A disorder characterized by a disturbed sense of body image, a morbid fear of obesity, a refusal to maintain a minimally normal body weight, and, in women, amenorrhea.

The etiology of the condition is unknown. Some association with social factors seems significant. There is a great emphasis in Western society to be thin; obesity is considered unattractive, unhealthy, and unwanted. There is an increased risk of anorexia nervosa, among first-degree biological relatives of individuals with the disorder.

The disorder may be minor and temporary, or severe and long-standing. Many persons who experience the disorder are meticulous, compulsive, and intelligent, with very high standards for accomplishment. Usually the initial indications of the imminent disorder are apprehension about body weight (even among patients who are not obese), and limits on food intake.

The most obvious finding on physical examination is emaciation. Fixation and anxiety about increase in weight occurs even as emaciation develops. Denial that the disorder exists is a major feature. Patients typically do not complain about anorexia or weight loss and often resist treatment. Their families, due to frequent illness or complaints about other symptoms (e.g., abdominal distress, and constipation), usually bring them for treatment. Females often present for evaluation of amenorrhea. The two general types of Anorexia Nervosa are as follows:

• Restricting Type - When weight loss is accomplished by dieting, fasting, or the participation in extreme exercise and, are not on a regular basis, binge-eating or purging.

• Binge-Eating/Purge Type - Used to describe the person who has regularly participated in binge eating or purging or both during the current episode. Participation is usually at least twice weekly. However, there has not been enough information available to specify the least amount required for making the diagnosis.

Some individuals exhibit no laboratory abnormalities. However, those that purge are prone to a number of disturbances that lead to abnormal laboratory findings. In addition, due to the semi-starvation state that this disorder causes, it can affect most organ systems. Abnormal laboratory values may include:

• Hematology - leukopenia and mild anemia often occur; thrombocytopenia appears rarely

• Chemistry

  • Increased blood urea nitrogen (BUN)

  • Hypercholesterolemia

  • Elevated liver function tests

  • Hypomagnesemia

  • Hypozincemia

  • Hypophosphatemia

  • Hyperamylasemia

  • Metabolic alkalosis

  • Hypochloremia

  • Hypokalemia

  • Low serum thyroxine (T4) levels.

Finally, an array of abnormal neuroendocrine challenges are indicated, e.g., females exhibit a low serum estrogen level and males have low levels of testosterone. In addition, other hormones may regress to pre-puberty or puberty secretion levels.

• Electrocardiography (EKG) - reveals sinus bradycardia and arrhythmias appear rarely.

• Electroencephalography (EEG) - may reveal wide spread abnormalities resulting from metabolic encephalopathy due to fluid and electrolyte imbalance.

• Brain Imaging - increase in the ventricular brain matter secondary to starvation.

• Resting Energy Expenditure - often reduced.

• Diagnostic criteria for anorexia nervosa includes:

  • Refusing to sustain body weight at or more than the minimal weight for age and height; specifically, less than 85% of the expected weight.

  • Manifesting extreme fear of gaining weight or becoming obese, even though the person is underweight.

  • Expressing anxiety regarding one's weight or shape; self-worth being influenced excessively by one's weight or shape, and denial of the severity of having low body weight.

  • Women, after menarche, experiencing absence of three consecutive menstrual cycles (amenorrhea) and who do not experience a period unless a hormone (i.e., estrogen) is administered.

Treatment includes two phases: short-term and long-term.

• Short-term therapy involves restoring body weight.

• Long-term therapy involves improving psychological health and preventing relapse. In severe cases, restoring weight as quickly as possible becomes crucial and hospitalization is essential. Nutrition via nasogastric tube or intravenously (IV) or both may be used; however, it is rarely necessary. Once the patient is stabilized physically, long-term treatment begins. Treatment can become complicated due to the patient's non-compliance with weight gain, denial of the condition, and scheming behavior. Therapy that involves the physician and a psychiatrist is helpful, as well as family therapy and consultation with referral to a specialist in eating disorders. An antidepressant may be useful for avoiding a relapse after weight has been re-established.

The course of this disorder varies from one individual to another. Some patients may recover after one episode while others experience alternating patterns of weight gain and relapse. Finally, others experience a continuous declining course over many years. In addition, patients who suffer from this condition can also develop dental problems and osteoporosis long after the correction of the underlying condition. Moreover, data collected via a university hospital study noted the long-term mortality from anorexia nervosa is over 10%. Death occurs most frequently secondary to starvation, suicide, or electrolyte imbalance.