Symptoms and Features of Anorexia Nervosa

Question 1

Diagnosis of AN

Answer 1

DSM-5

Question 2

What is AN

Answer 2

Nervous loss of appetite

Question 3

Symptom 1

Answer 3

Restriction of energy intake
Low body weight for age sex etc

Question 4

How does ICD-10 define low body weight

Answer 4

15% below expected or BMI is 17.5 or less

Question 5

Symptom 2

Answer 5

Fear of weight gain/ interfering behaviours
Behave in ways to prevent weight gaining (not just avoiding eating fattening foods)

Question 6

What does DSM-5 state about symptom 2

Answer 6

Intense fear of gaining weight or becoming fat

Question 7

What does iCD-10 say about symptom 2

Answer 7

Self induced vomiting and or purging, excessive exercise, using appetite suppressants

Question 8

Symptom 3

Answer 8

Disturbed experience of body weight/ shape
Weight or shape has a disproportionate influence on self evaluation
Fail to recognise how serious low body weight is

Question 9

ICD-10 states about symptom 3

Answer 9

Body-image disturbance

Question 10

Two subtypes of AN

Answer 10

Restricting
Bingeing and or purging

Question 11

Describe the restrictive subtype

Answer 11

No bingeing or purging in 3 months before diagnosis
Weight loss is achieved through dieting (e.g. one meal a day, one type/colour of food) and/or excessive exercise.

Question 12

Describe binge-eating
/ purging subtype

Answer 12

bingeing and/or purging in the previous three months (usually with restricting energy intake).

Question 13

What do we use to measure severity of disorder

Answer 13

DSM-5

Question 14

Categories of severity

Answer 14

mild (BMI >17)
moderate (16-16.99)
severe (15-15.99)
extreme (<15).

Question 15

Lifetime prevalence rate for females

Answer 15

1.7-3.6% (0.1% in males).

Question 16

Rate of new cases In 16-20 year age group

Answer 16

6.05 new cases per 10,000-person years
Female incidence much higher than male.

Question 17

Prognosis

Answer 17

six times as many deaths as expected for females with AN (highest mortality of all mental disorders)

Question 18

What predicts better outcomes for recovery

Answer 18

Being younger and staying longer in hospital during first hospitalisation predicts better outcomes (survival and recovery).

Question 19

Strength study

Answer 19

Sysko et al (2012)

Question 20

Sysko et al (2012) findings

Answer 20

Assessed ppts by telephone interview using the DSM-5 critera for AN
repeated this with a different assessor a few days later
The extent of agreement across the two occasions was described by the researchers as excellent
Suggests that trained assessors can reliably diagnose AN using the DSM-5 criteria

Question 21

CA of strength

Answer 21

However, this finding does not necessarily support the view that the DSM-5 criteria for AN are reliable. Thomas et al. (2015) point out that many studies go beyond the DSM-5 criteria in operationally defining AN.
For instance, many use a researcher-defined cut-off point for significantly low weight’ because none is specified in the DSM-5. This means reliability estimates in research studies are higher than they would be in real-life clinical practice (because it is easier to achieve agreement between raters when criteria are defined in detail).

Question 22

Weakness study

Answer 22

Smith et al (2017)

Question 23

Smith et al (2017)

Answer 23

Looked at validity of 4 severity specifiers
In 109 adults diagnosed with AN, higher BMI (low severity) was linked to greater eating disorder psychopathology - opposite of expected outcome
Issue for the DSM-5 severity specifiers as they fail to distinguish accurately between people and therefore lack validity