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Anorexia nervosa

"Anorexia" and "Anorexic" redirect here. For lack of appetite, see Anorexia (symptom). For the medication, see Anorectic. For other uses, see Anorexia (disambiguation).

Anorexia nervosa
Other namesAnorexia, AN
"Miss A—" depicted in 1866 and in 1870 after treatment. Her condition was one of the earliest case studies of anorexia, published in medical research papers of William Gull.
SpecialtyPsychiatry, clinical psychology
SymptomsFear of gaining weight, strong desire to be thin, food restrictions,[1] body image disturbance
ComplicationsOsteoporosis, infertility, heart damage, suicide,[1] whole-body swelling (edema), heart failure and/or lung failure, gastrointestinal problems, extensive muscle weakness, delirium, death[2]
Usual onsetAdolescence to early adulthood[1]
CausesUnknown[3]
Risk factorsFamily history, high-level athletics, bullying, social media, modelling, substance use disorder, being a dancer or gymnast[3][4][5]
Differential diagnosisBody dysmorphic disorder, bulimia nervosa, hyperthyroidism, inflammatory bowel disease, dysphagia, cancer[6][7]
TreatmentCognitive behavioral therapy, hospitalisation to restore weight[1][8]
Prognosis5% risk of death over 10 years[4][9]
Frequency2.9 million (2015)[10]
Deaths600 (2015)[11]

Anorexia nervosa (AN), often referred to simply as anorexia,[12] is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.[1]

Individuals with anorexia nervosa have a fear of being overweight or being seen as such, despite the fact that they are typically underweight.[1][3] The DSM-5 describes this perceptual symptom as "disturbance in the way in which one's body weight or shape is experienced".[8] In research and clinical settings, this symptom is called "body image disturbance"[13] or body dysmorphia. Individuals with anorexia nervosa also often deny that they have a problem with low weight[4] due to their altered perception of appearance. They may weigh themselves frequently, eat small amounts, and only eat certain foods.[1] Some patients with anorexia nervosa binge eat and purge to influence their weight or shape.[1] Purging can be defined by excessive exercise, induced vomiting, and/or laxative abuse. Medical complications may include osteoporosis, infertility, and heart damage,[1] along with the cessation of menstrual periods.[4] In cases where the patients with anorexia nervosa continually refuse significant dietary intake and weight restoration interventions, a psychiatrist can declare the patient to lack capacity to make decisions. Then, these patients' medical proxies[14] decide that the patient needs to be fed by restraint via nasogastric tube.[15] [16]

Anorexia often develops during adolescence or young adulthood.[1] The main origins of anorexia nervosa rest primarily in sexual abuse and problematic familial relations, especially those of overprotecting parents showing excessive possessiveness over their children.[17] The exacerbations of the mental illness are thought to follow a major life-change or stress-inducing events.[4] The causes of anorexia are varied and may differ from individual to individual.[3] There is emerging evidence that there is a genetic component, with identical twins more often affected than fraternal twins.[3] Cultural factors also appear to play a role, with societies that value thinness having higher rates of the disease.[4] Anorexia also commonly occurs in athletes who play sports where a low bodyweight is thought to be advantageous for aesthetics or performance, such as dance, gymnastics, running, and figure skating.[4][5][18]

Treatment of anorexia involves restoring the patient back to a healthy weight, treating their underlying psychological problems, and addressing underlying maladaptive behaviors.[1] A daily low dose of olanzapine (Zyprexa®, Eli Lilly) has been shown to increase appetite and assist with weight gain in anorexia nervosa patients.[19] Psychiatrists may prescribe their anorexia nervosa patients medications to better manage their anxiety or depression.[1] Different therapy methods may be useful, such as cognitive behavioral therapy or an approach where parents assume responsibility for feeding their child, known as Maudsley family therapy.[1][20] Sometimes people require admission to a hospital to restore weight.[8] Evidence for benefit from nasogastric tube feeding is unclear.[21] Such an intervention may be highly distressing for both anorexia patients and healthcare staff when administered against the patient's will under restraint.[15] Some people with anorexia will have a single episode and recover while others may have recurring episodes over years.[8] The largest risk of relapse occurs within the first year post-discharge from eating disorder therapy treatment. Within the first 2 years post-discharge from eating disorder treatment, approximately 31% of anorexia nervosa patients relapse.[22] Many complications, both physical and psychological, improve or resolve with nutritional rehabilitation and adequate weight gain.[8]

It is estimated to occur in 0.3% to 4.3% of women and 0.2% to 1% of men in Western countries at some point in their life.[23] About 0.4% of young women are affected in a given year and it is estimated to occur ten times more commonly among women than men.[4][23] It is unclear whether the increased incidence of anorexia observed in the 20th and 21st centuries is due to an actual increase in its frequency or simply due to improved diagnostic capabilities.[3] In 2013, it directly resulted in about 600 deaths globally, up from 400 deaths in 1990.[24] Eating disorders also increase a person's risk of death from a wide range of other causes, including suicide.[1][23] About 5% of people with anorexia die from complications over a ten-year period[4][9] with medical complications and suicide being the primary and secondary causes of death respectively.[25]

