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Anorexia nervosa

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Anorexia nervosa
ICD-10 F500-F501
ICD-9 307.1
OMIM {{{OMIM}}}
DiseasesDB {{{DiseasesDB}}}
MedlinePlus {{{MedlinePlus}}}
eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}}
MeSH {{{MeshNumber}}}

Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion. Individuals with anorexia often control body weight by voluntary starvation, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects young adolescent girls in the Western world and has one of the highest mortality rates of any psychiatric condition, with approximately 10% of people diagnosed with the condition eventually dying due to related factors. Anorexia nervosa is thought to be a complex condition, involving psychological, neurobiological, physiological and sociological components.

A person who is suffering from anorexia is referred to as 'anorexic' or (less commonly) 'anorectic'. "Anorectic" is the noun form, whereas "anorexic" is the adjectival form. These two are often used incorrectly when applied. Although technically incorrect, the term is frequently shortened to anorexia in both the popular media and scientific literature. This can also refer to the medical symptom of reduced appetite. In this article, for the purpose of brevity, anorexia will be used in the place of anorexia nervosa.


DescriptionEdit

The most commonly used criteria for diagnosing anorexia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD).

Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on a combination of behaviour, reported beliefs and experiences, and physical characteristics of the patient. Anorexia is typically diagnosed by a clinical psychologist, psychiatrist or other suitably qualified clinician.

Notably, diagnostic criteria are intended to assist clinicians, and are not intended to be representative of what an individual sufferer feels or experiences in living with the illness.

The full ICD-10 diagnostic critera for anorexia nervosa can be found here, and the DSM-IV-TR criteria can be found here.

To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
  2. Intense fear of gaining weight or becoming fat.
  3. 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 denial of the seriousness of the current low body weight.
  4. In postmenarcheal, premenopausal females (women who have had their first menstural period but have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).

Furthermore, the DSM-IV-TR specifies two subtypes:

  • Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
  • Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

The ICD-10 criteria are similar, but in addition, specifically mention: i) ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite supressants or diuretics); ii) physiological features, including "widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion"; and iii) if the onset if before puberty, development is delayed or arrested.

PresentationEdit

There are a number of features, that although not necessarilly diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.[1] [2]

PsychologicalEdit

  • Distorted body image
  • Poor insight
  • Self-evaluation largely, or even exclusively, in terms of their shape and weight
  • Pre-occupation or obsessive thoughts about food and weight
  • Perfectionism

EmotionalEdit

Interpersonal and socialEdit

  • Poor or deteriorating school performance
  • Withdrawal from previous friendships and other peer-relationships
  • Deterioration in relationships with the family

PhysiologicalEdit

BehaviouralEdit

  • Excessive exercise, food restriction and purging
  • Fainting
  • Secretive about eating or exercise behavior
  • Possible self-harm, substance abuse or suicide attempts



Main article: Anorexia nervosa - History of the disorder.
Main article: Anorexia nervosa - Theoretical approaches.
Main article: Anorexia nervosa - Epidemiology.
Main article: Anorexia nervosa - Risk factors.
Main article: Anorexia nervosa - Etiology.
Main article: Anorexia nervosa - Assessment.
Main article: Anorexia nervosa - Diagnosis.
Main article: Anorexia nervosa - Comorbidity.
Main article: Anorexia nervosa - Treatment.
Main article: Anorexia nervosa - Prognosis.
Main article: Anorexia nervosa - Service user page.
Main article: Anorexia nervosa - Carer page.

See alsoEdit

External linksEdit

Support organisations and information Edit

Further readingEdit

  • Wasted (ISBN 0060187395) by Marya Hornbacher. An autobiographical look at her lifetime of Bulimia nervosa and Anorexia nervosa.
  • Breaking Free from Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers (ISBN 0863777600) by Janet Treasure.
  • Overcoming Anorexia Nervosa (ISBN 1854879693) by Christopher Freeman and Peter Cooper.
  • Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence (ISBN 0863778046) by Bryan Lask and Rachel Bryant-Waugh.

ReferencesEdit

  1. Gowers S, Bryant-Waugh R. (2004) Management of child and adolescent eating disorders: the current evidence base and future directions. J Child Psychol Psychiatry, 45 (1), 63-83. PMID 14959803
  2. Lask B, and Bryant-Waugh, R (eds) (2000) Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence. Hove: Psychology Press. ISBN 0863778046.
  • Agree, W.S., Barlow, T.H., Charm, H.N., Abel, G.G. & Leitenberg, H. (1974). Behaviour modification of anorexia nervosa, Archives of General Psychiatry 30, 343-52.

Instructions_for_archiving_academic_and_professional_materials Anorexia nervosa: Academic support materials


Eating disorders
Preliminary aspects
Eating attitudes |Feeding practices | Overeating | Binge eating |
Types of Eating disorder
Anorexia nervosa | Bulimia nervosa | Binge eating disorder | Compulsive overeating |

Eating disorder NOS | Pica |

Assessing eating disorders
[[]] | [[]] | [[]] |
Treating eating disorders
CBT | Psychotherapy | Family therapy


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