12. Symptoms and features of anorexia

What is anorexia nervosa?

• AN is an eating disorder characterised by an intense fear of gaining weight, self starvation and a distorted body image.

If you were a doctor and were diagnosing someone with this eating disorder, what 4 signs of symptoms would you look for?

• Missing meals or eating very little.

• Having an unusually low BMI.

• Thinking about food a lot and being very careful about what you eat, such as avoiding eating foods you see as fattening.

• Believing you are fat when you are a healthy weight or underweight.

• Purging.

• Doing an extreme amount of exercise.

• Feeling lightheaded, or dizzy, hair loss or dry skin.

What is the ICD-11 classification criteria for Anorexia Nervosa? - Clinical characteristics of AN

• All 3 must be present

Criteria A - The person must be at least 15% below normal body weight (for expected age, sex, height etc). This is measured by BMI.

Criteria B - Person is terrified of weight gain and will persistently engage in activities to disrupt chances of weight gain. Restricting energy intake. Extreme exercise.

Criteria C - Person sees themselves as overweight even when extremely thin (distorted body image). They hugely overestimate body weight and have poor self-evaluations of how they look in relation to their weight. There is a denial of the reality of their body weight and their restrictive behaviours.

What are the 2 subtypes of Anorexia? - features of anorexia

Subtype 1 - Restricting type AN

• These people will show weight loss through weight gain prevention (excessive exercise/restrictive dieting) for a period of 3 months or more.

Subtype 2 - Binge - purge type AN

• These people have recurrent bouts of binge eating followed by periods of purging through the use of laxatives or inducing vomiting.

• Over a period of 3 months or more.

What is the prevalence rate of AN in the UK? - features of AN

• 0.3%-0.6%

• Usually prevalence is higher in westernised, highly industrialised cultures.

• This is because of the influence of media, different attitudes towards body shape.

Which gender is usually affected? - features of AN

• Significantly more females are diagnosed with anorexia than males.

• Diagnoses may occur in a ratio of 10:1 - female to male.

What age is peak onset? - Features of AN

• AN is usually diagnosed during adolescence or early adulthood.

• And it is usually a stressful life event that triggers onset.

What is the prognosis for this disorder? Features of AN

• Mortality rates are around 20% and death is usually as a result of cardiac arrest due to electrotype balances although suicide is also a leading cause of death.

• 60% of people of people with schizophrenia will attempt suicide - 10-15% will be successful.

• People with AN do not usually respond well to drug therapy; psychological therapies appear to be more successful and with treatment approximately 60% of people will recover.

What are internal medical complications that can arise as a result of this disorder?

• Heart problems - slow heart rate, low blood pressure, heart failure.

• Hormone imbalances - loss of periods (amenorrhea), infertility.

• Weak bones - osteoporosis.

• Bones become brittle due to the loss of calcium.

• Excessive thirst and frequent urination.

• Muscle weakness and loss.

• Digestive issues - constipation, bloating.

• Low body temperature.

• Kidney damage or dehydration.

• Risk of hypothermia.

• Cognitive deficits - brain fog.

• Bone density reduction.

• Severe anxiety, depression and an increased risk of suicide.

What are external medical complications that can arise as a result of AN?

• Nails and hair become brittle.

• Dry skin and hair loss.

• Growth of fine body hair.

• Fatigue and fainting.