110409Anorexia

110409Anorexia - Can you be too thin? A discussion on...

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Can you be too thin? A discussion on anorexia nervosa NPB 132
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Lecture Objectives 1. Define anorexia nervosa 2. Why it’s dangerous to be too thin 3. What factors contribute to becoming anorexic? 4. Why do anorexics catabolize proteins? 5. Refeeding syndrome -- why feeding anorexics can cause death.
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Anorexia Nervosa (AN) “A nervous loss of appetite” Category DSM-IV definition ICD-10 definition Weight Refusal to maintain normal body weight (<85% expected wt) • Failure to make expected wt gain during growth Body weight maintained at least 15% below normal • BMI < 17.5 Failure to make expected wt gain during growth Phobia/ associated behaviors • Intense fear of gaining wt or becoming fat Restrictive Binge-eating/purging • Wt loss by avoiding “fattening foods” • 1+ of following: self-induced vomiting, purging, excessive exercise, appetite suppressants Body perception • Disturbance in body perception • Undue influence of BW or shape on self-evaluation Or • Denial of seriousness of low BW • Body image distortion whereby a dread of fatness persists as an intrusive, overvalued idea Patient imposes a low weight threshold on himself/herself
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Anorexia Nervosa (AN) Category DSM-IV definition ICD-10 definition Amenorrhea/ hormonal fluctuations • In postmenarcheal females, absence of at least 3 consecutive menstrual cycles • Women: amenorrhea Men: loss of sexual interest and potency Elevated GH, cortisol, TH, abnormal insulin secretion Pubertal development • Not specified • Sequence of pubertal events is delayed or even arrested For DSM classification of AN, need to fit all 4 categories *DSM= Diagnostic and Statistical Manual of Mental Disorders ICD= International Classification of Disease
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Prevalence of AN Clinical AN: Estimated at ~0.3% (up to 2% for women) Sub-threshold AN: ~0.37%-1.3% Debate over increasing or stable rates Most common age of onset: 15-19 years 10:1 or 20:1 female:male ratio Most often Caucasian and middle to upper class Often participate in “low-fat” favoring activities- running, modeling, dance, etc.
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Anorexia Nervosa: A Complex Disorder Marked by psychological, social, and physical disturbances Psychological and social disturbances are difficult to disentangle-cause and effect Eating disorders are particularly persistent and difficult to treat
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associated with AN Difficult to entangle relationship with AN: Risk factor? Consequence? Common cause?
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110409Anorexia - Can you be too thin? A discussion on...

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