Psychological Medicine
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
The causes of anorexia nervosa are multifactorial, involving physical, psychological and social factors. Physical: Family and twin studies indicate a genetic susceptibility to anorexia nervosa.Psychological: There are no definite personality types associated with the eating disorders, although certain traits, such as low self-esteem and perfectionism, are more common.Social: Social and cultural pressures on women influence attitudes to weight and shape.
Gastrointestinal Aspects of Eating Disorders
Kevin W. Olden in Handbook of Functional Gastrointestinal Disorders, 2020
Table 1 summarizes diagnostic criteria for anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified, also known as atypical eating disorders, including a newer diagnostic subtype, binge eating disorder. Anorexia and bulimia nervosa are two sides of the same coin. Both disorders begin by attempts at weight loss in more than 95% of cases. In anorexia nervosa, the weight loss is sustained and then leads to the formal diagnosis of anorexia nervosa when weight becomes less than 85% of normal and is associated with an overvaluation of thinness and a phobic fear of fatness, plus abnormality of reproductive-hormone functioning (more than 3 months of amenorrhea in women or a decrease in sexual drive and functioning in men). These individuals are often very persevering in temperament, with anxious, perfectionistic, and obsessional features (5). Anorexia is divided into a pure food-restricting subtype (ANR) and a bulimic subtype (ANB), the latter being present when patients binge or purge during a significant part of their anorexic disorder.
Anorexia nervosa
MS Thambirajah in Case Studies in Child and Adolescent Mental Health, 2018
Assessment of a young person with anorexia nervosa necessarily involves proper physical examination. Weighing the young person, preferably in underclothes, and charting the weight and height is essential. Height and weight should be plotted on standard growth charts for comparison to population norms. Body Mass Index (calculated by dividing weight in kilograms, by height in cms2) has been found to be a useful index for assessment of weight deficits in adults. Usually a BMI below 17.5 is taken to indicate the anorexic range. BMI is not a linear constant in childhood and adolescents and may be unreliable, and calculation of weight to height is considered to be a better indicator. A Coles Growth Assessment Scale or slide ruler can be used to estimate the weight for height for the given age. A threshold of 85% of expected weight for height and age is used as the cut-off for diagnosing anorexia nervosa. Clinically the rate of weight loss may be more important than weight for height or BMI. Menstruation resumes at an average of 95% weight for height, but there is considerable variation around this.
Emerging therapeutic targets for anorexia nervosa
Published in Expert Opinion on Therapeutic Targets, 2023
Andreas Stengel, Katrin Giel
Also rikkunshito, a traditional Japanese medicine, known to enhance/stimulate ghrelin signaling [114], should be further investigated in the context of anorexia nervosa. In cisplatin-treated rats, rikkunshito prevented the reduction of plasma ghrelin levels by inhibiting ghrelin’s desacylation leading to an increased acyl/desacyl ghrelin ratio, likely contributing to the attenuated decrease in food intake [115]. In humans rikkunshito has only been tested in patients with chemotherapy-induced anorexia so far, also inducing desired effects such as reduced nausea and emesis and increased appetite [116]. This should be tested in patients with anorexia nervosa as well. Lastly, it should also be investigated whether liver-enriched antimicrobial peptide-2 (LEAP2), an endogenous peptide inhibiting ghrelin-induced activation of the ghrelin receptor and thereby e.g. the ghrelin-induced food intake [117] likely acting as an inverse agonist [118] plays a role in the pathogenesis of anorexia nervosa as well and/or therefore blockade of LEAP2 might be a treatment strategy as recently suggested [119].
Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum
Published in Eating Disorders, 2023
Jessica A Lin, Grace Jhe, Richa Adhikari, Julia A Vitagliano, Kelsey L. Rose, Melissa Freizinger, Tracy K Richmond
Anorexia nervosa (AN) is a condition that can affect people of all ages, genders, races, ethnicities, body shapes, and weight statuses (Deloitte Access Economics, 2020). When diagnosed with AN, individuals are often delineated into a diagnosis of AN or atypical AN (AAN) based on whether their presenting weight is considered underweight or not (American Psychiatric Association, 2013). Individuals with AAN have all of the features of AN, but weight remains in a ‘normal’ or elevated range despite significant weight loss. While the diagnosis differs based solely on the presenting weight status, the physical and psychological complications of AN and AAN are generally the same (Walsh et al., 2022). Thus, for the purposes of this study, AN and atypical AN will hereafter be referred together as AN (unless otherwise specified).
Mindfulness in persons with anorexia nervosa and the relationships between eating disorder symptomology, anxiety and pain
Published in Eating Disorders, 2021
Julie P. Dunne, Judith Shindul-Rothschild, Laura White, Christopher S. Lee, Barbara E. Wolfe
Anorexia nervosa (AN) is a serious, psychiatric illness associated with numerous medical and psychological comorbidities, and negative impacts on cognitive, emotional, social and physical functioning (Arcelus, Mitchell, Wales, & Nielsen, 2011; Smink, van Hoeken, Oldehinkel, & Hoek, 2014; Ulfvebrand, Birgegård, Norring, Högdahl, & von Hausswolff-juhlin, 2015). Treatment of AN is challenging as there are few pharmacological options, and none approved by the United States Food and Drug Administration (FDA) (Mitchell, Roerig, & Steffen, 2013). Family-based treatment is effective for children and adolescents with AN (Loeb & le Grange, 2009), but there are limited empirically based options available for adults (Herpertz et al., 2011). Alternative therapies, such as mindfulness, are now starting to be examined.
Related Knowledge Centers
- Binge Eating
- Eating Disorder
- Infertility
- Laxative
- Overweight
- Underweight
- Vomiting
- Osteoporosis
- Calorie Restriction
- Body Image Disturbance