Click here to view next page of this article


Anorexia Nervosa

DSM IV Diagnostic Criteria

The patient refuses to maintain weight above 85% of expected weight for age and height.

Intense fear of weight gain or of being fat, even though underweight.

Disturbance in the perception of ones weight and shape, or denial of seriousness of

Amenorrhea for three cycles in

Classification of Anorexia Nervosa

Restricting Type or Excessive Dieting Type. Binging or purging are not present.

Binge-Eating Type or Purging Type. Regular binging and purging behavior occurs during current episode (purging may be in the form of vomiting, laxative abuse, enema abuse, or diuretic abuse).

Clinical Features

It is characterized by obsessive compulsive features (counting calories, hoarding food), diminished sexual activity, rigid personality, strong need to control ones environment, social phobia (fear of eating in public). The disorder commonly coexists with major depressive disorder.

Complications. All body systems may be affected, depending on the degree of starvation and the type of purging. Leukopenia and anemia, dehydration, metabolic acidosis (due to vomiting), or alkalosis (due to laxatives), diminished thyroid function, low sex hormone levels, osteoporosis, bradycardia, and encephalopathy are commonly seen.

Physical signs and symptoms may include gastrointestinal complaints, cold intolerance, emaciation, parotid gland enlargement, lanugo hair development, hypotension, peripheral edema, poor dentition, and lethargy.


Ninety percent of cases occur in females. The prevalence in females is 0.5-1.0%. The disorder begins in early adolescence and is rare after the age of forty. Peak incidences occur at age 14 and at

There is an increased risk in first degree relatives, and there is a higher concordance rate in monozygotic twins. Patients with a history of hospitalization secondary have a

Laboratory Evaluation. Decreased serum albumin, globulin, calcium, hypokalemia, hyponatremia, anemia, and leukopenia may be present.


Psychotherapies include