Eating disorders. Anorexia nervosa: risk factors. Anorexia Nervosa ARID. A Amenorrhoea for 3 cycles R Refusal to maintain / gain weight > 85% expected I Intense fear gaining weight despite underweight D Disturbed self-image
Diagnostic criteria for 307.1 Anorexia NervosaA. 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% ofthat expected; or failure to make expected weight gain during period of growth,leading to body weight less than 85% of that expected).B. Intense fear of gaining weight or becoming fat, even though underweight.C. 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 theseriousness of the current low body weight.D. In postmenarcheal females, amenorrhea, i.e., the absence of at least threeconsecutive menstrual cycles. (A woman is considered to have amenorrhea if herperiods occur only following hormone, e.g., estrogen, administration.)
Restricting // Binge-Eating/Purging Type
Give family therapy & dietary advice to all, with CBT also likely to be helpful
Antidepressants may be helpful if depressive symptoms present
Antipsychotics may help if over-active. Zn, Li, cyproheptadine warrant further study.
Low-birth weight babies
Up to 30-50% health care utilization reduction reported in tx studies
Unlikely to respond to long-term intensive psychodynamic psychotherapy*!
Intensity of patient’s complaint
International association for the study of painTaxonomic Guidelines:
Inpatient programs in Canada/Germany: no published data
Follow general somatoform disorder treatment guidelines focussing on gradual functional recovery through a physical rehabilitation program and keeping in mind that patients are often resistant to psychological interventions
70% after 12-16 sessions improved vs 25% with relaxation tx
Improvements sustained at 1 and possibly 5 year follow up