Anorexia Nervosa

Happy Monday, and welcome to Medical Mondays! I don’t think(?) I’ve ever written anything that’s required a trigger warning before, but this topic would definitely qualify.

I know it’s not Monday yet, but my Recipe ReDux is tomorrow (see past ReDuxes!), and National Eating Disorder Awareness Week started today. There was no feasible way for me to cover them all in the span of a single post, so I’ll be going over Anorexia Nervosa today.

90-95% cases of anorexia are found in women, most commonly in ages 13-14 and 17-18 (due to hormonal influences, and environmental influences, respectively).

Anorexia is more common in industrialized countries, and where a thin body ideal is held. It is also more often found in sports that involve thinness, revealing attire, subjective judging, and weight classes (e.g. running, ballet, gymnastics, wrestling, cheerleading, figure skating).

There are a number of theories behind how anorexia manifests. Psychodynamic theories include difficulty with separation and autonomy due to parental enmeshment or a strict and controlling home life. It could also be due to a struggle to gain control, or an attempt to stop or reverse secondary sexual characteristics. Social theories include an exaggeration of social values (e.g. a preoccupation with achievement, control, and perfection), and/or the idealization of a thin body type.

Anorexia can be life-threatening, and onset is typically very gradual, so changes may go unnoticed.

There are two main subdivisions of anorexia:

• Restrictive: has not regularly engaged in binge-eating or purging behavior, and often possesses obessessive-compulsive personality traits
• Binge-eating/purging: eats in binges followed by self-induced vomiting, laxative use, excessive exercise, and/or use of diuretics

Diagnosis

• Refusal to maintain minimally normal body weight for one’s age + height (<85% of ideal body weight, or BMI < 17.5)
• Intense fear of gaining weight or “becoming fat”
• Disturbed body image, undue influence of weight/shape on self-evaluation, or denial of the seriousness of their current low body weight
• Amenorrhea in postmenarchal females (absence of >3 consecutive menstrual cycles) caused by weight loss

Symptoms

Anorexia is often very well hidden, and as such, many of the symptoms and findings may go unnoticed. Some symptoms include:

• Amenorrhea
• Cold intolerance or hypothermia
• Hypotension (low blood pressure, especially orthostasis)
• Bradycardia (HR < 60 beats/min)
• Constipation
• Lanugo hair (fine body hair normally present on prepubertal children) or alopecia
• Edema
• Dehydration

Clinical/Lab Findings

• Hyponatremia (low sodium in the blood)
• Hypochloremic hypokalemic alkalosis (low chloride/potassium + high blood pH)
• Arrhythmia, acute coronary syndrome, cardiomyopathy, mitral valve prolapse
• Peripheral neuropathy, seizures
• Hypothyroidism
• Osteopenia, osteoporosis
• Hypercholesterolemia
• Leukopenia, anemia
• Increased GH (growth hormone), cortisol
• Reduced gonadotropins (LH + FSH; luteinizing hormone, follicle-stimulating hormone), sex steroid hormones (estrogen, testosterone)
• Hypoglycemia

Treatment

• Food is the best medicine
  • Monitor daily fluid intake and output
  • Weigh daily
• Behavioral therapy, family therapy, and supervised weight-gain programs
• Patients may be treated as outpatients unless they are >20% below their ideal body weight, or if there are serious medical or psychiatric complications, in which case they should be hospitalized for supervised refeeding*
• Psychiatric medications may be necessary in severely malnourished patients with anorexia nervosa

*Refeeding syndrome occurs when a severely malnourished patient is refed too quickly. This can lead to fluid retention and metabolic imbalance, and complications can lead to arrhythmias, respiratory failure, delirium, and seizures. Replace electrolytes and slow the feedings.

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)