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Chapter 076. Eating Disorders (Part 4)

Refusal to maintain body weight at or above a minimally normal weight for age and height. (This includes a failure to achieve weight gain expected during a period of growth leading to an abnormally low body weight.) Intense fear of weight gain or becoming fat. Distortion of body image (e.g., feeling fat despite an objectively low weight or minimizing the seriousness of low weight). Amenorrhea. (This criterion is met if menstrual periods occur only following hormone—e.g., estrogen—administration.) The diagnosis of AN can usually be made confidently in a patient with a history of weight loss accomplished by restrictive dieting and excessive exercise, accompanied by. | Chapter 076. Eating Disorders Part 4 Table 76-2 Diagnostic Features of Anorexia Nervosa Refusal to maintain body weight at or above a minimally normal weight for age and height. This includes a failure to achieve weight gain expected during a period of growth leading to an abnormally low body weight. Intense fear of weight gain or becoming fat. Distortion of body image e.g. feeling fat despite an objectively low weight or minimizing the seriousness of low weight . Amenorrhea. This criterion is met if menstrual periods occur only following hormone e.g. estrogen administration. The diagnosis of AN can usually be made confidently in a patient with a history of weight loss accomplished by restrictive dieting and excessive exercise accompanied by a marked reluctance to gain weight. Patients with AN often deny that they have a serious problem and may be brought to medical attention by concerned family or friends. In atypical presentations other causes of significant weight loss in previously healthy young people should be considered including inflammatory bowel disease gastric outlet obstruction diabetes mellitus central nervous system CNS tumors or neoplasm Chap. 41 . Prognosis The course and outcome of AN are highly variable. One-quarter to one-half of patients eventually recover fully with few psychological or physical sequelae. However many patients have persistent difficulties with weight maintenance depression and eating disturbances including BN. The development of obesity following AN is rare. The long-term mortality of AN is among the highest associated with any psychiatric disorder. Approximately 5 of patients die per decade of follow-up primarily due to the physical effects of chronic starvation or by suicide. Virtually all of the physiologic abnormalities associated with AN are observed in other forms of starvation and markedly improve or disappear with weight gain. A worrisome exception is the reduction in bone mass which may not recover fully particularly .