Anorexia Nervosa

Published on 21/03/2015 by admin

Filed under Pediatrics

Last modified 21/03/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 926 times

Chapter 1 Anorexia Nervosa

PATHOPHYSIOLOGY

Anorexia nervosa is an eating disorder that typically begins in adolescence and is characterized by the refusal to maintain a body weight within the minimal range of normal for height, weight, and body frame. The patient denies the seriousness of weight loss and has a distorted body image. Despite being dangerously thin, the individual feels fat. In addition, there may be a focus on the shape and size of particular body parts (Box 1-1).

There are two general subtypes of anorexia nervosa. The restricting type involves severe restriction of food intake and compulsive exercising. The binge eating and purging type involves restricted dietary intake coupled with intermittent episodes of binge eating, followed by purging. Self-induced vomiting and use of ipecac, laxatives, diuretics, or enemas are common means of purging. Excessive use of appetite suppressants or diet pills is seen in both types.

Purging and semistarvation may induce electrolyte imbalance and cardiac problems, which may ultimately lead to death. Starvation creates a range of medical symptoms. Changes in growth hormone levels, diminished secretion of sex hormones, defective development of bone marrow tissue, structural abnormalities of the brain, cardiac dysfunction, and gastrointestinal difficulties are common. A notable problem associated with anorexia in adolescents is the potential for growth retardation, delay of menarche, and peak bone mass reduction. When normal eating is reestablished and laxative use is stopped, the youth may be at risk for developing medical complications.

A variety of psychologic factors are associated with anorexia nervosa. Personality traits of perfectionism and compulsiveness are common. Low self-esteem also plays a role. In many cases, weight loss is experienced as an achievement, and self-esteem becomes dependent on body size and weight. At the same time the adolescent may experience peer, familial, and cultural pressures to be thin. There is a high incidence of co-occurring mood disorders in anorexic patients. In some cases, major depression may result from nutritional deprivation. Individuals with anorexia nervosa may lack spontaneity in social situations and may be emotionally restrained. Family dynamics may play a role in development of symptoms. Eating behaviors ostensibly emerge in an unconscious attempt to gain control in cases where parents are perceived to be controlling and overprotective. For some adolescents, diminished weight and loss of secondary sexual characteristics are related to difficulty accepting maturation into adulthood. A reflection of the sociocultural ideal of thinness, disordered eating that is not severe enough to meet criteria for anorexia nervosa is common among adolescent girls in the United States and is on the rise in males.

CLINICAL MANIFESTATIONS

1. Sudden, unexplained weight loss

Buy Membership for Pediatrics Category to continue reading. Learn more here