Anorexia Nervosa

BASICS

An eating disorder characterized by the restriction of food intake leading to significantly low weight with intense fear of weight gain and distorted perception of body weight and shape
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) divides anorexia into two types:
- Restricting type: characterized by restricting intake of calories or extreme amounts of exercise without binge-eating and purging behaviors within the last 3 months
- Binge-eating/purging type: regular engagement in binge intake or purging behaviors (self-induced vomiting, misuse of laxatives, diuretics, or enemas) within the past 3 months
System(s) affected: nervous, cardiovascular, endocrine, metabolic, pulmonary, gastrointestinal, reproductive, ophthalmic, taste, and dermatologic
Severity of anorexia nervosa (AN) is based on BMI; severe is <16 kg/m².

Complex relationships among genetic, biologic, environmental, psychological, and social factors that result in the development of this disorder.
Serotonin, norepinephrine, and dopamine neuronal systems are implicated.

Aggregates in families—11-fold risk amongst female relatives of a proband with the disorder
Evidence of high concordance rates in monozygotic than in dizygotic twins
GWAS study showing 8 loci exceeding genome wide significance on chromosomes 1, 3, 10, and 11.

Body dissatisfaction, negative self-evaluation
Perfectionism, high parental demands, academic pressure, severe life stressors
Personal history of other psychiatric disorders—including anxiety and obsessive compulsive disorder
History of sexual or physical abuse or parental maltreatment
Participation in sports or activities that emphasize leanness: ballet, figure skating, gymnastics, cheerleading
Type 1 diabetes mellitus
Family history of substance abuse, affective disorders, or eating disorders

Prevention programs for adolescents and young women ≥15 years of age can reduce risk factors and future onset of eating disorders.

Encourage realistic and healthy weight management strategies and attitudes.
Promote self-esteem; reduce focus on thin as ideal.
Decrease co-occurring anxiety/depressive symptoms and improve stress management.

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