ANOREXIA NERVOSA

DIAGNOSTIC CRITERIA

Definition : Persistent refusal to eat due to morbid fear of obesity, leading to excessive dieting and marked loss of weight, and later to features of malnutrition. Could alternate with Bulimia nervosa characterized by episodes of binge eating with self-induced vomiting, misuse of laxatives, enema, or / diuretics, but still persistent worries about weight. gain.

1. Most often a female at pubertal age, with a perceptual distortion of body image., Denial of the problem is common. History of sexual abuse found in many patients.
2. High level of activity and alertness, Associated physiologic and endocrinologic changes amenorrhoea, low resting metabolic rate, increased body hirsutism, May present with vomiting or bulimia.
3. Co-morbid major depression in a majority of cases. Suicide could occur.

Prognosis: Better if onset is at an early age. Poor in severe cases, those with continued low weight, poor response to treatment and or repeated vomiting.5-20% mortality cited with death due to electrolyte abnormalities, starvation or suicide. Many symptoms resolve with weight gain.

MANAGEMENT

Generai Principles:

Initial hospitalisation for studies. Majority can be treated as Outpatients. Basically treated by psychotherapy, correction of nutritional and metabolic disturbances and pharmaco-therapy. There is no drug of proven efficacy for this disorder. In cases with rapid weight Ioss, sudden death might occur. Starved patients are very sensitive to medications and could suffer dangerous side effects due to compromised cardiac, renal or hepatic function. Also they could attempt suicide by overdose. Hence would need careful dosage and monitoring.

Supportive care by an understanding physician, can achieve much.

General Measures

• Calls for psycho-therapy, structured behavioural therapy and family counselling.
• Bed rest with supervised meals until patient has gained considerable weight. Weight gain to be gradual at 1-3 pound aweekto prevent gastric dilatation.
• Develop trust of patient and focus on overall improvement of health rather than weight gain.
• Challenge the fear of uncontrollable weight gain.

Patient teaching

• Provide information on nutrition, metabolic demands, and basic health parameters.
• Ask patient to maintain a “food diary” listing foods eaten, and associated feelings.
• The patient should be repeatedly reassured that she ‘would not be allowed to get fat’.

Follow up

• Establish regular schedule to monitor weight, deprived feelings, rituals of eating, level of physical activity.