  1. ^ a b c d e f g h i j k l m n "What are Eating Disorders?". NIMH. Archived from the original on 23 May 2015. Retrieved 24 May 2015.
  2. ^ "Anorexia Nervosa". My.clevelandclinic.org. Retrieved 9 June 2022.
  3. ^ a b c d e f Attia E (2010). "Anorexia nervosa: current status and future directions". Annual Review of Medicine. 61 (1): 425–435. doi:10.1146/annurev.med.050208.200745. PMID 19719398.
  4. ^ a b c d e f g h i Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Washington: American Psychiatric Publishing. 2013. pp. 338–345. ISBN 978-0-89042-555-8.
  5. ^ a b Arcelus J, Witcomb GL, Mitchell A (March 2014). "Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis". European Eating Disorders Review. 22 (2): 92–101. doi:10.1002/erv.2271. PMID 24277724.
  6. ^ Parker R, Sharma A (2008). General Medicine. Elsevier Health Sciences. p. 56. ISBN 978-0-7234-3461-0.
  7. ^ First MB (19 November 2013). DSM-5 Handbook of Differential Diagnosis. American Psychiatric Pub. ISBN 978-1-58562-462-1 – via Google Books.
  8. ^ a b c d e Cite error: The named reference DSM5 was invoked but never defined (see the help page).
  9. ^ a b Cite error: The named reference Espie_2015 was invoked but never defined (see the help page).
  10. ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. ISSN 0140-6736. PMC 5055577. PMID 27733282.
  11. ^ Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  12. ^ Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, et al. (November 2015). "Anorexia nervosa". Nature Reviews. Disease Primers. 1: 15074. doi:10.1038/nrdp.2015.74. PMID 27189821. S2CID 21580134.
  13. ^ Artoni P, Chierici ML, Arnone F, Cigarini C, De Bernardis E, Galeazzi GM, et al. (March 2021). "Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study". Eating and Weight Disorders. 26 (2): 499–514. doi:10.1007/s40519-020-00875-x. PMID 32124409. S2CID 211728899.
  14. ^ "Proxy definition and meaning". Collins English Dictionary. Retrieved 2 October 2020.
  15. ^ a b Kodua M, Mackenzie JM, Smyth N (December 2020). "Nursing assistants' experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa". International Journal of Mental Health Nursing. 29 (6): 1181–1191. doi:10.1111/inm.12758. PMID 32578949. S2CID 220046454.
  16. ^ "Force-Feeding of Anorexic Patients and the Right to Die" (PDF). Archived from the original (PDF) on 23 November 2020. Retrieved 2 October 2020.
  17. ^ Matt Lacoste S (1 September 2017). "Looking for the origins of anorexia nervosa in adolescence - A new treatment approach". Aggression and Violent Behavior. 36: 76–80. doi:10.1016/j.avb.2017.07.006. ISSN 1359-1789.
  18. ^ Sudi K, Öttl K, Payerl D, Baumgartl P, Tauschmann K, Müller W (2004). "Anorexia athletica". Nutrition. 20 (7–8): 657–661. doi:10.1016/j.nut.2004.04.019. PMID 15212748.
  19. ^ Walsh T (2020). Eating Disorders: What Everyone Needs to Know. Oxford University Press. pp. 105–113. ISBN 978-0190926595.
  20. ^ Hay P (July 2013). "A systematic review of evidence for psychological treatments in eating disorders: 2005–2012". The International Journal of Eating Disorders. 46 (5): 462–469. doi:10.1002/eat.22103. PMID 23658093.
  21. ^ "Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders". 2004. p. 103. PMID 23346610.
  22. ^ Berends T (2018). "Relapse in anorexia nervosa: a systematic review and meta-analysis". Current Opinion in Psychiatry. 31 (6): 445–455. doi:10.1097/YCO.0000000000000453. hdl:1874/389359. PMID 30113325.
  23. ^ a b c Smink FR, van Hoeken D, Hoek HW (August 2012). "Epidemiology of eating disorders: incidence, prevalence and mortality rates". Current Psychiatry Reports. 14 (4): 406–414. doi:10.1007/s11920-012-0282-y. PMC 3409365. PMID 22644309.
  24. ^ Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, et al. (GBD 2013 Mortality and Causes of Death Collaborators) (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
  25. ^ Smith AR, Zuromski KL, Dodd DR (1 August 2018). "Eating disorders and suicidality: what we know, what we don't know, and suggestions for future research". Current Opinion in Psychology. Suicide. 22: 63–67. doi:10.1016/j.copsyc.2017.08.023. ISSN 2352-250X. PMID 28846874.
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