Anorexia nervosa
Encyclopedia
Anorexia nervosa is an eating disorder
characterized by refusal to maintain a healthy body weight
and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite
and is not strictly accurate. Certain medications or extreme stress, for example, may cause one to have anorexia. Anorexia Nervosa, on the other hand, has many complicated implications and may be thought of as a lifelong illness that survivors battle. The authors of the remaining entry do not follow the strict definitions (and interchange the terms)but it is worthwhile for the public to understand the difference.
Anorexia Nervosa is often coupled with a distorted self image
which may be maintained by various cognitive bias
es that alter how the affected individual evaluates and thinks about her or his body, food and eating. Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600–800 calories per day, but extreme cases of complete self-starvation are known. It is a serious mental illness with a high incidence of comorbidity
and the highest mortality rate of any psychiatric disorder.
Anorexia most often has its onset in adolescence and is most prevalent among adolescent girls. However, more recent studies show that the onset age of anorexia decreased from an average of 13 to 17 years of age to 9 to 12. While it can affect men and women of any age, race, and socioeconomic
and cultural
background, Anorexia nervosa occurs in females 10 times more than in males.
The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), thus meaning a lack of desire to eat.
that results from self-imposed starvation
, can cause severe complications in every major organ system in the body.
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 because of 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.
, ethnicity and socio-economic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk. People in professions where there is a particular social pressure to be thin (such as models
and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss.
Anorexia nervosa is more likely to occur in a person’s pubertal years, especially for girls. Female students are 10 times more likely to suffer from anorexia nervosa than male students. According to a survey of 1799 Japanese female high school students, “85% who were a normal weight wanted to be thinner and 45% who were 10–20% underweight wanted to be thinner.” Teenage girls concerned about their weight and who believe that slimness is more attractive among peers trend to weight-control behaviors. Teen girls are learning from each other to consume low-caloric, low-fat foods and diet pills. This results in lack of nutrition and a greater chance of developing anorexia nervosa.
It has also been noted that anorexia nervosa is more likely to occur in populations in which obesity is more prevalent. It has been suggested that anorexia nervosa results from a sexually selected evolutionary drive to appear youthful in populations in which size becomes the primary indicator of age.
There is also evidence to suggest that patients who have anorexia nervosa can be characterised by Alexithymia
and also a deficit in certain emotional functions. A research study showed that this was the case in both adult and adolescent anorexia nervosa patients.
There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia. The connection between eating disorders and abuse has been convincingly evidenced by a number of studies, including one published in Epidemiology (and strengthened by blind hypothesis survey), which showed in a comparison of women with no history of eating disorders, women with a history of eating disorders were twice as likely to have reported childhood sexual abuse. While the joint effect of both physical and sexual abuse resulted in a nearly 4-fold risk of eating disorders that met DSM-IV criteria. It is thought that links between childhood abuse and sexual abuse are complex, such as by influencing psychologic processes that increase a woman's susceptibility to the development of an eating disorder, or perhaps by producing changes in psychobiologic process and neurotransmitting function, associated with eating behaviour.
Recent efforts have been made to dispel some of the myths around anorexia nervosa and eating disorders, such as the misconception that families, in particular mothers, are responsible for their daughter developing an eating disorder.
(1983 & 1985) and others' initial suggestion of relationship between anorexia nervosa and autism
, a large-scale longitudinal study
into teenage-onset anorexia nervosa conducted in Sweden confirmed that 23% of people with a long-standing eating disorder are on the autism spectrum
. Those on autism spectrum tend to have a worse outcome, but may benefit from the combined use of behavioural and pharmacological therapies tailored to ameliorate autism rather than anorexia nervosa per se. Other studies, most notably research conducted at the Maudsley Hospital
, UK, furthermore suggest that autistic traits are common in people with anorexia nervosa; shared traits include, e.g., poor executive function, autism quotient score, central coherence
, theory of mind, cognitive-behavioural flexibility, emotion regulation and understanding facial expressions.
Zucker et al. (2007) proposed that conditions on the autism spectrum make up the cognitive endophenotype
underlying anorexia nervosa and appealed for increased interdisciplinary collaboration (see figure to right). A pilot study into the effectiveness Cognitive Behaviour Therapy, which based its treatment protocol on the hypothesised relationship between anorexia nervosa and an underlying autistic like condition, reduced perfectionism and rigidity in 17 out of 19 participants.
medical professional. There are multiple medical conditions, such as viral or bacterial infections, hormonal imbalances
, neurodegenerative diseases
and brain tumor
s which may mimic psychiatric disorders including anorexia nervosa.
According to an in depth study conducted by psychiatrist Richard Hall as published in the Archives of General Psychiatry
:
. The DSM-IV should not be used by laypersons to diagnose themselves.
misdiagnosed as AN, the patient spent two months confined to a psychiatric hospital.
There are various other psychological issues that may factor into anorexia nervosa, some fulfill the criteria for a separate Axis I diagnosis
or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 "clusters", A, B and C.The causality
between personality disorders and eating disorders has yet to be fully established. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder. Some develop them afterwards. The severity and type of eating disorder symptoms have been shown to affect comorbidity.
BDD is a chronic and debilitating condition which may lead to social isolation, major depression, suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe
and left parietal lobe
showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21 year old male following an inflammatory brain process. Neuroimaging showed the presence of new atrophy in the frontotemporal region.
The distinction between the diagnoses of anorexia nervosa, bulimia nervosa
and eating disorder not otherwise specified
(EDNOS) is often difficult to make as there is considerable overlap between patients diagnosed with these conditions. Seemingly minor changes in a patient's overall behavior or attitude can change a diagnosis from "anorexia: binge-eating type" to bulimia nervosa. It is not unusual for a person with an eating disorder to "move through" various diagnoses as his or her behavior and beliefs change over time.
In cases of adolescent anorexia nervosa that utilize Family treatment 75% of patients have a good outcome and an additional 15% show an intermediate yet more positive outcome. In a five year post treatment follow-up of Maudsley Family Therapy the full recovery rate was between 75% and 90%.
Even in severe cases of AN, despite a noted 30% relapse rate after hospitalization, and a lengthy time to recovery ranging from 57–79 months, the full recovery rate was still 76%. There were minimal cases of relapse even at the long term follow-up conducted between 10–15 years. The long-term prognosis of anorexia nervosa is changeable: a fifth of patients stay severely ill, another fifth of patients recover fully and three fifths of patients have a fluctuating and chronic course (Gelder, Mayou and Geddes 2005).
of 0.3-1% in women and 0.1% in men for the diagnosis in developed countries. The condition largely affects young adolescent women, with between 15 and 19 years old making up 40% of all cases. Approximately 75% of people with anorexia are female. Anorexia nervosa is more prevalent in the upper social classes and it is declared to be rare in less developed countries (Gelder, Mayou and Geddes 2005).
and continuing into the medieval period. A number of well known historical figures, including Catherine of Siena
and Mary, Queen of Scots are believed to have suffered from the condition.
Of interest in terms of anorexia nervosa is the medieval practice of self-starvation by women, including some young women, in the name of religious piety and purity. This is sometimes referred to as anorexia mirabilis
. By the thirteenth century, it was increasingly common for women to participate in religious life and to even be named as saints by the Catholic Church. Many women who ultimately became saints engaged in self-starvation, including Saint Hedwig of Andechs in the thirteenth century and Catherine of Siena in the fourteenth century. By the time of Catherine of Siena, however, the Church became concerned about extreme fasting as an indicator of spirituality and as a criteria for sainthood. Indeed, Catherine of Siena was told by Church authorities to pray that she would be able to eat again, but was unable to give up fasting.
The earliest medical descriptions of anorexic illnesses are generally credited to English physician Richard Morton
, in 1689.
However it was not until the late 19th century that anorexia nervosa was to be widely accepted by the medical profession as a recognised condition. In 1873, Sir William Gull, one of Queen Victoria’s personal physicians, published a seminal paper which established the term anorexia nervosa and provided a number of detailed case descriptions and treatments. In the same year, French physician Ernest-Charles Lasègue
similarly published details of a number of cases in a paper entitled De l’Anorexie Histerique.
