Psychiatric anxiety disorders

1. Haramaya university
College of health and medical science
School of public health
Psychiatry group assignment
Submitted to: Mr birhanu
Submission date: 05/03/2025

2. Group members ID
Deribo bedada samu 2559/14
Dibaba tadesa damissie 2572/14
Eleni Nega alene 2655/14
Esayas berhane mesfin T/4896/14
Eshetie adisu gebrie 2706/14
1. Etsubdink addisu wondimu 2718/14

3. Anorexia nervosa

4. Introduction
 Anorexia nervosa is a serious and potentially life-threatening eating
disorder characterized by an intense fear of gaining weight, a
distorted body image, and an extreme restriction of food intake.
Individuals with anorexia often perceive themselves as overweight,
even when they are underweight, leading to severe dietary
limitations and excessive weight loss.

5. Definition
Anorexia nervosa is a serious eating disorder characterized by:
 Restriction of energy intake: This leads to a significantly low body weight.
 Intense fear of gaining weight: Even when underweight, individuals with
anorexia nervosa have a persistent and overwhelming fear of becoming fat.
 Disturbed body image: They often have a distorted perception of their body
weight and shape, and may see themselves as overweight even when they are
dangerously thin.

6. Here are some key points to understand about anorexia nervosa:
 It's a mental health condition, not just a problem with food.
 It can have severe physical and psychological consequences.
 It affects people of all ages, genders, and backgrounds.
 It has one of the highest mortality rates of any mental health disorder.
Essentially, it's a complex condition where a person's self-worth becomes overly tied
to their body weight and shape, leading to harmful eating behaviours'.

7. Epidemiology
 Understanding the epidemiology of anorexia nervosa involves looking at its
distribution and patterns within populations. Here’s a breakdown of key
aspects:
Prevalence:
It’s challenging to get exact figures, but studies indicate that anorexia nervosa
affects a significant portion of the population, particularly young women.
Lifetime prevalence rates have been studied, and there is variation in the
reporting of those numbers.
 It’s important to know that anorexia nervosa occurs in males as well, though
it is more common in females

8. Incidence:
Research suggests that while overall incidence rates might be relatively stable,
there are concerns about increased incidence among younger individuals.
 This raises questions about earlier onset and the need for early intervention.

9. Factors Influencing Epidemiology
 Age and Gender:
 Adolescence and young adulthood are periods of heightened risk.
 While traditionally considered a "female" disorder, it's crucial to recognize that men
also experience anorexia nervosa.
 Sociocultural Factors: Societal pressures related to thinness and body image
play a significant role.
 Media portrayals and cultural ideals can contribute to the development of
body dissatisfaction and disordered eating behaviors.

10. Geographic and Ethnic Variations:
While anorexia nervosa is found worldwide, there may be variations in prevalence across different
cultures and regions.
 Research is ongoing to further understand these variations
Co-occurring Conditions:
 Anorexia nervosa often co-occurs with other mental health conditions, such as anxiety disorders,
depression, and obsessive-compulsive disorder. This comorbidity complicates epidemiological
studies

11. Etiology
The etiology of anorexia nervosa is complex and multifaceted, meaning it arises
from a combination of interacting factors. It’s not caused by a single thing, but
rather a confluence of
1. Genetic Factors:
Research suggests a genetic predisposition to anorexia nervosa.
Studies involving twins have shown that genetics play a significant role.
 Specific genes that may contribute to the disorder are being actively
researched

12. 2. Psychological Factors:
Perfectionism: Individuals with anorexia nervosa often exhibit perfectionistic
tendencies.
Obsessive-compulsive traits: Many also have obsessive thoughts and compulsive
behaviors.
 Low self-esteem: Feelings of inadequacy and low self-worth can contribute
 Anxiety: Anxiety disorders often co-occur with anorexia nervosa.
 Difficulty expressing emotions: Some individuals may struggle to express their
emotions, using food restriction as a coping mechanism.
 Trauma: Past traumatic experiences can also be a contributing factor

13. 3. Sociocultural Factors:
Societal pressures: The emphasis on thinness in Western cultures and media can
contribute to body dissatisfaction and disordered eating.
Media influence: Images in magazines and on social media can create unrealistic
body ideals.
Peer pressure: Pressure from peers to be thin can also play a role.
 Certain professions and activities: Professions and activities that emphasize
thinness, such as modeling, ballet, and certain sports, can increase risk.

14. 4. Biological Factors:
Neurobiological factors: Research is exploring the role of neurotransmitters and
brain regions involved in appetite regulation and reward.
 Hormonal imbalances: Changes in hormones may also play a role.

15. Key points
It’s crucial to understand that anorexia nervosa is a serious mental health
disorder, not a lifestyle choice.
The interplay of these factors can vary from person to person.
Effective treatment requires addressing these multiple factors.
 It is important to understand that no one factor is the sole cause of anorexia
nervosa.
 It is important to seek professional help if you or someone you know is
struggling with an eating disorder.

