Anorexia Nervosa

Anorexia nervosa occurs in individuals of all ethnicities and socioeconomic statuses, although the incidence is higher in industrialized Westernized countries and increases with exposure to Western culture and media. The peak age of anorexia nervosa onset is about 15 years, although some studies suggest that the onset may have a bimodal distribution with peaks at ages 14 and 18 years. With a point prevalence of 0.48%-0.7%, anorexia nervosa is a relatively common disorder in adolescent females. Although it is uncertain if the overall incidence of anorexia nervosa is increasing, the rate is definitely on the rise among adolescents (Lucas et al. 1991; van Son et al. 2006). Only 5%-10% of patients with anorexia nervosa are male, but the true incidence may be higher because males are often less likely to come to clinical attention and the current diagnostic criteria emphasize female body concerns.

The restrictive eating pattern in anorexia nervosa results in severe weight loss (or lack of appropriate weight gain during periods of growth), distorted body weight and shape perceptions, denial or minimization of the health risks of malnutrition, and loss of regular menstruation in postmenarcheal females. Anorexia nervosa may also be associated with binge eating or purging, although the restrictive eating pattern predominates, particularly in younger patients (Peebles et al. 2006). Comorbid psychiatric disorders, including anxiety disorders (especially obsessive-compulsive disorder), mood disorders, social withdrawal, and interpersonal/familial difficulties, are common. Approximately 60% of patients with anorexia nervosa have a lifetime mood disorder, whereas 35% suffer from obsessive-compulsive disorder (Kaye et al. 2004). A moderate overlap appears to exist between anorexia nervosa and symptoms of avoidant personality disorder (Casper et al. 1992).

A range of short- and long-term medical complications are related to severe malnutrition (see Table 10-3). Bradycardia, cardiac arrhythmia, hypothermia, hypotension, and orthostasis are significant acute health issues. A life-threatening refeeding syndrome can occur if a severely malnourished patient is provided nutrition replacement too quickly. In this syndrome, the total body phosphate levels that are already depleted due to malnutrition can become dangerously low when phosphate enters the cells during refeeding, leading to possible cardiac arrhythmias and even cardiac arrest. The most worrisome long-term medical complications include growth retardation, pubertal delay/interruption, and peak bone mass reduction hypophosphatemia (Katzman 2005). Mortality rates are higher in anorexia nervosa than for any other psychiatric disorders, with the possible exception of substance abuse disorders. The aggregate mortality rate is approximately 5.6% per decade (Sullivan 1995), and the crude mortality rate is 5.1% (Herzog et al. 2000). About half of the deaths are due to physical causes (e.g., cardiac arrest), and the remainder are due to completed suicides (Zipfel et al. 2000).

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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