Awareness of the condition was largely limited to the medical profession until the latter part of the 20th century, when German-American psychoanalyst Hilde Bruch
published her popular work The Golden Cage: the Enigma of Anorexia Nervosa in 1978. This book created a wider awareness of anorexia nervosa among lay readers. A further important event was the death of the popular singer Karen Carpenter
in 1983, which prompted widespread ongoing media coverage of eating disorders.
November 16 International Day against anorexia since 2005.
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
characterized by refusal to maintain a healthy body weight
Body weight
The term body weight is used in daily English speech as well as in the contexts of biological and medical sciences to describe the mass of an organism's body. Body weight is measured in kilograms throughout the world, although in some countries it is still measured in pounds or stones and pounds...
and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite
Anorexia (symptom)
Anorexia is the decreased sensation of appetite...
and is not strictly accurate. Certain medications or extreme stress, for example, may cause one to have anorexia. Anorexia Nervosa, on the other hand, has many complicated implications and may be thought of as a lifelong illness that survivors battle. The authors of the remaining entry do not follow the strict definitions (and interchange the terms)but it is worthwhile for the public to understand the difference.
Anorexia Nervosa is often coupled with a distorted self image
Body image
Body image refers to a person's perception of the aesthetics and sexual attractiveness of their own body. The phrase body image was first coined by the Austrian neurologist and psychoanalyst Paul Schilder in his masterpiece The Image and Appearance of the Human Body...
which may be maintained by various cognitive bias
Cognitive bias
A cognitive bias is a pattern of deviation in judgment that occurs in particular situations. Implicit in the concept of a "pattern of deviation" is a standard of comparison; this may be the judgment of people outside those particular situations, or may be a set of independently verifiable...
es that alter how the affected individual evaluates and thinks about her or his body, food and eating. Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600–800 calories per day, but extreme cases of complete self-starvation are known. It is a serious mental illness with a high incidence of comorbidity
Comorbidity
In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...
and the highest mortality rate of any psychiatric disorder.
Anorexia most often has its onset in adolescence and is most prevalent among adolescent girls. However, more recent studies show that the onset age of anorexia decreased from an average of 13 to 17 years of age to 9 to 12. While it can affect men and women of any age, race, and socioeconomic
Socioeconomics
Socioeconomics or socio-economics or social economics is an umbrella term with different usages. 'Social economics' may refer broadly to the "use of economics in the study of society." More narrowly, contemporary practice considers behavioral interactions of individuals and groups through social...
and cultural
Culture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...
background, Anorexia nervosa occurs in females 10 times more than in males.
The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), thus meaning a lack of desire to eat.
Signs and symptoms
A person with anorexia nervosa may exhibit a number of signs and symptoms, some of which are listed below. The type and severity vary in each case and may be present but not readily apparent. Anorexia nervosa and the associated malnutritionMalnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
that results from self-imposed starvation
Starvation
Starvation is a severe deficiency in caloric energy, nutrient and vitamin intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, death...
, can cause severe complications in every major organ system in the body.
- Refusal to reach healthy Body Mass Index (weight at or above the minimally normal body weight for their age and height)
- amenorrhea: The absence of 3 consecutive menstural cycles
- anxious about weight gain and fearful of becoming overweight
- obvious, rapid, dramatic weight lossWeight lossWeight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
- lanugoLanugoLanugo is fine, downy hair as a type of fur. It is often found in teratomas .-Fetal development:Lanugo grows on fetuses as a normal part of gestation, but is usually shed and replaced by vellus hair at about 33 to 36 weeks of gestational age...
: soft, fine hair grows on face and body - obsessionFixation (psychology)Fixation: 'concept originated by Sigmund Freud to denote the persistence of anachronistic sexual traits'. Subsequently '"Fixation" acquired a broader connotation...
with caloriesFood energyFood energy is the amount of energy obtained from food that is available through cellular respiration.Food energy is expressed in food calories or kilojoules...
and fatFatFats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
content - preoccupation with foodFoodFood is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals...
, recipes, or cookingCookingCooking is the process of preparing food by use of heat. Cooking techniques and ingredients vary widely across the world, reflecting unique environmental, economic, and cultural traditions. Cooks themselves also vary widely in skill and training...
; may cook elaborate dinners for others but not eat themselves - dietingDietingDieting is the practice of eating food in a regulated fashion to achieve or maintain a controlled weight. In most cases dieting is used in combination with physical exercise to lose weight in those who are overweight or obese. Some athletes, however, follow a diet to gain weight...
despite being thin or dangerously underweightUnderweightThe term underweight refers to a human who is considered to be under a healthy weight. "Underweight" means weighing less than what is expected to be a healthy person . The definition is usually made with reference to the body mass index . A BMI of under 18.5 is usually referred to as underweight... - rituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food
- purging: uses laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomitingVomitingVomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
; may run to the bathroom after eating in order to vomit and quickly get rid of the calorieCalorieThe calorie is a pre-SI metric unit of energy. It was first defined by Nicolas Clément in 1824 as a unit of heat, entering French and English dictionaries between 1841 and 1867. In most fields its use is archaic, having been replaced by the SI unit of energy, the joule...
s (see also bulimia nervosaBulimia nervosaBulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
). - may engage in frequent, strenuous exercise
- perceptionPerceptionPerception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...
: perceives self to be overweight despite being told by others they are too thin - becomes intolerant to cold: frequently complains of being cold from loss of insulating body fat or poor circulation resulting from extremely low blood pressure; body temperature lowers (hypothermiaHypothermiaHypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
) in effort to conserve energy - depressionDepression (mood)Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
: may frequently be in a sad, lethargic state - solitudeSolitudeSolitude is a state of seclusion or isolation, i.e., lack of contact with people. It may stem from bad relationships, deliberate choice, infectious disease, mental disorders, neurological disorders or circumstances of employment or situation .Short-term solitude is often valued as a time when one...
: may avoid friends and family; becomes withdrawn and secretive - clothing: some may wear baggy, loose-fitting clothes to cover weight loss if they have been confronted about their health and wish to hide it, while others will wear baggy clothing to hide what they see as an unattractive and overweight body.
- cheeks may become swollen because of enlargement of the salivary glandSalivary glandThe salivary glands in mammals are exocrine glands, glands with ducts, that produce saliva. They also secrete amylase, an enzyme that breaks down starch into maltose...
