This is a Presentation done for psychiatry subject More concise version for anorexia nervosa .

1. Anorexia Nervosa
Sudhandra Devi
Group 4

2. Introduction
• Anorexia Nervosa is a serious mental illness.
• It's associated with one of the highest mortality risks of any
psychiatric disorder.
• It's is a psychiatric disorder that's defined by both physical &
mental characteristics.
• Often associated with other illness - [Anxiety, OCD, depression]

3. Criteria 1
restriction of
energy intake
that leads to
low body
weight
Criteria 2
• expression of fear of gaining
weight
• persistent, restrictive eating
• engagement in excessive
exercising or fasting
• Purging behaviours
Criteria 3
disturbances
of body
image
It's a Complex eating disorder characterized by Obsessive pursuit of thinness through
dieting with extreme weight loss & disturbances of body image
The Diagnostic & Statistical Manual of mental disorders (DSM-5) defines
Anorexia Nervosa by 3 criteria:

4. Low body weight in anorexia nervosa:
 Adults: <18.5 BMI
 Kids & adolescents: <5th percentile of growth
trajectory
Disturbance of body image:
 Seeing oneself as fat, even though one is
underweight
 Undue influence of weight & shape of one's
self-worth
 Not recognizing how dangerous low weight can
be

5. Two types
Binge-eating/
purging type
Restricting type
• Recurring purging behaviours
(I.e. laxative or diuretic abuse,
self-induced vomiting) or
binge eating over the last 3
months
• Different than Bulimia
nervosa because weight is
abnormally low (BMI <18.5)
• Primary disordered
behaviours include
dieting, fasting, and/or
over-exercising
• No recurring purging
behaviours or binge
eating over the last 3
months

6. Epidemiology
• Anorexia nervosa is a serious mental illness that affects all ages & sex
• Prevalence rates are generally described as ranging from 0.5% to 1.0% among
females of which 95% are late adolescence or early adulthood onset & males being
affected about one-tenth as frequently.
• Research shows that up to 25% of patients will develop an enduring form of AN &
up to 1/3rd will continue to experience residual symptoms throughout adulthood
• Anorexia nervosa has the highest mortality rate of any mental health disorder, with
an estimated all-cause standardised mortality ratio 1.7 to 5.9

7. Aetiology
We think of anorexia nervosa as a Biopsychosocial
• Genetics
• psychological factors that increase risk factors for eating disorders:
- Perfectionism, low self-esteem, anxiety, body dissatisfaction, overemphasis
on a thin body ideal
• Social point of view:
- engagement in behaviours or activities that place a heavy emphasis on
importance of being thin (exposure to social media)

8. Psychological effects
Temperament: Following are the traits associated with AN:
• Anxiety
• Negative emotionality
• Perfectionism: High levels of perfectionism are known to precede the onset of AN
and is associated with poor recovery and shorter duration of remission
• Inflexibility: Impaired set-shifting is identified with cognitive inflexibility as a trait
marker
• Harm avoidance
• Obsessive behaviours (order, exactness and symmetry) Dietary restraint and
reduced caloric intake in AN is associated with an anxiety-reducing effect while
food consumption has a dysphoric effect.

9. • Between 25% and 75% of patients with anorexia
nervosa report a lifetime history of at least one
anxiety disorder, which typically precedes
anorexia nervosa and starts in childhood.
• The most common was social phobia (42%),
followed by posttraumatic stress disorder (26%)
and generalized anxiety disorder (23%)
• Obsessive-compulsive symptoms in up to 79% at
some time in their life OCD – 15-29%
• Alcohol misuse 9-25%
• Anorexia nervosa is associated with an increased
risk of suicide, with the suicide standardized
mortality ratio estimated to be as high as 31 in
one meta-analysis.

12. Physiological effects
Muscle loss &
cardiac
muscle loss
Electrolyte
abnormalities
Vitamin
deficiencies
Dry & scaly skin.
Halitosis
Amenorrhea
Bone marrow
suppression
Decreased bone
density
Lanugo- soft
brittle hairs on
adults

13. Treatment
Prioritization of needs: The primary aim for
treatment is to achieve a minimum of 90% of
the average weight for the patient’s sex, age,
and height through a joint behavioral and
nutritional intervention
Psychotherapy : Cognitive behavioral therapy
That Focuses on
- Individual & family
- Improve self-esteem
- Cope with stress & social pressures
- Identify certain thought pattern
•For children and adolescents, family-based treatment
•Sometimes 2nd-generation antipsychotics (Olanzapine up to 10 mg orally once daily)

14. Refeeding syndrome
• Can occur with nutrient rehabilitation
• Can occur with significantly
malnourished patients
• Increased calorie intake
• Increased insulin
1. Hypophosphatemia
2. Hypokalaemia
3. Hypomagnesemia leads to
- cardiac complications
- Rhabdomyolysis
- Seizures

15. References
• https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2007.07071151
• https://www.msdmanuals.com/professional/psychiatric-disorders/eating-
disorders/anorexia-nervosa
• https://www.mentalhealth.gov/what-to-look-for/eating-disorders/anorexia
• https://bpsmedicine.biomedcentral.com/articles/10.1186/s13030-019-0173-0
• https://psychscenehub.com/psychinsights/anorexia-nervosa-a-review-of-
neurobiology-diagnosis-and-management/
• https://www.intechopen.com/chapters/64858

16. Stay healthy mentally & physically!
THANK YOU