ED: Anorexia Nervosa

Question 1

Define anorexia nervosa.

Answer 1

Ed characerised by deliberate weight loss resulting in weight below 15% of expected or BMI <17.5, with secondary endocrine and metabolic disturbances.

Question 2

Explain the aetiology/risk factors for anorexia nervosa.

Answer 2

Genetic link

Dysfunction of 5HT

Sociocultural view of thin is desirable

Family relationships

Personality – Perfectionism and obsessiveness

Question 3

Summarise the epidemiology of anorexia nervosa.

Answer 3

Associated with certain occupations (i.e. modelling) and comorbid depression, substance misuse and personality disorder

Mainly female, peak age 15-19

Higher in high SES

Question 4

What are signs and symptoms of anorexia nervosa?

Answer 4

Weight loss induced by vomiting, excessive exercise, appetite suppression, diuretics and laxatives.

Morbid fear of fatness, body image distortion, loss of libido, fatigue, amenhorrea, obsessional thoughts and rituals.

Question 5

How would an anorexia patient appear on examination?

Answer 5

Dehydration

Proximal myopathy

Cold extremities

Bradycardia

Hypotension

Fine lanugo hair

Peripheral odema

Parotid enlargement and erosion of tooth enamel (vomiting)

Low mood likely

Question 6

What are investigations for anorexia nervosa?

Answer 6

Investigate other potential causes: FBCs, U+Es, Ca2+, LFTs, TFTs

Hormone screen

Glucose, amylase, lipids, toxicology, electrolytes

Bone scan – very high risk of osteoporosis

Question 7

What is the management for anorexia nervosa?

Answer 7

Correct medical complications (hydration, electrolytes)

Psychiatric admission and feeding (either controled or NG tube if will not take food)

Negotiate dietary aims

CBT, family therapy, SSRIs may help

Question 8

What are complications associated with anorexia nervosa?

Answer 8

Osteoporosis

Arrhythmias

Electrolyte disturbances

Renal failure

Pancreatitis

Hepatitis

Seizures

Peripheral neuropathies

Suicide

Question 9

What is the prognosis of anorexia nervosa?

Answer 9

Some patients recover after single episode, some relapse with chronic deteriorating course over years. 10% mortality due to comorbidities.

Poor coutcome if older onset age, long duration of illness, low weight at presentation and poor childhood social adjustment.