s caused by excessive vomiting - swollen joints
- abdominal distension
- bad breath
- hair loss or thinning
- low blood cell count and an abnormally low blood pressure
| xerosis Xerosis Xerosis cutis is the medical term for dry skin.It can have many different causes, including general dehydration, atopic dermatitis, Vitamin A deficiency, and maybe diabetes. Treatment is primarily symptomatic. "Xero", meaning dry or dehydrated, "osis" usually referring to a medical disease or... |
telogen effluvium Telogen effluvium Telogen effluvium is a scalp disorder characterized by thinning/shedding of hair resulting from the early entry of hairs into the telogen phase.Emotional or physiological stressful events may result in an alteration of the normal hair cycle.... |
carotenoderma | acne Acne Acne is a general term used for acneiform eruptions. It is usually used as a synonym for acne vulgaris, but may also refer to:*Acne aestivalis*Acne conglobata*Acne cosmetica*Acne fulminans*Acne keloidalis nuchae*Acne mechanica... |
hyperpigmentation Hyperpigmentation In dermatology, hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.-Causes:Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris... |
| seborrheic dermatitis | acrocyanosis Acrocyanosis Acrocyanosis is persistent blue or cyanotic discoloration of the extremities, most commonly occurring in the hands, although it also occurs in the feet and distal parts of face.... |
perniosis | petechiae | livedo reticularis |
| interdigital intertrigo Intertrigo An intertrigo is an inflammation of the body folds .An intertrigo sometimes refers to a bacterial, fungal, or viral infection that has developed at the site of broken skin due to such inflammation... |
paronychia Paronychia The nail disease paronychia , commonly misidentified as a synonym for whitlow or felon, is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail... |
generalized pruritus | acquired striae distensae Striae distensae Striae distensae are depressed lines or bands of thin reddened skin, which later become white, smooth, shiny, and depressed, occurring in response to changes in weight or muscle mass and skin tension. They are commonly referred to as stretch marks.... |
angular stomatitis |
| prurigo pigmentosa Prurigo pigmentosa Prurigo pigmentosa is a rare skin condition of unknown cause, characterized by the sudden onset of erythematous papules that leave a reticulated hyperpigmentation when they heal.-References:... |
edema Edema Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling... |
linear erythema craquele Erythema Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation... |
acrodermatitis enteropathica Acrodermatitis enteropathica Acrodermatitis enteropathica is an autosomal recessive metabolic disorder affecting the uptake of zinc, characterized by periorificial and acral dermatitis, alopecia , and diarrhea.... |
pellagra Pellagra Pellagra is a vitamin deficiency disease most commonly caused by a chronic lack of niacin in the diet. It can be caused by decreased intake of niacin or tryptophan, and possibly by excessive intake of leucine. It may also result from alterations in protein metabolism in disorders such as carcinoid... |
| constipation Constipation Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation... |
diarrhea Diarrhea Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and... |
electrolyte imbalance Electrolyte In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible.... |
cavities Dental caries Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the... |
tooth loss Tooth Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are... |
| cardiac arrest Cardiac arrest Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively... |
amenorrhoea Amenorrhoea Amenorrhoea , amenorrhea , or amenorrhœa, is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and lactation , the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method... |
edema Edema Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling... |
osteoporosis Osteoporosis Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered... |
osteopenia Osteopenia Osteopenia is a condition where bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis... |
| hyponatremia Hyponatremia Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular... |
hypokalemia Hypokalemia Hypokalemia or hypokalaemia , also hypopotassemia or hypopotassaemia , refers to the condition in which the concentration of potassium in the blood is low... |
optic neuropathy Optic neuropathy The optic nerve contains axons of nerve cells that emerge from the retina, leave the eye at the optic disc, and go to the visual cortex where input from the eye is processed into vision. There are 1.2 million optic nerve fibers that derive from the retinal ganglion cells of the inner retina. Optic... |
brain atrophy Cerebral atrophy Cerebral atrophy is a common feature of many of the diseases that affect the brain. Atrophy of any tissue means loss of cells. In brain tissue, atrophy describes a loss of neurons and the connections between them... |
leukopenia Leukopenia Leukopenia is a decrease in the number of white blood cells found in the blood, which places individuals at increased risk of infection.... |
Causes
Studies have hypothesizedHypothesis
A hypothesis is a proposed explanation for a phenomenon. The term derives from the Greek, ὑποτιθέναι – hypotithenai meaning "to put under" or "to suppose". For a hypothesis to be put forward as a scientific hypothesis, the scientific method requires that one can test it...
that the continuance of disordered eating patterns may be epiphenomena
Epiphenomenon
An epiphenomenon is a secondary phenomenon that occurs alongside or in parallel to a primary phenomenon.-Medicine:...
of starvation. The results of the Minnesota Starvation Experiment
Minnesota Starvation Experiment
The Minnesota Starvation Experiment, also known as the Minnesota Semi-Starvation Experiment, the Minnesota Starvation-Recovery Experiment and the Starvation Study, was a clinical study performed at the University of Minnesota between November 19, 1944 and December 20, 1945...
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 because of 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.
Biological
- Obstetric complications: various prenatal and perinatal complications may factor into the development of AN such as maternal anemiaAnemiaAnemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
, diabetes mellitusDiabetes mellitusDiabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, preeclampsia, placental infarctionInfarctionIn medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
, and neonatal cardiac abnormalities. Neonatal complications may also have an influence on harm avoidanceHarm avoidanceIn psychology, harm avoidance is a personality trait characterized by excessive worrying; pessimism; shyness; and being fearful, doubtful, and easily fatigued...
, one of the personality traits associated with the development of AN. - GeneticsGeneticsGenetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
: anorexia nervosa is believed to be highly heritable, with estimated inheritance rates ranging from 56% to 84%. Association studies have been performed, studying 128 different polymorphismsPolymorphism (biology)Polymorphism in biology occurs when two or more clearly different phenotypes exist in the same population of a species — in other words, the occurrence of more than one form or morph...
related to 43 genesGênesGênes is the name of a département of the First French Empire in present Italy, named after the city of Genoa. It was formed in 1805, when Napoleon Bonaparte occupied the Republic of Genoa. Its capital was Genoa, and it was divided in the arrondissements of Genoa, Bobbio, Novi Ligure, Tortona and...
including genes involved in regulation of eating behavior, motivationMotivationMotivation is the driving force by which humans achieve their goals. Motivation is said to be intrinsic or extrinsic. The term is generally used for humans but it can also be used to describe the causes for animal behavior as well. This article refers to human motivation...
and reward mechanicsReward systemIn neuroscience, the reward system is a collection of brain structures which attempts to regulate and control behavior by inducing pleasurable effects...
, personality traits and emotionEmotionEmotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
. Consistent associations have been identified for polymorphisms associated with agouti-related peptideAgouti-related peptideAgouti-related protein also called Agouti-related peptide is a neuropeptide produced in the brain by the AgRP/NPY neuron. It is only synthesised in NPY containing cell bodies located in the ventromedial part of the arcuate nucleus in the hypothalamus...
, brain derived neurotrophic factor, catechol-o-methyl transferase, SK3SK3SK3 is a small-conductance calcium-activated potassium channel partly responsible for the calcium-dependent after hyperpolarisation current . It belongs to a family of channels known as small-conductance potassium channels, which consists of three members – SK1, SK2 and SK3 , which share a 60-70%...
and opioid receptor delta-1. In one study, variations in the norepinephrine transporterNorepinephrine transporterThe norepinephrine transporter , also known as solute carrier family 6 member 2 , is a protein that in humans is encoded by the SLC6A2 gene....
gene promoter were associated with restrictive anorexia nervosa, but not binge-purge anorexia. Recent studies have advanced the theory that the sex difference in incidence and the common onset at the age of puberty may reflect an abnormal response of the brain to anorexic (feeding suppressing) effects of the female sex hormone, estrogen. This viewpoint has been recently supported by a report that abnormal forms of the estrogen receptor are more common in women with anorexia nervosa of the restricting type.- epigeneticsEpigeneticsIn biology, and specifically genetics, epigenetics is the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence – hence the name epi- -genetics...
: Epigenetic mechanisms: are means by which genetic mutations are caused by environmental effects that alter gene expression via methods such as DNA methylationDNA methylationDNA methylation is a biochemical process that is important for normal development in higher organisms. It involves the addition of a methyl group to the 5 position of the cytosine pyrimidine ring or the number 6 nitrogen of the adenine purine ring...
, these are independent of and do not alter the underlying DNA sequence. They are heritable, as was shown in the Överkalix studyÖverkalix studyThe Överkalix study was a study conducted on the physiological effects of various environmental factors on transgenerational epigenetic inheritance. The study was conducted utilizing historical records, including harvests and food prices, in Överkalix, a small isolated municipality in northeast...
, but also may occur throughout the lifespan, and are potentially reversible. Dysregulation of dopaminergicDopaminergicDopaminergic means related to the neurotransmitter dopamine. For example, certain proteins such as the dopamine transporter , vesicular monoamine transporter 2 , and dopamine receptors can be classified as dopaminergic, and neurons which synthesize or contain dopamine and synapses with dopamine...
neurotransmissionNeurotransmissionNeurotransmission , also called synaptic transmission, is the process by which signaling molecules called neurotransmitters are released by a neuron , and bind to and activate the receptors of another neuron...
and Atrial natriuretic peptideAtrial natriuretic peptideAtrial natriuretic peptide , atrial natriuretic factor , atrial natriuretic hormone , or atriopeptin, is a powerful vasodilator, and a protein hormone secreted by heart muscle cells. It is involved in the homeostatic control of body water, sodium, potassium and fat...
homeostasisHomeostasisHomeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
resulting from epigenetic mechanisms has been implicated in various eating disorders."We conclude that epigenetic mechanisms may contribute to the known alterations of ANPAtrial natriuretic peptideAtrial natriuretic peptide , atrial natriuretic factor , atrial natriuretic hormone , or atriopeptin, is a powerful vasodilator, and a protein hormone secreted by heart muscle cells. It is involved in the homeostatic control of body water, sodium, potassium and fat...
homeostasis in women with eating disorders."
- epigenetics
- serotoninSerotoninSerotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
dysregulation; particularly high levels in those areas in the brain with the 5HT1A receptor5-HT receptorThe serotonin receptors, also known as 5-hydroxytryptamine receptors or 5-HT receptors, are a group of G protein-coupled receptors and ligand-gated ion channels found in the central and peripheral nervous systems. They mediate both excitatory and inhibitory neurotransmission...