16. Clinical manifestation
 The clinical manifestation of anorexia nervosa presents in a variety of
ways, affecting both physical and psychological health. Here’s a breakdown
of the key areas:
Physical Manifestations:
Significant Weight Loss:
This is a hallmark sign, often leading to a dangerously low body weight.
 In children and adolescents, there may be a failure to gain weight as
expected

17. Physiological Changes:
Cardiovascular: Slow heart rate (bradycardia), low blood pressure, heart
arrhythmias.
Gastrointestinal: Constipation, abdominal pain, bloating.
 Endocrine: Amenorrhea (absence of menstruation) in females, hormonal
imbalances in males.
 Metabolic: Electrolyte imbalances, which can be life-threatening.
 Dermatological: Dry skin, lanugo (fine, downy hair), brittle nails, hair loss.
 Temperature Regulation: Intolerance to cold.
 Other: Fatigue, dizziness, fainting, edema (swelling)

18. Other physical signs:
Dehydration.
Muscle weakness.
Psychological and Behavioral Manifestations:
Distorted Body Image:
Perceiving oneself as overweight even when severely underweight.
 Intense fear of gaining weight

19. Obsessive Behaviors:
Preoccupation with food, calories, and weight.
Rigid eating rituals.
Excessive exercise.
Emotional Changes:
Anxiety, depression, irritability.
Social withdrawal.
Low self-esteem.
 Difficulty concentrating

20. Behavioral changes:
Denial of hunger.
Lying about food intake.
Hiding food.
 Use of laxatives, diuretics, or vomiting to control weight.
Important Considerations:
The severity of these manifestations can vary greatly.
Anorexia nervosa can have severe and potentially life-threatening
complications.
 It is important to remember that people suffering from anorexia nervosa,
often hide their symptoms, so observation of behavioral changes is very
important

21. Diagnosis
The diagnosis of anorexia nervosa involves a comprehensive evaluation,
considering both physical and psychological factors. Here’s a breakdown of the
process:
1. Clinical Evaluation:
Medical History: This includes a thorough review of the individual’s weight
history, eating habits, and any related physical symptoms.

22.  Physical Examination: A physical exam is essential to assess the individual's
current health status.
This may include:
 Measuring weight and height to calculate body mass index (BMI).
 Checking vital signs (heart rate, blood pressure).
 Examining for signs of malnutrition, such as dry skin, lanugo, and edema.
Psychological Assessment:
 This involves evaluating the individual’s thoughts, feelings, and behaviors related
to food, weight, and body image.

23. A mental health professional will assess for:
Distorted body image.
Intense fear of gaining weight.
Obsessive-compulsive tendencies.
Co-occurring mental health conditions, such as anxiety
or depression.
2. Diagnostic Criteria: DSM-5: The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5), provides the
standard criteria for diagnosing anorexia nervosa

24. The key criteria include:
Restriction of energy intake, leading to a significantly low body weight.
 Intense fear of gaining weight or becoming fat, or persistent behavior
that interferes with weight gain.
 Disturbance in the way in which one’s body weight or shape is
experienced, undue influence of body weight or shape on self-
evaluation, or persistent lack of recognition of the seriousness of the
current low body weight
 Severity: The DSM-5 also specifies severity levels based on BMI.

25. 3. Laboratory Tests:
Blood tests: These can help identify electrolyte imbalances, anemia, and
other medical complications.
Electrocardiogram (ECG): This may be used to assess heart function.
 Other tests may be used as needed to evaluate organ function.

26. 4. Differential Diagnosis:
 It’s important to rule out other medical or psychiatric conditions that may
cause similar symptoms.
This may include:
Other eating disorders, such as bulimia nervosa or avoidant/restrictive food
intake disorder (ARFID).
Medical conditions that cause weight loss.
 Depression.

27. Key Considerations:
Early diagnosis and intervention are crucial for improving outcomes.
 A multidisciplinary approach, involving medical, psychological, and nutritional
professionals, is often necessary.

28. Treatment
Treating anorexia nervosa requires a comprehensive, multidisciplinary approach
that addresses the complex physical and psychological aspects of the disorder.
Here’s an overview of common treatment components
1. Medical Stabilization:
Addressing Physical Complications: This is the first priority, especially in severe
cases.
It may involve hospitalization to correct electrolyte imbalances, cardiac
abnormalities, and other life-threatening conditions.
 Nutritional rehabilitation is crucial, with careful refeeding to avoid refeeding
syndrome

29. Monitoring:
 Regular monitoring of vital signs, weight, and laboratory values is essential.
2. Psychotherapy:
 Cognitive Behavioral Therapy (CBT): Helps individuals identify and change
distorted thoughts and beliefs about weight, shape, and food. Focuses on
developing healthier coping mechanisms.

30. Family-Based Therapy (FBT): Especially effective for adolescents. Involves the
family in the refeeding process and helps improve family communication.
 Other Therapies: Other forms of therapy, like Dialectical Behavior Therapy
(DBT), can be used to treat co-occurring conditions and help people
regulate their emotions
3. Nutritional Counselling:
Restoring Healthy Eating Patterns: A registered dietitian can help create a meal
plan that meets the individual’s nutritional needs.
Education about healthy eating and portion control is vital.
 Weight Restoration: Gradual and controlled weight gain is a key goal.

31. 4. Medication: Addressing Co-occurring Conditions:
Antidepressants or anti-anxiety medications may be prescribed to treat co-existing
mental health conditions.
Medications for Anorexia: While there are no medications that specifically cure
anorexia, some medications may be used to help with symptoms, or comorbid
conditions

32. 5. Multidisciplinary Team:
Effective treatment requires a team of professionals, including:
Physicians
Psychiatrists
Psychologists
Registered dietitians
 Social workers

33. Key Considerations:
Early Intervention: The sooner treatment begins, the better the chances of
recovery.
Long-Term Approach: Recovery from anorexia nervosa can take time, and ongoing
support is often necessary.
Individualized Treatment: Treatment plans should be tailored to the individual’s
specific needs.
 Relapse Prevention: Strategies to prevent relapse are crucial for long-term
recovery

34. Reference
 Kaplan & Sadock Synopsis of Psychiatry 11th
edition.
 Stahl’s Essential Psychopharmacology Prescriber’s Guide Fifth Edition.
 Essentials of psychiatric mental health nursing / Mary C. Townsend — 4th
ed.

35. Thank you