False regarding Anorexia Nervosa :
D. i.e. Decreased appetite. Although all features i.e. self perception of being fat, under weight, amenorrhoea and binge eating may be present in anorexia nervosa. It is binge eating that is least common (present only in 25-50% cases ; whereas other 3 features are present in 100% cases). However, it is impoant to mention that binge eating (i.e. consuming large amount of food in sho period of time & a feeling that the eating is out of control) followed by inappropriate behaviour to compensate it (i.e. self induced vomiting, purging, diuretic use, missing insulin etc.) is a characteristic & essential feature required for diagnosis of bulimia nervosa. Features Anorexia nervosa Bulimia nervosa Onset Mid adolescence Late adolescence / early adulthood Female : Male 10 : 1 10 :1 Lifetime 1% 1 - 3 % prevalence in -- 5% per decade Low women Markedly decreasedQ ( Usually normalQ Moality & height) Weight Menstruation Absent{2 Amenorrhea 100%Q (required for diagnosis; this criteria is met if Usually normal (absence of atleast 3 menstrual period occurs only following hormone eg. Present in 50% consecutive menstrual cycles) estrogen administration, or OCP) Body image - There is self perception of being too fat, with an There is self perception of being too fat, disturbance intrusive dread of fatnessQ, which lit a self with an intrusive dread of fatnessQ. imposed low weight threshold. (included in both (included in ICD- 10 only) DSM - IV & ICD- 10 criteria) Self evaluation is undualy influenced - Despite objectively low weight, patient feels that (over concerned) by body weight and their body as a whole, or some pa of it is too fat; shape (DSM-IV) undue influence of body weight or shape on self evaluation; or denying or minimizing the seriousness of low weight (DSM - IV) Method of weight - By drastically reducing total food intakeQ, with a - By recurrent inappropriate compensatory control dispropoionate decrease in high - carbohydrate self induced purging (vomiting & laxative and fatty foods, (mostly) abuse)Q in 80% - Ritualistic exercising, extensive cycling, walking, - Fasting, excessive exercise, use of appetite jogging, running are common suppressants and thyroxine and omission - Purging (with or without binging) is less common of insulin (in 20%) Pecaliliar behaviour about PresentQ in form of - Hiding food all over house AbsentQ food - Carrying large amount of candies with them - Cutting meat into very small pieces & spending a great deal of time rearranging pieces on their plate. Confronted with their peculiar behaviour , they often deny that it is unusual or flatly refuse to discuss it Hunger (Anorexia) - Term anorexia is a misnomer because loss of Irresistable craving for food with episodes of appetite is usually rareQ until late (Kaplan). binge eating often followed by post binge However they rarely complain of hunger or fatigue. anguish (depression) - As weight loss progresses, thoughts of food dominate mental life & idiosyncratic rules develop around eating. Evidence that patients are thinking constantly about food is their passion for collecting recipes, and for preparing elaborate meal for others, and be drawn to food related occupations. Subtypes 1. Food Restricting type (more common) : During 1. Purging type (more common): during current episode, the person is not regulary engaged current episode, the person is regularly in binge- eating or purging behaviour. These often engaged in self induced purging have obscessive compulsive traits. (vomiting, & misuse of laxative, diuretics, 2. Binge- eating/purging type (less common) : or enemas). These are more likely to be during current episode, the person is regularly associated with substance abuse (alcohol, engaged in binge eating /purging. These are more drug), impulse control disorder (stealing, likely to be associated with substance abuse (alcohol, shopping), antisocial behaviour, personality drug), impulse control disorders, (stealing) personality disorder, suicide attempts & sexual disorder, risk of suicide & sexual promiscuity promiscuity. 2. Non purging type (less common): during current episode, the person has used other inappropriate compensatory behaviour eg. fasting or excessive exercise. Binge Eating (i.e eating definitely a large amount of food in 25 - 50% 100%, Required for diagnosisQ sho period than most people would eat in same period (At least twice a week over under similar circumstance; and a sense of lack of control over eating). period of 3 months). Recurrent inappropriate compensatory behaviour eg. self Uncommon 100%, Required for diagnosisQ induced vomiting, purging, diuretic useQ (in 80%). (25- 50%) Omission of insulin, fasting or excessive exercise, use of appetite suppressants & thyroid preparations (in 20%) (At least twice a week for 3 months) Features secondary to purging (vomiting & laxative abuse) Uncommon; and persent Common - Enamel erosion & dental decay (caries)Q only in binge eating - Salivary gland & pancreatic inflammation & /purging subtype of hyperophyQ with increase in serum amylase anorexia nervosa. - Esophageal & gastric erosion, bowel dysfunction with haustral dilation - Electrolyte abnormalities esp. hypokalemic, hypochloremic akalosis, (d/t vomiting)Q; hypomagnesemia; metabolic acidosis (d/t laxative abuse) - Seizures (d/t electrolyte imbalance), mild neuropathies, weakness, fatigue, cognitive disorder. Features secondary to excessive weight loss Present Absent (mostly) - Cachexia, cold intolerance, hypothermia - Lanugo (fine baby like hair over body), edema, acrocyanosis - Leucopenia, anemia (normocytic normochromic), thrombocytopenia, increased BUN & creatinine, and hypokalemia, hypoglycemia, hypophosphatemia, hyper chlosterolaemia, hypercarotenemia (yellow palm skin) - Low estrogen / testosterone /LH/ FSH/ thyroid metabolism /T3; increased coisol - Osteopenia, osteoporosis - Hypotension, bradycardia, prolonged HIS bundle transmission (prolonged QT interval), small hea, cardiac arrhythmias (atrial & ventricular premature contractions, ventricular tachycardia), & sudden death. - Abnormal taste sensation (Zn def.) Sexual Orientation & other disorders - Have poor sexual - Most are sexually active adjustment, delayed - More oftenly associated psychosocial sexual development and a markedly decreased with anxiety disorders, bipolar I disorder, dissociate disorders & interest in sex and tend to become socially withdrawn. sexual abuse. - Are perfectionist & rigid. Prognosis Poor Better
Evident psychosis
Vigor exceeding physical ill being
Weight loss
Decreased appetite