- a system particularly linked to anxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, moodMood (psychology)A mood is a relatively long lasting emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event....
and impulse control. Starvation has been hypothesized to be a response to these effects, as it is known to lower tryptophanTryptophanTryptophan is one of the 20 standard amino acids, as well as an essential amino acid in the human diet. It is encoded in the standard genetic code as the codon UGG...
and steroid hormoneSteroid hormoneA steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into five groups by the receptors to which they bind: glucocorticoids, mineralocorticoids, androgens, estrogens, and progestogens...
metabolism, which might reduce serotonin levels at these critical sites and ward off anxiety. Other studies of the 5HT2A serotonin receptor (linked to regulation of feeding, mood, and anxiety), suggest that serotonin activity is decreased at these sites. There is evidence that both personality characteristics associated with AN, and disturbances to the serotonin system are still apparent after patients have recovered from anorexia. - Brain-derived neurotrophic factorBrain-derived neurotrophic factorBrain-derived neurotrophic factor, also known as BDNF, is a protein that, in humans, is encoded by the BDNF gene. BDNF is a member of the "neurotrophin" family of growth factors, which are related to the canonical "Nerve Growth Factor", NGF...
(BDNF) is a proteinProteinProteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
that regulates neuronal developmentNeural developmentNeural development comprises the processes that generate, shape, and reshape the nervous system, from the earliest stages of embryogenesis to the final years of life. The study of neural development aims to describe the cellular basis of brain development and to address the underlying mechanisms...
and neuroplasticityNeuroplasticityNeuroplasticity is a non-specific neuroscience term referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Plasticity occurs on a variety of levels, ranging from cellular changes involved in...
, it also plays a role in learningLearningLearning is acquiring new or modifying existing knowledge, behaviors, skills, values, or preferences and may involve synthesizing different types of information. The ability to learn is possessed by humans, animals and some machines. Progress over time tends to follow learning curves.Human learning...
, memoryMemoryIn psychology, memory is an organism's ability to store, retain, and recall information and experiences. Traditional studies of memory began in the fields of philosophy, including techniques of artificially enhancing memory....
and in the hypothalamic pathway that controls eating behavior and energy homeostasisHomeostasisHomeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
. BDNF amplifies neurotransmitterNeurotransmitterNeurotransmitters are endogenous chemicals that transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to...
responses and promotes synaptic communication in the enteric nervous systemEnteric nervous systemThe enteric nervous system is a subdivision of the autonomic nervous system that directly controls the gastrointestinal system in vertebrates.It is derived from neural crest.-Function:...
. Low levels of BDNF are found in patients with AN and some comorbid disorders such as major depression. Exercise increases levels of BDNF - leptinLeptinLeptin is a 16 kDa protein hormone that plays a key role in regulating energy intake and energy expenditure, including appetite and metabolism. It is one of the most important adipose derived hormones...
and ghrelinGhrelinGhrelin is a 28 amino acid peptide and hormone that is produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone...
; leptin is a hormone produced primarily by the fat cells in white adipose tissueWhite adipose tissueWhite adipose tissue or white fat is one of the two types of adipose tissue found in mammals. The other kind of adipose tissue is brown adipose tissue....
of the body it has an inhibitory (anorexigenic) effect on appetite, by inducing a feeling of satiety. Ghrelin is an appetite inducing (orexigenicOrexigenicAn orexigenic is a drug or hormone that increases appetite. This can be a naturally occurring neuropeptide hormone such as ghrelin, orexin or neuropeptide Y, or a medication which increases hunger and therefore enhances food consumption...
) hormone produced in the stomachStomachThe stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
and the upper portion of the small intestineSmall intestineThe small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
. Circulating levels of both hormones are an important factor in weight control. While often associated with obesity both have been implicated in the pathophysiologyPathophysiologyPathophysiology is the study of the changes of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from an abnormal syndrome...
of anorexia nervosa and bulimia nervosa. - cerebral blood flowCerebral blood flowCerebral blood flow, or CBF, is the blood supply to the brain in a given time. In an adult, CBF is typically 750 millitres per minute or 15% of the cardiac output. This equates to 50 to 54 millilitres of blood per 100 grams of brain tissue per minute. CBF is tightly regulated to meet the brain's...
(CBF); neuroimaging studies have shown reduced CBF in the temporal lobeTemporal lobeThe temporal lobe is a region of the cerebral cortex that is located beneath the Sylvian fissure on both cerebral hemispheres of the mammalian brain....
s of anorectic patients, which may be a predisposing factor in the onset of AN. - autoimmune system; Autoantibodies against neuropeptides such as melanocortinMelanocortinThe melanocortins are a group of peptide hormones which include adrenocorticotropic hormone and the different forms of melanocyte-stimulating hormone . They can be synthetic . In humans they can be endogenously produced from proopiomelanocortin in the pituitary gland...
have been shown to affect personality traits associated with eating disorders such as those that influence appetite and stress responses.
- Nutritional deficiencies
- ZincZincZinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...
deficiency may play a role in anorexia. It is not thought responsible for causation of the initial illness but there is evidence that it may be an accelerating factor that deepens the pathology of the anorexia. A 1994 randomized, double-blind, placebo-controlled trial showed that zinc (14 mg per day) doubled the rate of body mass increase compared to patients receiving the placebo.
- Zinc
Environmental
Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialized nations, particularly through the media. A recent epidemiological study of 989,871 Swedish residents indicated that genderGender
Gender is a range of characteristics used to distinguish between males and females, particularly in the cases of men and women and the masculine and feminine attributes assigned to them. Depending on the context, the discriminating characteristics vary from sex to social role to gender identity...
, ethnicity and socio-economic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk. People in professions where there is a particular social pressure to be thin (such as models
Model (person)
A model , sometimes called a mannequin, is a person who is employed to display, advertise and promote commercial products or to serve as a subject of works of art....
and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss.
Anorexia nervosa is more likely to occur in a person’s pubertal years, especially for girls. Female students are 10 times more likely to suffer from anorexia nervosa than male students. According to a survey of 1799 Japanese female high school students, “85% who were a normal weight wanted to be thinner and 45% who were 10–20% underweight wanted to be thinner.” Teenage girls concerned about their weight and who believe that slimness is more attractive among peers trend to weight-control behaviors. Teen girls are learning from each other to consume low-caloric, low-fat foods and diet pills. This results in lack of nutrition and a greater chance of developing anorexia nervosa.
It has also been noted that anorexia nervosa is more likely to occur in populations in which obesity is more prevalent. It has been suggested that anorexia nervosa results from a sexually selected evolutionary drive to appear youthful in populations in which size becomes the primary indicator of age.
There is also evidence to suggest that patients who have anorexia nervosa can be characterised by Alexithymia
Alexithymia
Alexithymia from the Ancient Greek words λέξις and θυμός modified by an alpha-privative—literally "without words for emotions"—is a term coined by psychotherapist Peter Sifneos in 1973 to describe a state of deficiency in understanding, processing, or describing...
and also a deficit in certain emotional functions. A research study showed that this was the case in both adult and adolescent anorexia nervosa patients.
There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia. The connection between eating disorders and abuse has been convincingly evidenced by a number of studies, including one published in Epidemiology (and strengthened by blind hypothesis survey), which showed in a comparison of women with no history of eating disorders, women with a history of eating disorders were twice as likely to have reported childhood sexual abuse. While the joint effect of both physical and sexual abuse resulted in a nearly 4-fold risk of eating disorders that met DSM-IV criteria. It is thought that links between childhood abuse and sexual abuse are complex, such as by influencing psychologic processes that increase a woman's susceptibility to the development of an eating disorder, or perhaps by producing changes in psychobiologic process and neurotransmitting function, associated with eating behaviour.
Recent efforts have been made to dispel some of the myths around anorexia nervosa and eating disorders, such as the misconception that families, in particular mothers, are responsible for their daughter developing an eating disorder.
Relationship to autism
Since Gillberg'sChristopher Gillberg
Lars Christopher Gillberg , who has sometimes published as Gillberg and Gillberg with his wife Carina Gillberg, is a professor of child and adolescent psychiatry at Gothenburg University in Gothenburg, Sweden, and an honorary professor at the Institute of Child Health , University College London...
