Anorexia nevosa as a disorder

1. ANOREXIA NERVOSA
MV Manyike

2. Learning outcomes
At the of the lesson students should be
able to:
 Describe the disorder: Anorexia Nervosa
 Describe the subtypes of Anorexia
Nervosa
 Explain the etiology of Anorexia Nervosa
 Explain the clinical features of Anorexia
Nervosa
 Discuss the hospital management of
Anorexia Nervosa

3. Anorexia Nervosa -
Description
 A disorder in which a person refuses to maintain
minimal normal weight
 It is characterized by:-
 Self-induced starvation
 Relentless drive for thinness
 A morbid fear of gaining weight
 Presence of medical signs and symptoms of
starvation
• It is associated with disturbance and
misperception of body image
• There is significant misinterpretation of one’s
body and shape
 It is a psychological and potentially life-
threatening disorder

4. Anorexia Nervosa – Description
cont.
 It is more prevalent in females
 Onset is in adolescence stage –
between 14 and 18 years
 More frequent in developed countries

6. Subtypes of Anorexia Nervosa
 The food-restricting category
 The purging category

7. The food-restricting type
 Present in about 50% of all Anorexia
cases
 Food intake is highly restricted
 Consume fewer than 300-500 calories
per day
 Relentlessly and compulsively
overactive

8. The purging type
 Alternate strict dieting with intermittent
binge or purge episodes
 Purging is accomplished by self-
induced vomiting or laxative abuse
 Purging sometimes occurs without
binging

9. Etiology
 Biological factors
 Social factors
 Psychological and psychodynamic
factors

10. Biological factors
 Endogenous opioids – contribute to
denial of hunger
 Enlarged CSF spaces
 Dysfunction in serotonin, dopamine,
and norepinephrine – responsible for
regulating eating behaviour

11. Social factors
 Society’s emphasis on thinness and exercise
 Participation in strict ballet schools and
modelling - weight is highly emphasized
 Certain sports, such as wrestling
 Gay orientation in men – norms of slimness
are very strong in the gay community
 Children who have close but troubled
relationship with their parents - develop an
eating disorder as a form of withdrawal from
the relationship
 Families who exhibit high levels of hostility,
chaos and isolation and low levels of
nurturance and empathy

12. Psychological and
psychodynamic factors
 Lack of selfhood and sense of
autonomy in adolescence
Substitute with eating and weight gain
obsessions
Gain validation through starvation
• Inability of adolescents to separate
psychologically from their mothers

13. Evidence based practice
 Social media has had a negative
influence on Anorexia Nervosa and other
eating disorders
 Social media emphasizes on
"thinspiration" or "fitspiration“
 Slender women and athletic, V-shaped
muscular men are favoured by social
media
 That leads to body dissatisfaction and
internalization of body ideals - leading to
Anorexia Nervosa

15. Anorexia Nervosa symptoms
 Gross distortion of body image
 Manifested by the individual’s perception
of being “fat” when he or she is obviously
underweight or even emaciated
 Preoccupation with food
 Refusal to eat
 Weight loss accomplished by reduction
in food intake, often extensive
exercising, Self-induced vomiting and the
abuse of laxatives or diuretics

16. Anorexia Nervosa symptoms
cont.
 Marked weight loss e.g. , weighing
less than 85 percent of expected
weight.
 Physical symptoms - hypothermia,
bradycardia, hypotension, edema,
lanugo, and a variety of metabolic
changes

18. Anorexia Nervosa symptoms
cont.
 An obsession with food.
e.g. may hoard or conceal food, talk
about food and recipes at great length,
or prepare elaborate meals for others
 Compulsive behaviors such as hand
washing and eating of clothes
 Depression and anxiety

19. Anorexia Nervosa symptoms
cont.
 Poor sexual adjustment
 Amenorrhea
 Cut their food into smaller pieces and
spend time rearranging the pieces on
their plates
 Tend to be rigid and perfectionist

21. Evidence-based practice
 Anorexia Nervosa has the highest
mortality rate of any psychiatric
disorder
 5–20% of people diagnosed with
anorexia nervosa die from it
(WHO,2018)

23. Hospital management of
Anorexia Nervosa
 MHCU should be weighed daily early
morning after emptying the bladder
 Record fluid intake and output daily
 If vomiting – monitor serum electrolyte
levels and assess the development of
hypokalemia
 Make bathroom inaccessible for at
least 2 hours after meals

24. Hospital management of
Anorexia Nervosa cont.
 If there is an urgent need for bathroom
– MHCU should be accompanied
 Stool softeners to be given for
constipation – never give laxatives
 Calories should be given in 6 equal
feedings throughout the day
 Liquid food supplements are also
recommended
 Outpatient supervision to be done
after discharge