Pathophysiology
severe disturbance of caloric intake with refusal to maintain an adequate body weight
Signs and Symptoms
1) self-starvation and over concern with body weight and shape 2) binge eating and purging 3) weight < 85% of normal 4) fear that weight will get out of control with even small caloric intake 5) distorted body image (patients see themselves as fat even when emaciated) 6) lack of menses 7) acrocyanosis of digits 8) cold intolerance 9) hypothermia 10) self-induced vomiting 11) decreased cardiac output 12) cardiac failure 13) bradycardia 14) enlarged salivary glands 15) dental erosion 16) edema 17) lanugo (soft downy hair on body) 18) onset usually in mid to late adolescence
Characteristic Test Findings
Laboratory – 1) hypoglycemia 2) decreased estrogen 3) increased T4 (thyroxine) 4) increased cortisol 5) hypokalemia 6) hypochloremia 7) alkalosis 8) anemia 9) leukopenia 10) increased transaminases Radiology – 11) decreased bone density on nuclear medicine scan
Associated Conditions
1) bulimia 2) physical and/or sexual abuse 3) family history of substance abuse
Inheritance/Epidemiology
1) 10 times more common in females than males 2) occurs in cultures where food is plentiful and thinness is attractive 3) occurs in female professions where thinness is prized (models, ballet dancers) 4) affects 0.5% of female population in USA 5) prognosis is poor” only 25-50% make complete recovery 6) 20% fatality rate
Treatment
1) intensive counseling to correct cognitive distortions around eating 2) psychotherapy for underlying emotional issues
Tips for USMLE
anorexics often have idiosyncratic behavior concerning food (collecting cookbooks, working in the food industry)
Fiona Place says
This is an appalling description of the condition. It dehumanises and objectifies any individual with an eating disorder!