(1983 & 1985) and others' initial suggestion of relationship between anorexia nervosa and autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
, a large-scale longitudinal study
Longitudinal study
A longitudinal study is a correlational research study that involves repeated observations of the same variables over long periods of time — often many decades. It is a type of observational study. Longitudinal studies are often used in psychology to study developmental trends across the...
into teenage-onset anorexia nervosa conducted in Sweden confirmed that 23% of people with a long-standing eating disorder are on the autism spectrum
Autism spectrum
The term "autism spectrum" is often used to describe disorders that are currently classified as pervasive developmental disorders. Pervasive developmental disorders include autism, Asperger syndrome, Childhood disintegrative disorder, Rett syndrome and Pervasive Developmental Disorder Not Otherwise...
. Those on autism spectrum tend to have a worse outcome, but may benefit from the combined use of behavioural and pharmacological therapies tailored to ameliorate autism rather than anorexia nervosa per se. Other studies, most notably research conducted at the Maudsley Hospital
Maudsley Hospital
The Maudsley Hospital is a British psychiatric hospital in South London. The Maudsley is the largest mental health training institution in the country...
, UK, furthermore suggest that autistic traits are common in people with anorexia nervosa; shared traits include, e.g., poor executive function, autism quotient score, central coherence
Weak central coherence theory
The weak central coherence theory , also called the central coherence theory , suggests that a specific perceptual-cognitive style, loosely described as a limited ability to understand context or to "see the big picture", underlies the central disturbance in autism and related autism spectrum...
, theory of mind, cognitive-behavioural flexibility, emotion regulation and understanding facial expressions.
Zucker et al. (2007) proposed that conditions on the autism spectrum make up the cognitive endophenotype
Endophenotype
Endophenotype is a psychiatric concept and a special kind of biomarker. The purpose of the concept is to divide behavioral symptoms into more stable phenotypes with a clear genetic connection...
underlying anorexia nervosa and appealed for increased interdisciplinary collaboration (see figure to right). A pilot study into the effectiveness Cognitive Behaviour Therapy, which based its treatment protocol on the hypothesised relationship between anorexia nervosa and an underlying autistic like condition, reduced perfectionism and rigidity in 17 out of 19 participants.
Medical
The initial diagnosis should be made by a competentCompetence (human resources)
Competence is the ability of an individual to perform a job properly. A competency is a set of defined behaviors that provide a structured guide enabling the identification, evaluation and development of the behaviors in individual employees. As defined, the term "competence" first appeared in...
medical professional. There are multiple medical conditions, such as viral or bacterial infections, hormonal imbalances
Hormone imbalance
Hormones are the chemical messengers in the body that travel the bloodstream to the organs and tissues. They slowly work and affect many of the body's processes over time. Endocrine glands, which are special groups of cells, make hormones....
, neurodegenerative diseases
Neurodegeneration
Neurodegeneration is the umbrella term for the progressive loss of structure or function of neurons, including death of neurons. Many neurodegenerative diseases including Parkinson’s, Alzheimer’s, and Huntington’s occur as a result of neurodegenerative processes. As research progresses, many...
and brain tumor
Brain tumor
A brain tumor is an intracranial solid neoplasm, a tumor within the brain or the central spinal canal.Brain tumors include all tumors inside the cranium or in the central spinal canal...
s which may mimic psychiatric disorders including anorexia nervosa.
According to an in depth study conducted by psychiatrist Richard Hall as published in the Archives of General Psychiatry
Archives of General Psychiatry
Archives of General Psychiatry is a monthly professional medical journal published by the American Medical Association. Archives of General Psychiatry publishes original, peer reviewed articles about psychiatry, mental health, behavioral sciences and related fields. It is the psychiatric journal...
:
- Medical illness often presents with psychiatric symptoms.
- It is difficult to distinguish physical disorders from functional psychiatric disorders on the basis of psychiatric symptoms alone.
- Detailed physical examination and laboratory screening are indicated as a routine procedure in the initial evaluation of psychiatric patients.
- Most patients are unaware of the medical illness that is causative of their psychiatric symptoms.
- The conditions of patients with medically induced symptoms are often initially misdiagnosed as a functional psychosis.
- Complete Blood CountComplete blood countA complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
(CBC): a test of the white blood cells. red blood cells and platelets used to assess the presence of various disorders such as leukocytosisLeukocytosisLeukocytosis is a raised white blood cell count above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, and is observed in certain parasitic infections...
, leukopeniaLeukopeniaLeukopenia is a decrease in the number of white blood cells found in the blood, which places individuals at increased risk of infection....
, thrombocytosisThrombocytosisThrombocytosis is the presence of high platelet counts in the blood, and can be either primary or reactive...
and anemiaAnemiaAnemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
which may result from malnutritionMalnutritionMalnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
. - urinalysisUrinalysisA urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
: a variety of tests performed on the urine used in the diagnosis of medical disorders, to test for substance abuse, and as an indicator of overall health - ELISAELISAEnzyme-linked immunosorbent assay , is a popular format of a "wet-lab" type analytic biochemistry assay that uses one sub-type of heterogeneous, solid-phase enzyme immunoassay to detect the presence of a substance in a liquid sample."Wet lab" analytic biochemistry assays involves detection of an...
: Various subtypes of ELISA used to test for antibodies to various viruses and bacteriaBacteriaBacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
such as Borrelia burgdoferi (Lyme Disease) - Western Blot AnalysisWestern blotThe western blot is a widely used analytical technique used to detect specific proteins in the given sample of tissue homogenate or extract. It uses gel electrophoresis to separate native proteins by 3-D structure or denatured proteins by the length of the polypeptide...
: Used to confirm the preliminary results of the ELISA - Chem-20: Chem-20 also known as SMA-20 a group of twenty separate chemical tests performed on blood serumBlood serumIn blood, the serum is the component that is neither a blood cell nor a clotting factor; it is the blood plasma with the fibrinogens removed...
. Tests include cholesterolCholesterolCholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
, proteinProteinProteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
and electrolytes such as potassiumPotassiumPotassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...
, chlorineChlorineChlorine is the chemical element with atomic number 17 and symbol Cl. It is the second lightest halogen, found in the periodic table in group 17. The element forms diatomic molecules under standard conditions, called dichlorine...
and sodiumSodiumSodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...
and tests specific to liverLiverThe liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
and kidneyKidneyThe kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
function. - glucose tolerance testGlucose tolerance testA glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of...
: Oral glucose tolerance test (OGTT) used to assess the body's ability to metabolize glucose. Can be useful in detecting various disorders such as diabetes, an insulinomaInsulinomaAn insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin.Beta cells secrete insulin in response to increases in blood glucose. The resulting increase in insulin acts to lower blood glucose back to normal levels at which point further secretion of insulin is...
, Cushing's SyndromeCushing's syndromeCushing's syndrome is a hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone or CRH...
, hypoglycemiaHypoglycemiaHypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...
and polycystic ovary syndromePolycystic ovary syndromePolycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease.... - Secritin-CCK TestSecretin-cholecystokinin testThe secretin-cholecystokinin test is a combination of the secretin test and the cholecystokinin test and is used to assess the function of both the pancreas and gall bladder...
: Used to assess function of pancreasPancreasThe pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
and gall bladder - SerumSerumSerum may refer to:*Blood serum, a component of blood which is collected after coagulation.**Antiserum, blood serum with specific antibodies for passive immunity*Serous fluid, any clear bodily fluid*any drug derived from an animal's blood or serous fluid...
cholinesteraseCholinesteraseIn biochemistry, cholinesterase is a family of enzymes that catalyze the hydrolysis of the neurotransmitter acetylcholine into choline and acetic acid, a reaction necessary to allow a cholinergic neuron to return to its resting state after activation.-Types:...
test: a test of liver enzymes (acetylcholinesteraseAcetylcholinesterase"Acetylcholinesterase, also known as AChE or acetylcholine acetylhydrolase, is an enzyme that degrades the neurotransmitter acetylcholine, producing choline and an acetate group. It is mainly found at neuromuscular junctions and cholinergic nervous system, where its activity serves to terminate...
and pseudocholinesteraseButyrylcholinesteraseButyrylcholinesterase is a non-specific cholinesterase enzyme that hydrolyses many different choline esters...
) useful as a test of liver function and to assess the effects of malnutrition - Liver Function TestLiver function testsLiver function tests , are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver. The parameters measured include PT/INR, aPTT, albumin, billirubin and others...
