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Feeding and Eating Disorders: Anorexia Nervosa
Feeding and Eating Disorders: Anorexia Nervosa
Anorexia Nervosa
o Definition
1
Anorexia nervosa (AN) is a syndrome characterized by three essential criteria. The first is a self-
induced starvation to a2significant degree—a behavior. The second is a relentless drive for
thinness and/or a morbid fear of fatness—a psychopathology. The third criterion is the presence of
3 medical signs and symptoms resulting from starvation—a physiological symptomatology.
o Epidemiology
o Subtypes:
1- Restricting subtype: This is the most commonly known type of Anorexia Nervosa whereby a
person severely restricts their food intake.
2- Bing - eating / purging subtype: A person restricts their intake as above, but also during some
bouts of restriction the person has regularly engaged in binge-eating OR purging behavior (e.g.
self induced vomiting, over-exercise, misuse of laxatives, diuretics or enemas).
The difference between this type and bulimia that in this type the patient has very
low weight
1
Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry
o Etiology:
• Multifactorial.
• Individual: Perfectionism and impulse to control ( common in gymnasts & ballet dancers).
• Familial: Family effect, dysfuncional family environment
• Social factors: Wrong seeking for body perfectionism, preassure of the society to be thin,
effect of media, others.
• Biological: hypothalamic dysfunction, disordered serotonin, norepinphrine and dopamine.
o Medical Complication:
A. Persistent restriction of energy intake leading to significantly low body weight (in context of
what is minimally expected for age, sex, developmental trajectory, and physical health) .
B. Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that
interferes with weight gain (even though significantly low weight).
C. Disturbance in the way one's body weight or shape is experienced, undue influence of body
shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the
current low body weight.
2
Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry
o Management:
Bulimia Nervosa
Female>male
o Etiology:
• Genetic: MZ : DZ = 22% : 9%
3
Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry
• Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is
definitely larger than most people would eat during a similar period of time and under similar
circumstances.
• A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop
eating or control what or how much one is eating).
Purging
• Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as
self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or
excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least
once a week for three months.
• The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Management:
• Identifying and treat any associated mental health disorders such as depression or anxiety
• Nutritional counseling .
• Cognitive behavior therapy.
4
Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry
• Binge Eating Disorder is less common but much more severe than overeating.
Eating, in a discrete period of time (e.g. within any 2-hour period), an amount
of food that is definitely larger than most people would eat during a similar period of
time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g. a feeling that
one cannot stop eating or control what or how much one is eating).
• Binge eating not associated with the recurrent use of inappropriate compensatory
behaviours as in Bulimia Nervosa and does not occur exclusively during the course of
Bulimia Nervosa, or Anorexia Nervosa methods to compensate for overeating, such as self-
induced vomiting.
o Management:
5
Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry
Pica
o Management: