Anorexia Nervosa

Classification and Diagnosis of Anorexia Nervosa

  • Anorexia nervosa classified as a behavioral or psychiatric disorder.

  • Key nutritional and endocrine features are significant.

  • Discussion will not cover bulimia and mixed disorders due to differing medical and metabolic consequences.

  • Diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders V-TR (DSM):

    • Criteria include persistent restriction of energy intake leading to significantly low body weight.

    • Distorted body image and undue influence of body shape and weight on self-evaluation.

    • Denial of the importance of low body weight and fear of gaining weight.

    • Requirement for amenorrhea and weighing less than 85% of ideal body weight were removed.

    • This change allows diagnosing males and establishes a less rigid weight definition.

  • Prevalence common among young women but affects other demographic groups as well.

    • Typically observed in individuals from middle or upper-income families.

    • Males account for approximately 10% of cases.

Prevalence of Anorexia Nervosa

  • Anorexia nervosa affects approximately 0.3% to 3.0% of women in the U.S.

  • It is among the most prevalent chronic diseases in adolescent women, ranking third after obesity and asthma.

  • Eating disorders affect an estimated 1 million teenagers in total, including:

    • Anorexia Nervosa

    • Bulimia Nervosa

    • Binge Eating Disorder

    • Other unspecified eating disorders.

  • Typical onset shortly after the onset of menstruation or in college years/early 20s.

  • Serious medical complications include:

    • Osteoporosis

    • Depression

    • Reproductive dysfunction

    • Increased risk of death.

  • Recovery statistics indicate that around 50% of women recover fully, while others may experience partial recovery or persistence of the disorder.

Medical and Endocrine Consequences of Anorexia Nervosa

  • Anorexia nervosa, while primarily a behavioral/psychiatric disorder, has severe medical consequences that are nutritional/metabolic in nature.

  • Mortality rates indicate that up to 20% of women with eating disorders die prematurely due to:

    • Complications, including suicide and heart problems such as arrhythmias and sudden death.

  • Common medical complications include:

    • Anemia

    • Immune deficiencies

    • Low blood pressure

    • Dry skin and brittle hair/loss of hair

    • Bloating and constipation

    • Hypoglycemia

    • Abdominal discomfort.

  • Endocrine disorders associated include:

    • Hypogonadism

    • Amenorrhea

    • Hypercortisolemia

    • Reduced thyroid function

    • Low basal metabolic rate

    • Severe bone loss leading to fractures and osteoporosis.

Classic Forms of Starvation

  • Comparison of starvation types relevant to anorexia nervosa:

    • “Marasmus”: Characterized by weight loss but a healthy appearance without swelling.

    • “Kwashiorkor”: Presents with a sick appearance and swollen abdomen; often leads to death.

Hormonal Consequences of Starvation or Semi-Starvation

  • Effects on daily life observed due to hormonal changes include:

    • Growth (involvement of growth factors like GH/IGF-1):

    • Consequences for height and muscle mass are noted.

    • Reproductive system effects include:

    • Gonadotropins and gonadal function affected leading to hypogonadism and amenorrhea.

    • Low estrogens or androgens with low body weight can cause irreparable bone mass loss.

    • Low female hormone levels in women may negate cardiac protective effects:

      • Impacts HDL levels and clotting.

    • Loss of secondary sexual characteristics and libido can occur.

    • Thyroid axis functionality (involvement of T4/T3/TSH) results in lower energy expenditure.

  • Behavior and cognitive changes due to starvation include:

    • Loss of concentration

    • Increased rates of depression

    • Reduced energy levels.

Treatment Approaches to Eating Disorders

  • Recognizing that individuals with anorexia nervosa often think about food continuously, behavioral factors are also key.

  • Family dynamics play an important role, usually marked by:

    • Anxiety, rigidity, and compulsivity.

  • The media and external pressures significantly impact eating behaviors.

  • Effective treatment strategies are multidisciplinary, prioritizing:

    • Prevention and early intervention.

    • Acute interventions for severe cases, including hospitalization.

    • Intensive outpatient programs, particularly in college settings.

    • Behavioral therapy has shown significant efficacy.

    • Long-term management includes counseling with physicians, nutritionists, and possibly family involvement.

    • UC Berkeley offers specialized programs via the Eating Disorders Team (Tang Center).

Types of Treatment of Eating Disorders

  • Treatment modalities include:

    • Physical Health Management

    • Nutritional Counseling and Advice

    • Mental Health Management:

    • Psychotherapy

    • Cognitive Behavioral Therapy (CBT)

    • Interpersonal Psychotherapy

    • Dialectical Behavioral Therapy (DBT)

    • Intensive Short-Term Dynamic Psychotherapy (ISTDP)

    • Mindfulness-Based Therapy

    • Group Therapy

    • Family-Based Therapy (The Maudsley Approach)

    • Drug Treatment

    • Support Groups

    • Self-education

    • Alternative Therapies such as hypnosis.

Specific Treatments for Eating Disorders

  • Cognitive Behavioral Therapy (CBT):

    • Popular method based on the interdependence of thoughts and feelings.

    • Aims to challenge and restructure existing thought patterns to promote healthier behaviors.

    • Specifically targets distorted views on food and self-perception.

  • Dialectical Behavioral Therapy (DBT):

    • Emotion regulation model aimed at helping individuals deal with emotional distress through appropriate coping strategies.

    • While most studies have investigated its effect on Bulimia Nervosa and Binge Eating Disorder, its principles are beneficial for those with anorexia nervosa as well.