: A series of tests used to assess liver function some of the tests are also used in the assessment of malnutrition, protein deficiency, kidney function, bleeding disorders, Crohn's Disease - Lh response to GnRH: Luteinizing hormoneLuteinizing hormoneLuteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...
(Lh) response to gonadotropin-releasing hormoneGonadotropin-releasing hormoneGonadotropin-releasing hormone , also known as Luteinizing-hormone-releasing hormone and luliberin, is a tropic peptide hormone responsible for the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. GnRH is synthesized and released from neurons within...
(GnRH): Tests the pituitary glands' response to GnRh a hormone produced in the hypothalumus. Central hypogonadismHypogonadismHypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...
is often seen in anorexia nervosa cases. - Creatine Kinase TestCreatine kinaseCreatine kinase , also known as creatine phosphokinase or phospho-creatine kinase , is an enzyme expressed by various tissues and cell types. CK catalyses the conversion of creatine and consumes adenosine triphosphate to create phosphocreatine and adenosine diphosphate...
(CK-Test): measures the circulating blood levels of creatine kinase an enzyme found in the heart (CK-MB), brain (CK-BB) and skeletal muscle (CK-MM). - Blood urea nitrogen (BUN) testBunA bun is a small, usually sweet, bread. Commonly they are hand-sized or smaller, domed in shape, with a flat bottom. A bun can also be a savory bread roll similar to a bap or barmcake....
: urea nitrogen is the byproduct of protein metabolism first formed in the liver then removed from the body by the kidneys. The BUN test is used primarily to test kidneyKidneyThe kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
function. A low BUN level may indicate the effects of malnutrition. - BUN-to-creatinine ratioBUN-to-creatinine ratioIn medicine, the BUN-to-creatinine ratio is the ratio of two serum laboratory values, the blood urea nitrogen and serum creatinine . Outside the United States, particularly in Canada and Europe, the truncated term urea is used and the units are different...
: A BUN to creatinine ratio is used to predict various conditions. High BUN/creatinine ratio can occur in severe hydration, acute kidney failure, congestive heart failure, intestinal bleeding. A low BUN/creatinine can indicate a low protein diet, celiac disease rhabdomyolysisRhabdomyolysisRhabdomyolysis is a condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure...
, cirrhosisCirrhosisCirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...
of the liver. - echocardiogram: utilizes ultrasound to create a moving picture of the heartHuman heartThe human heart is a muscular organ that provides a continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body...
to assess function - electrocardiogramElectrocardiogramElectrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...
(EKG or ECG): measures electrical activity of heart can be used to detect various disorders such as hyperkalemiaHyperkalemiaHyperkalemia refers to the condition in which the concentration of the electrolyte potassium in the blood is elevated... - electroencephalogram (EEG): measures the electrical activity of the brain. Can be used to detect abnormalities such as those associated with pituitary tumors
- Upper GI SeriesUpper GI seriesUpper GI series, also upper gastrointestinal tract radiography, is a radiologic examination of the upper gastrointestinal tract. It consists of a series of X-ray images of the esophagus, stomach and duodenum...
: test used to assess gastrointestinal problems of the middle and upper intestinal tract - Thyroid Screen TSH, t4, t3 :test used to assess thyroid functioning by checking levels of thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3)
- Parathyroid hormoneParathyroid hormoneParathyroid hormone , parathormone or parathyrin, is secreted by the chief cells of the parathyroid glands as a polypeptide containing 84 amino acids...
(PTH) test: tests the functioning of the parathyroid by measuring the amount of (PTH) in the blood. Test is used to diagnose parahypothyroidism. PTH also controls the levels of calciumCalciumCalcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
and phosphorusPhosphorusPhosphorus is the chemical element that has the symbol P and atomic number 15. A multivalent nonmetal of the nitrogen group, phosphorus as a mineral is almost always present in its maximally oxidized state, as inorganic phosphate rocks...
in the blood (homeostasisHomeostasisHomeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
). - barium enemaBarium enemaA lower gastrointestinal series, also called a barium enema, is a medical procedure used to examine and diagnose problems with the human colon . X-ray pictures are taken while barium sulfate fills the colon via the rectum.-Procedure:...
: an x-rayX-rayX-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
examination of the lower gastrointestinal tract - neuroimagingNeuroimagingNeuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...
; via the use of various techniques such as PET scan, fMRI, MRI and SPECT imaging should be included in the diagnostic procedure for any eating disorder to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder.
Psychological
Anorexia nervosa is classified as an Axis I disorder in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), published by the American Psychiatric AssociationAmerican Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
. The DSM-IV should not be used by laypersons to diagnose themselves.
- DSM-IV-TR: diagnostic criteria for AN includes intense fear of gaining weight, a refusal to maintain body weight above 85% of the expected weight for a given age and height, and three consecutive missed periodsMenstrual cycleThe menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
and either refusal to admit the seriousness of the weight loss, or undue influence of shape or weight on one's self image, or a disturbed experience in one's shape or weight. There are two types: the binge-eating/purging type is characterized by overeating or purging, and the restricting type is not.- Criticism of DSM-IV There has been criticisms over various aspects of the diagnostic criteria utilized for anorexia nervosa in the DSM-IV. Including the requirement of maintaining a body weight below 85% of the expected weight and the requirement of amenorrhea for diagnosis; some women have all the symptoms of AN and continue to menstruate. Those who do not meet these criteria are usually classified as eating disorder not otherwise specifiedEating disorder not otherwise specifiedEating disorder not otherwise specified involves disordered eating patterns. EDNOS is described in the DSM-IV-TR as a "category [of] disorders of eating that do not meet the criteria for any specific eating disorder".- Characteristics :...
this may affect treatment options and insurance reimbursments. The validity of the AN subtype classification has also been questioned because of the considerable diagnostic overlap between the binge eating/ purging type and the restricting type and the propensity of the patient to switch between the two.
- Criticism of DSM-IV There has been criticisms over various aspects of the diagnostic criteria utilized for anorexia nervosa in the DSM-IV. Including the requirement of maintaining a body weight below 85% of the expected weight and the requirement of amenorrhea for diagnosis; some women have all the symptoms of AN and continue to menstruate. Those who do not meet these criteria are usually classified as eating disorder not otherwise specified
- ICD-10ICDThe International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
: The criteria are similar, but in addition, specifically mention:
- The ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics).
- If onset is before puberty, that development is delayed or arrested.
- Certain physiological features, including "widespread endocrine disorder involving hypothalamicHypothalamusThe Hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions...
-pituitary-gonadGonadThe gonad is the organ that makes gametes. The gonads in males are the testes and the gonads in females are the ovaries. The product, gametes, are haploid germ cells. For example, spermatozoon and egg cells are gametes...
al axis is manifest in women as amenorrhoeaAmenorrhoeaAmenorrhoea , amenorrhea , or amenorrhœa, is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and lactation , the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method...
and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormoneGrowth hormoneGrowth hormone is a peptide hormone that stimulates growth, cell reproduction and regeneration in humans and other animals. Growth hormone is a 191-amino acid, single-chain polypeptide that is synthesized, stored, and secreted by the somatotroph cells within the lateral wings of the anterior...
s, raised cortisolCortisolCortisol is a steroid hormone, more specifically a glucocorticoid, produced by the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat,...
levels, changes in the peripheral metabolismMetabolismMetabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...
of thyroidThyroidThe thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
hormone and abnormalities of insulin secretion".
Differential diagnoses
There are various medical and psychological conditions that have been misdiagnosed as anorexia nervosa, in some cases the correct diagnosis was not made for more than ten years. In a reported case of achalasiaAchalasia
Achalasia , also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter...
misdiagnosed as AN, the patient spent two months confined to a psychiatric hospital.
