treatment

The treatment of AN tries to address three main areas:

1. Restoring the person to a healthy weight
2. Treating the psychological disorders related to the illness
3. Reducing or eliminating behaviors or thoughts that originally led to the disordered eating.

• Diet and nutrition
  Zinc and essential fatty acids have been shown to be very helpful in the treatment of AN. One is often also helped by a medical nutrition therapist. The therapy is based on a detailed assessment of the person's medical history, psychosocial history, physical examination and dietary history.

• Medication
  Olanzapine has been shown to be effective in treating certain aspects of AN including to help raise the BMI (Body Mass Index) and reduce obsessionality, such as the thoughts about food.

• Psychotherapy/Cognitive remediation
  CBT (Cognitive Behavioral Therapy) is an evidence based approach which in studies to date has shown to be useful in adolescents and adults with AN. So has various forms of family therapy.