Anorexia Nervosa

Question 1

Who does anorexia affect?

Answer 1

-9 in 1000 females in their lifetime
-Women 10x more likely to be affected by it
-Typical age of onset is early to mid-adolescence

Question 2

What causes anorexia?

Answer 2

-Maintenance of a low body weight as a result of a preoccupation with weight, often construed either as a fear of fatness or a pursuit of thinness
-Often believe they are fat and are terrified of becoming a ‘normal’ weight or shape
-Aetiology and sustenance of the disease is thought to be multifactorial

Question 3

What risk factors are there for anorexia?

Answer 3

-Female gender
-Age
-Western
-FHx of eating disorders, depression or substance misuse
-Hx of sexual abuse, occupational / social pressure
-Personal characteristics such as perfectionism, obsessional traits, anxiety, premorbid obesity

Question 4

How does anorexia present?

Answer 4

-Refusal to maintain a normal body weight - below 85% of predicted ie BMI<18.5
-Dieting or restrictive eating practices
-Rapid weight loss
-Dread of gaining weight
-Denial
-Resistance to any interventions
-Social withdrawal
-Over-exercise, use of diuretics / laxatives, self-induced vomiting
Further physical symptoms:
-Amenorrhoea (women)
-Constipation, feeling of fullness, dysphagia, abdo pain
-Fatigue, fainting, dizziness, cold intolerance
-Delay in secondary sexual development

Question 5

What signs might the patient have on examination?

Answer 5

-Low weight and BMI
-Low core temperature
-Poor circulation and oedema on peripheral examination
-Check BP for postural hypotension
-Reduced muscle power

Question 6

How would you investigate this patient?

Answer 6

-ESR + TFTs to screen for other causes of weight loss
-U+Es if using diuretics, vomiting, laxatives
-Consider DEXA scan
-ECG may show bradycardia and prolonged QT in severe disease

Question 7

What treatment would you consider?

Answer 7

Adults:
-Individual eating disorder-focused CBT - involves 40 sessions over 40 weeks, initially several times a week
-MANTRA (Maudsley Anorexia Nervosa Treatment for Adults) - usually 20 sessions
-SSCM (Specialist supportive clinical management)
Children:
-Family therapy for 18-20 sessions, consisting of 3 phases:
1. Control of YP’s eating is given to the parents
2. Once weight has been restored, YP is encouraged to take back independence in managing eating
3. Planning to maintain healthy weight and prevent relapse
-Individual CBT are alternatives