There are various other psychological issues that may factor into anorexia nervosa, some fulfill the criteria for a separate Axis I diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 "clusters", A, B and C.The causality
Causality
Causality is the relationship between an event and a second event , where the second event is understood as a consequence of the first....
between personality disorders and eating disorders has yet to be fully established. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder. Some develop them afterwards. The severity and type of eating disorder symptoms have been shown to affect comorbidity.
| Comorbid Disorders | |
|---|---|
| Axis I | Axis II |
| depression | obsessive compulsive personality disorder |
| substance abuse Substance abuse A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a... , alcoholism Alcoholism Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing... |
borderline personality disorder Borderline personality disorder Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the... |
| anxiety disorders |
narcissistic personality disorder Narcissistic personality disorder Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity... |
| obsessive compulsive disorder | histrionic personality disorder Histrionic personality disorder Histrionic personality disorder is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive behavior, usually beginning in early... |
| Attention-Deficit-Hyperactivity-Disorder Attention-deficit hyperactivity disorder Attention deficit hyperactivity disorder is a developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age.ADHD is the most commonly studied and... |
avoidant personality disorder Avoidant personality disorder Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of... |
- Body dysmorphic disorderBody dysmorphic disorderBody Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...
(BDD) is listed as a somatoform disorderSomatoform disorderIn psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...
that affects up to 2% of the population. BDD is characterized by excessive ruminationRumination (psychology)Rumination is a way of responding to distress that involves repetitively focusing on the symptoms of distress, and on its possible causes and consequences. Rumination is more common in people who are pessimistic, neurotic, and who have negative attributional styles. The tendency to ruminate is a...
over an actual or perceived physical flaw. BDD has been diagnosed equally among men and women. While BDD has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 25% to 39% of AN cases.
BDD is a chronic and debilitating condition which may lead to social isolation, major depression, suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe
Temporal lobe
The temporal lobe is a region of the cerebral cortex that is located beneath the Sylvian fissure on both cerebral hemispheres of the mammalian brain....
and left parietal lobe
Parietal lobe
The parietal lobe is a part of the Brain positioned above the occipital lobe and behind the frontal lobe.The parietal lobe integrates sensory information from different modalities, particularly determining spatial sense and navigation. For example, it comprises somatosensory cortex and the...
showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21 year old male following an inflammatory brain process. Neuroimaging showed the presence of new atrophy in the frontotemporal region.
The distinction between the diagnoses of anorexia nervosa, bulimia nervosa
Bulimia nervosa
Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
and eating disorder not otherwise specified
Eating disorder not otherwise specified
Eating disorder not otherwise specified involves disordered eating patterns. EDNOS is described in the DSM-IV-TR as a "category [of] disorders of eating that do not meet the criteria for any specific eating disorder".- Characteristics :...
(EDNOS) is often difficult to make as there is considerable overlap between patients diagnosed with these conditions. Seemingly minor changes in a patient's overall behavior or attitude can change a diagnosis from "anorexia: binge-eating type" to bulimia nervosa. It is not unusual for a person with an eating disorder to "move through" various diagnoses as his or her behavior and beliefs change over time.
Treatment
Treatment for anorexia nervosa 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 behaviours or thoughts that originally led to the disordered eating. If anorexia nervosa is not treated, serious complications such as heart conditions and kidney failure can innitiate and eventually lead to death.Dietary
- ZincZincZinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...
supplementation has been shown in various studies to be beneficial in the treatment of AN even in patients not suffering from zinc deficiency, by helping to increase weight gain. - Essential fatty acids:The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been shown to benefit various neuropsychiatric disorders. There was reported rapid improvement in a case of severe AN treated with ethylEthylEthyl may refer to:* Ethyl group, a functional group in organic chemistry* Ethyl Corporation, a fuel additive company* Ethanol, also known as ethyl alcohol* Cold Ethyl, a rock band founded by Nicke Andersson...
-eicosapentaenoic acid (E-EPA) and micronutrients. DHA and EPA supplementation has been shown to be a benefit in many of the comorbid disorders of AN including: attention deficit/hyperactivity disorder (ADHD), autism, major depressive disorder (MDD), bipolar disorder, and borderline personality disorder. Accelerated cognitive decline and mild cognitive impairment (MCI) correlate with lowered tissue levels of DHA/EPA, and supplementation has improved cognitive function. - NutritionNutritionNutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
counseling - Medical Nutrition TherapyMedical nutrition therapyMedical nutrition therapy is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a registered dietician...
;(MNT) also referred to as Nutrition Therapy is the development and provision of a nutritional treatment or therapy based on a detailed assessment of a person's medical history, psychosocial history, physical examination, and dietary history.
Medication
- OlanzapineOlanzapineOlanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder...
: has been shown to be effective in treating certain aspects of AN including to help raise the body mass index and reduce obsessionality, including obsessional thoughts about food.
Therapy
- Cognitive behavioral therapy (CBT) CBT is an evidence based approach which in studies to date has shown to be useful in adolescents and adults with anorexia nervosa.
- Acceptance and commitment therapyAcceptance and Commitment TherapyAcceptance and commitment therapy or ACT is a cognitive–behavioral model of psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological...
: A type of CBT, has shown promise in the treatment of AN" participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up." - Cognitive Remediation TherapyCognitive Remediation TherapyCognitive Remediation Therapy is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning.CRT...
(CRT): is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memoryWorking memoryWorking memory has been defined as the system which actively holds information in the mind to do verbal and nonverbal tasks such as reasoning and comprehension, and to make it available for further information processing...
, cognitive flexibilityCognitive flexibilityCognitive flexibility is the term used to describe one of the executive functions; a function which is an important component of human behavior; the ability to switch behavioral response according to the context of the situation...
and planningPlanning (cognitive)Cognitive planning is one of the executive functions, it encompases the neurological processes involved in the formulation, evaluation and selection of a sequence of thoughts and actions to achieve a desired goal...
, and executive functioning which leads to improved social functioning. Neuropsychological studies have shown that patients with AN have difficulties in cognitive flexibility. In studies conducted at Kings College and in Poland with adolescents CRT was proven to be beneficial in treating anorexia nervosa, in the United States clinical trials are still being conducted by the National Institute of Mental HealthNational Institute of Mental HealthThe National Institute of Mental Health is one of 27 institutes and centers that make up the National Institutes of Health...
on adolescents age 10-17 and Stanford University in subjects over 16 as a conjunctive therapy with Cognitive behavioral therapy.
- Family therapyFamily therapyFamily therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...
: The most effective form of therapy for adolescents with anorexia is family therapy. There are various forms of family therapy that have been proven to work in the treatment of adolescent AN including "conjoint family therapy" (CFT), in which the parents and child are seen together by the same therapist, "separated family therapy" (SFT) in which parents and child attend therapy separately with different therapists. "Eisler's cohort show that, irrespective of the type of FBT, 75% of patients have a good outcome, 15% an intermediate outcome... ". - Maudsley Family TherapyMaudsley Family TherapyMaudsley Family Therapy, also known as Family-Based Treatment or the Maudsley Approach, is a family therapy devised by Christopher Dare and colleagues at the Maudsley Hospital in London in 1985. It was originally intended for the treatment of anorexia nervosa in adolescents under the age of 18 in...
: A 4 to 5 year follow up study of the Maudsley approach, a manualized model, that shows full recovery at rates up to 90%.
Alternative medicine
- YogaYogaYoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
: In preliminary studies indivualized yoga treatment has shown positive results for use as an adjunctive therapy to standard care. The treatment was shown to reduce eating disorder symptoms, including food preoccupation, which decreased immediately after each session. Scores on the Eating Disorder ExaminationEating Disorder Examination InterviewThe Eating Disorder Examination Interview devised by Fairburn et al. in 1987 is a semi-structured interview conducted by a clinician in the assessment of an eating disorder.-EDE:...
decreased consistently over the course of treatment.
Prognosis
The long term prognosis of anorexia is more on the favorable side. The National Comorbidity Replication Survey was conducted among more than 9,282 participants throughout the United States, the results found that the average duration of anorexia nervosa is 1.7 years. "Contrary to what people may believe, anorexia is not necessarily a chronic illness; in many cases, it runs its course and people get better..."In cases of adolescent anorexia nervosa that utilize Family treatment 75% of patients have a good outcome and an additional 15% show an intermediate yet more positive outcome. In a five year post treatment follow-up of Maudsley Family Therapy the full recovery rate was between 75% and 90%.
Even in severe cases of AN, despite a noted 30% relapse rate after hospitalization, and a lengthy time to recovery ranging from 57–79 months, the full recovery rate was still 76%. There were minimal cases of relapse even at the long term follow-up conducted between 10–15 years. The long-term prognosis of anorexia nervosa is changeable: a fifth of patients stay severely ill, another fifth of patients recover fully and three fifths of patients have a fluctuating and chronic course (Gelder, Mayou and Geddes 2005).
