Anorexia nervosa | |
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Other names | Anorexia |
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"Miss A—" depicted in 1866 and in 1870 after treatment. Her condition was one of the earliest case studies of anorexia, published in medical research papers of William Gull. | |
Specialty | Psychiatry, clinical psychology |
Symptoms | Fear of gaining weight, strong desire to be thin, food restrictions,[1] body image disturbance |
Complications | Osteoporosis, infertility, heart damage, suicide,[1] whole-body swelling (edema), heart failure and/or lung failure, gastrointestinal problems, extensive muscle weakness, delirium, death[2] |
Usual onset | Adolescence to early adulthood[1] |
Causes | Unknown[3] |
Risk factors | Family history, high-level athletics, modelling, substance use disorder, dancing[3][4][5] |
Differential diagnosis | Body dysmorphic disorder, bulimia nervosa, hyperthyroidism, inflammatory bowel disease, dysphagia, cancer[6][7] |
Treatment | Cognitive behavioral therapy, hospitalisation to restore weight[1][8] |
Prognosis | 5% risk of death over 10 years[4][9] |
Frequency | 2.9 million (2015)[10] |
Deaths | 600 (2015)[11] |
Anorexia nervosa (AN), often referred to simply as anorexia,[12] is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.[1]
Individuals with anorexia nervosa have a fear of being overweight or being seen as such, despite the fact that they are typically underweight.[1][3] The DSM-5 describes this perceptual symptom as "disturbance in the way in which one's body weight or shape is experienced".[8] In research and clinical settings, this symptom is called "body image disturbance".[13] Individuals with anorexia nervosa also often deny that they have a problem with low weight.[4] They may weigh themselves frequently, eat small amounts, and only eat certain foods.[1] Some exercise excessively, force themselves to vomit (in the "anorexia purging" subtype), or use laxatives to lose weight and control body shapes, and/or binge eat.[1] Medical complications may include osteoporosis, infertility, and heart damage,[1] along with the cessation of menstrual periods.[4] In extreme cases, patients with anorexia nervosa who continually refuse significant dietary intake and weight restoration interventions, and are declared to lack capacity to make decisions by a psychiatrist, may be fed by force under restraint via nasogastric tube[14] after asking their parents or proxies[15] to make the decision for them.[16]
Anorexia often develops during adolescence or young adulthood.[1] The causes of anorexia are varied and may differ from individual to individual.[3] There is emerging evidence that there is a genetic component, with identical twins more often affected than fraternal twins.[3] Cultural factors also appear to play a role, with societies that value thinness having higher rates of the disease.[4] Additionally, it occurs more commonly among those involved in activities that value thinness, such as high-level athletics, modeling, and dancing.[4][5] Anorexia often develops following a major life-change or stress-inducing event.[4]
Treatment of anorexia involves restoring the patient back to a healthy weight, treating their underlying psychological problems, and addressing underlying maladaptive behaviors.[1] While medications do not help with weight gain, they may be used to help with associated anxiety or depression.[1] Different therapy methods may be useful, such as cognitive behavioral therapy or an approach where parents assume responsibility for feeding their child, known as Maudsley family therapy.[1][17] Sometimes people require admission to a hospital to restore weight.[8] Evidence for benefit from nasogastric tube feeding is unclear.[18] Such an intervention may be highly distressing for both anorexia patients and healthcare staff when administered against the patient's will under restraint.[14] Some people with anorexia will have a single episode and recover while others may have recurring episodes over years.[8] Many complications improve or resolve with the regaining of weight.[8]
It is estimated to occur in 0.3% to 4.3% of women and 0.2% to 1% of men in Western countries at some point in their life.[19] About 0.4% of young women are affected in a given year and it is estimated to occur ten times more commonly among women than men.[4][19] It is unclear whether the increased incidence of anorexia observed in the 20th and 21st centuries is due to an actual increase in its frequency or simply due to improved diagnostic capabilities.[3] In 2013, it directly resulted in about 600 deaths globally, up from 400 deaths in 1990.[20] Eating disorders also increase a person's risk of death from a wide range of other causes, including suicide.[1][19] About 5% of people with anorexia die from complications over a ten-year period.[4][9]
DSM5
was invoked but never defined (see the help page).Espie_2015
was invoked but never defined (see the help page).