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8/12/2019 Anorexia Nervosa Calvina
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ANOREXIA NERVOSA
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What is eating disorders?
Eating disorders are disorders of eating
behavior overvalued desire of weight
loss functional medical,
psychological, and social impairment.
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Pathways to Eating Disorders
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Types of eating disorders
Anorexia Nervosa
Bulimia Nervosa
Binge-eating disorder
MAJOR TYPES
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ANOREXIA NERVOSA?
The term anorexia nervosa is derived from
the Greekterm means loss o f appet i te.
Anorexia nervosa is a psychiatric illness
that describes an eating disorder
characterized by extremely low body
weight and body image distortion with an
obsessive fear of gaining weight.
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Epidemiology
Lifetime prevalence of anorexia nervosa is
less than 1% and is 10 times more
frequent in women than in men.
Peaks occur at early and late teen years.
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Three essential criteria!!
1. Behaviorself-induced starvation to a
significant degree.
2. Psychopathologystrong drive for
thinness and/or a morbid fear of fatness.
3. Physiological symptomatology the
presence of medical signs and
symptoms resulting from starvation.
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Types of anorexia nervosa
Restricting typeloses weight by severely
limiting the amount of food consumed.
Binge-eating-purgingtypeengages in
binges (large amount of food consumed)
following by purging (vomiting or use of
laxatives).
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Etiology
1. Physiological factors:
Genetic factors
Neurobiological factors
Nutritional factors
2. Psychological factors
3. Social and environmental factors
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CLINICAL FEATURES
Ph i l f t
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Physical features : Extreme weight loss
Body mass index less than 17.5 in adults, or 85% of expected weight inchildren
Stunted growth
Endocrine disorder, leading to cessation of periods in girls (amenorrhoea) Decreased libido; impotence in males
Starvation symptoms, such as reduced metabolism, slow heart rate(bradycardia), hypotension, hypothermia and anemia
Abnormalities of mineral and electrolyte levels in the body
Thinning of the hair Constantly feeling cold
Zinc deficiency
Constipation
Dry skin
In cases of extreme weight loss, there can be nerve deterioration, leading todifficulty in moving the feet
Fragile appearance; frail body image
Slowing of the rate of growth of breasts
Drastic changes in blood pressure upon standing
Dizzyness and fainting
Etc.
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Psychological features: Distorted body image
Poor insight
Self-evaluation largely, or even exclusively, in terms oftheir shape and weight
Pre-occupation or obsessive thoughts about food andweight
Perfectionism
Obsessive compulsive disorder (OCD) Belief that control over food/body is synonymous with
being in control of one's life
Refusal to accept that one's weight is dangerously loweven when it could be deadly
Refusal to accept that one's weight is normal, or healthy loss in memory
hallucinations
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Emotional features :
Low self-esteem and self-efficacy
Phobia of becoming overweight
Clinical depression
Mood swings
Feelings of loneliness
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Behavioral features:
Excessive exercise, food restrictions
Secretive about eating or exercise behavior Self-harm, substance abuse
Very sensitive to references about body weight
Aggressive when forced to eat Social withdraw or being anti-social
Checking body in the mirror constantly
Checking body weight on scale constantly Thoughts of suicide
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Table 1. DSM-IV-TR Diagnostic Criteria for Anorexia Nervosa
A.Refusal to maintain body weight at or above a minimally normal weight for age
and height (e.g., weight loss leading to maintenance of body weight less than 85%of
that expected, or failure to make expected weight gain during period of growth, leadingto body weight less than 85% of that expected).
B.Intense fear of gaining weightor becoming fat, even though underweight.
C.Disturbancein the way in which onesbody weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or denialof the seriousness of the
current low body weight.D.In postmenarcheal women, amenorrhea, i.e., the absence of at least three
consecutive menstrual cycles. (A woman is considered to have amenorrhea if her
periods occur only following hormone, e.g., estrogen, administration.)
Specify type:
Restricting type: during the current episode of anorexia nervosa, the person has not
regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the
misuse of laxatives, diuretics, or enemas)
Binge-eating or purging type: during the current episode of anorexia nervosa, the
person has regularly engaged in binge-eating or purging behavior (i.e., self-induced
vomiting or the misuse of laxatives, diuretics, or enemas)
T bl 2 ICD 10 Di i C i i f A i N
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Table 2. ICD-10 Diagnostic Criteria for Anorexia Nervosa
Anorexia nervosa :
A.There is weight lossor, in children, a lack of weight gain, leading to a body weight at least
15% below the normalor expected weight for age and height.
B.The weight loss is self-inducedby avoidance of fatteningfoods.
C.There is self-perception of being too fat, with an intrusive dread of fatness, which leads to a
self-imposed low weight threshold.
D.A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is
manifest in women as amenorrheaand in men as a loss of sexual interest and potency. (An
apparent exception is the persistence of vaginal bleeds in anorexic women who are on
replacement hormonal therapy, most commonly taken as a contraceptive pill.)
E.The disorder does not meet Criteria A and B for bulimia nervosa.
Comments :
The following features support the diagnosis but are not essential elements: self-induced
vomiting, self-induced purging, excessive exercise, and use of appetite suppressants or diuretics.
If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth
ceasesin girls, the breasts do not develop and there is a primary amenorrhea; in boys, thegenitals remain juvenile). With recovery, puberty is often completed normally, but the menarche
is late.
Atypical anorexia nervosa :
Researchers studying atypical forms of anorexia nervosa are recommended to make their own
decisions about the number and type of criteria to be fulfilled.
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COMPLICATIONS
Cardiovascular
Muscular Skeletal
GIT
Endocrine System
Death
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TREATMENT
Medical care
Psychotherapy
Nutritional therapy
Medications
Hospitalization
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THANK YOU