Epidemiology
Anorexia has an average prevalencePrevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
of 0.3-1% in women and 0.1% in men for the diagnosis in developed countries. The condition largely affects young adolescent women, with between 15 and 19 years old making up 40% of all cases. Approximately 75% of people with anorexia are female. Anorexia nervosa is more prevalent in the upper social classes and it is declared to be rare in less developed countries (Gelder, Mayou and Geddes 2005).
History
The history of anorexia nervosa begins with descriptions of religious fasting dating from the Hellenistic eraHellenistic civilization
Hellenistic civilization represents the zenith of Greek influence in the ancient world from 323 BCE to about 146 BCE...
and continuing into the medieval period. A number of well known historical figures, including Catherine of Siena
Catherine of Siena
Saint Catherine of Siena, T.O.S.D, was a tertiary of the Dominican Order, and a Scholastic philosopher and theologian. She also worked to bring the papacy of Gregory XI back to Rome from its displacement in France, and to establish peace among the Italian city-states. She was proclaimed a Doctor...
and Mary, Queen of Scots are believed to have suffered from the condition.
Of interest in terms of anorexia nervosa is the medieval practice of self-starvation by women, including some young women, in the name of religious piety and purity. This is sometimes referred to as anorexia mirabilis
Anorexia mirabilis
Anorexia mirabilis literally means "miraculous lack of appetite". It refers almost exclusively to women and girls of the Middle Ages who would starve themselves, sometimes to the point of death, in the name of God...
. By the thirteenth century, it was increasingly common for women to participate in religious life and to even be named as saints by the Catholic Church. Many women who ultimately became saints engaged in self-starvation, including Saint Hedwig of Andechs in the thirteenth century and Catherine of Siena in the fourteenth century. By the time of Catherine of Siena, however, the Church became concerned about extreme fasting as an indicator of spirituality and as a criteria for sainthood. Indeed, Catherine of Siena was told by Church authorities to pray that she would be able to eat again, but was unable to give up fasting.
The earliest medical descriptions of anorexic illnesses are generally credited to English physician Richard Morton
Richard Morton (physician)
Richard Morton was an English physician who was the first to state that tubercles were always present in the tuberculosis disease of the lungs. In Morton's time, this wasting disease was termed consumption, or by its Greek name of phthisis...
, in 1689.
However it was not until the late 19th century that anorexia nervosa was to be widely accepted by the medical profession as a recognised condition. In 1873, Sir William Gull, one of Queen Victoria’s personal physicians, published a seminal paper which established the term anorexia nervosa and provided a number of detailed case descriptions and treatments. In the same year, French physician Ernest-Charles Lasègue
Charles Lasègue
Charles Lasègue, full name Ernest-Charles Lasègue was a French physician who was born in Paris. In 1847 he received his medical doctorate from the University of Paris, and during the following year was sent to Southern Russia by the French government to research an epidemic of cholera...
similarly published details of a number of cases in a paper entitled De l’Anorexie Histerique.
Awareness of the condition was largely limited to the medical profession until the latter part of the 20th century, when German-American psychoanalyst Hilde Bruch
Hilde Bruch
Hilde Bruch was a German-born American psychoanalyst, known foremost for her work on eating disorders and obesity.Bruch emigrated to the United States in 1934...
published her popular work The Golden Cage: the Enigma of Anorexia Nervosa in 1978. This book created a wider awareness of anorexia nervosa among lay readers. A further important event was the death of the popular singer Karen Carpenter
Karen Carpenter
Karen Anne Carpenter was an American singer and drummer. She and her brother, Richard, formed the 1970s duo The Carpenters. She was a drummer of exceptional skill, but she is best remembered for her vocal performances of idealistic romantic ballads of true love...
in 1983, which prompted widespread ongoing media coverage of eating disorders.
Research
- Marinol (dronabinol): a synthetic form of delta-9-THC a psychoactive compound extracted from the resinResinResin in the most specific use of the term is a hydrocarbon secretion of many plants, particularly coniferous trees. Resins are valued for their chemical properties and associated uses, such as the production of varnishes, adhesives, and food glazing agents; as an important source of raw materials...
of the cannabis sativaCannabis sativaCannabis sativa is an annual herbaceous plant in the Cannabaceae family. Humans have cultivated this herb throughout recorded history as a source of industrial fibre, seed oil, food, recreation, spiritual enlightenment and medicine...
plant is currently the subject of a clinical trialClinical trialClinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
for use in the treatment of AN, the study is slated to end in 2011. - Ghrelin treatmentGhrelinGhrelin is a 28 amino acid peptide and hormone that is produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone...
: pilot studies have been concluded in the use of ghrelin infusionIntravenous therapyIntravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
for the inhospital treatment of patients with AN. The results showed positive effect in the reduction of the associated gastrointestinal symptoms, an increase in appetiteAppetiteThe appetite is the desire to eat food, felt as hunger. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Decreased desire to eat is...
and energy intake without adverse effectAdverse effectIn medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
s.
November 16 International Day against anorexia since 2005.
See also
- Anti-fat biasAnti-fat biasAnti-fat bias refers to the prejudicial assumption of personality characteristics based on a visual assessment of a person as suffering from obesity based on physical characteristics...
- Binge eating disorderBinge eating disorderBinge eating disorder is the most common eating disorder in the United States affecting 3.5% of females and 2% of males and is prevalent in up to 30% of those seeking weight loss treatment...
- Bulimia nervosaBulimia nervosaBulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
- Cigarette smoking for weight lossCigarette smoking for weight lossCigarette Smoking for Weight Loss is a practice dating to early knowledge of nicotine as an appetite suppressant. Tobacco use was associated with appetite suppression among pre-Columbian indigenous Americans, and old world Europeans...
- Hungry: A Mother and Daughter Fight AnorexiaHungry: A Mother and Daughter Fight AnorexiaHungry: A Mother and Daughter Fight Anorexia is a 2009 book cowritten by Sheila Himmel and Lisa Himmel. Written by a daughter and her mother, Hungry depicts Lisa Himmel's struggle with anorexia and bulimia. Published by Berkley Trade, Hungry took six years to be completed because of Lisa's...
(book) - Karen CarpenterKaren CarpenterKaren Anne Carpenter was an American singer and drummer. She and her brother, Richard, formed the 1970s duo The Carpenters. She was a drummer of exceptional skill, but she is best remembered for her vocal performances of idealistic romantic ballads of true love...
- Muscle dysmorphiaMuscle dysmorphiaMuscle dysmorphia or bigorexia is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. Those who suffer from muscle dysmorphia tend to hold delusions that they are "skinny" or "too small" but are often above average in musculature...
- Depression (differential diagnoses)Depression (differential diagnoses)Depression, one of the most commonly diagnosed psychiatric disorders, is being diagnosed in increasing numbers in various segments of the population worldwide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at increased risk...
- Eating RecoveryEating RecoveryEating recovery refers to the full spectrum of care that acknowledges and treats the multiple etiologies of anorexia nervosa and bulimia, including the biological, psychological, social and emotional/spiritual causes of the disorder, through a comprehensive, integrated treatment regimen...
- Marya HornbacherMarya HornbacherMarya Justine Hornbacher is an American author and freelance journalist. Her book Wasted: A Memoir of Anorexia and Bulimia, is an autobiographical account of her struggle with eating disorders, written when she was twenty-two. It has been translated into fourteen languages and sold over a million...
- National Association of Anorexia Nervosa and Associated DisordersNational Association of Anorexia Nervosa and Associated DisordersThe National Association of Anorexia Nervosa and Associated Disorders is the oldest organization aimed at fighting eating disorders in the United States. ANAD assists people struggling with eating disorders such as Anorexia nervosa and Bulimia nervosa and also provides resources for families,...
- Orthorexia nervosaOrthorexia nervosaOrthorexia nervosa is a term used by Steven Bratman to describe people who have developed a fixation with healthy or righteous eating and has been referred to as a mental disorder. It is not a medically recognized term....
- Pro-anaPro-anaPro-ana refers to the promotion of the eating disorder anorexia nervosa. It is often referred to simply as "ana" and is sometimes personified by anorexics as a girl named Ana. The lesser-used term pro-mia refers likewise to bulimia nervosa and is sometimes used interchangeably with...