Anorexia Nervosa

Anorexia nervosa:

an intense fear of gaining weight

Characteristics of anorexia nervosa:

intense fear of weight gain, distorted body image, restricted calories w significantly low BMI

Behaviors of someone w anorexia nervosa:

restriction, compensatory behaviors

Purging:

compensatory behavior → vomiting, excessive exercise, use of laxatives or stimulants, or thyroid meds aimed at decreased weight

Factors that influence the stage of recovery in anorexia nervosa:

the % of weight restoration, extent to which self-worth is defined by shape and weight, and functional impairment in the pt’s personal life

Typical onset for anorexia nervosa:

median age 18

How many individuals w anorexia nervosa seek help?

adolescence or young adults

Anorexia nervosa is more common in:

those who are athletes participating in sports that emphasize aesthetics or leanness for advantage in competition → running, gymnastics, wrestling, rowing, and figure skating; also those in the LGBTQ community

Those w anorexia nervosa can be deficient in:

tryptophan bc of their diet

Tryptophan:

an amino acid critical to the synthesis of serotonin

What type of disorder is anorexia nervosa?

an ego-syntonic disorder

Ego-syntonic disorder:

a disorder in which the individual w the disorder values; they can be aware that they are harming their bodies but believe that the benefits outweigh the harm

Pts w anorexia struggle w:

emotional identification, regulation, and processing → causing them to have a low distress tolerance and deficits in behavioral control in response to stress

You may find what in the general assessment of someone w anorexia nervosa?

underweight, lanugo on the face and back, mottled cool skin on the extremities, low BP, low HR, low temp, electrolyte imbalances (if purging)

Lanugo:

fine, downy hair

What is used to determine the severity of anorexia nervosa?

BMI

Mild anorexia:

BMI 17 or more

Moderate anorexia:

BMI 16-17

Severe anorexia:

BMI 15-16

Extreme anorexia:

BMI less than 15

Tx for anorexia nervosa:

a medical unit specialized in eating disorders - if not available, in cardiac or med/surg for a short period of time

Refeeding syndrome:

abnormalities in fluid balance and glucose metabolism as well as hypophosphatemia, hypomagnesemia, and hypokalemia; sometimes thiamine deficieny

Refeeding syndrome occurs when:

a pt is severely malnourished

Pharmacotherapy for anorexia nervosa:

none FDA approved; psychotropic meds for associated symptoms of the disorder (SSRIs, antianxiety agents, second-gen antipsychotics, and mood stabilizers)

Integrative therapy for anorexia nervosa:

yoga, massage, acupuncture, or bright light therapy

Psychological therapies for anorexia nervosa:

supportive individual, group, or fam therapy

Family-based therapy (F-BT):

an out-pt 6-12 week tx that helps parents disrupt their child’s starvation and excessive exercise and encourage the child to develop a more constructive approach to weight

F-BT and CBT can be helpful in which pts w anorexia nervosa?

in adolescents